Ann Vasc Surg 2012; 26(3) Originals

1. Ann Vasc Surg. 2012 Apr;26(3):353-8. doi: 10.1016/j.avsg.2011.10.014. Epub 2012 Feb 8.

Ten-year comparative analysis of bovine pericardium and autogenous vein for patch angioplasty in patients undergoing carotid endarterectomy.
Kim JH, Cho YP, Kwon TW, Kim H, Kim GE. Source Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. Abstract BACKGROUND: To evaluate early and late clinical outcomes of carotid endarterectomy (CEA) with bovine pericardium patch in comparison with autogenous vein. METHODS: During a 10-year period, 456 CEAs were performed using patch closure of the arteriotomy with bovine pericardium (252 cases) and autogenous vein (204 cases). Retrospectively, surgical outcomes were evaluated and compared regarding CEArelated parameters, early and late mortality and morbidity rates, and the incidence of restenosis and aneurysmal dilatation between patients with bovine pericardium patch closure and those with autogenous vein closure. RESULTS: The two groups were comparable regarding basic demographics, clinical data, and anatomic data, except the incidence of coronary or peripheral arterial diseases. In patients with bovine pericardium patch closure, the total operating time and carotid clamping duration were statistically significantly shorter than in those with autogenous vein closure (P < 0.01). During the early postoperative period, 10 major (stroke and death) complications (2.2%) occurred without statistically significant difference between the two groups. The incidence of early minor postoperative complications was less with bovine pericardium patch closure (5.6% vs. 10.8%; P < 0.05). With a mean follow-up of 62 months for bovine pericardium patch closure and 67 months for autogenous vein closure, the incidence of restenosis was similar, but aneurysmal dilatation was higher in patients with autogenous vein closure with a statistically significant difference (0% vs. 2.0%; P < 0.05). CONCLUSION:

CEA with bovine pericardium patch angioplasty showed excellent early and late clinical outcomes. Our results demonstrated bovine pericardium to be a suitable patch material for routine use in CEA. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22321487 [PubMed - indexed for MEDLINE] Related citations

2. Ann Vasc Surg. 2012 Apr;26(3):306-11. doi: 10.1016/j.avsg.2011.08.017. Epub 2012 Feb 8.

Incidental findings in patients evaluated for thoracic aortic pathology using computed tomography angiography.
Kasirajan K, Dayama A. Source East Bay Cardiovascular and Thoracic Associates, Concord, California 94520, USA. kasi@ebcvt.com Abstract BACKGROUND: Computed tomography angiography (CTA) is routinely used to diagnose thoracic aortic pathology and for surveillance after thoracic endovascular aortic repair. The purpose of our study was to assess the prevalence of unsuspected disease identified on CTA examination for thoracic aortic pathology and to determine potential clinical significance of these findings. METHODS: A retrospective review of 242 patients (136 men and 106 women; mean age, 65.7 13.9 years) referred for clinical evaluation of thoracic aortic pathology during a 12-year period was performed. CTA was acquired after obtaining full written informed consent and injecting nonionic contrast Omnipaque 350 intravenously. Subsequently, axial images were obtained from the thoracic inlet through the pubic symphysis. The prevalence of incidental findings was recorded. A finding was judged potentially significant if a therapeutic intervention or radiologic follow-up was deemed advisable on the basis of the CTA findings. RESULTS: Prevalence of incidental findings were noncalcified pulmonary lesions (subcentimeter nodule [28, 11.57%], nodule >1 cm [16, 6.61%], and pulmonary mass >3 cm [4,

1.65%]), calcified pulmonary nodules (35, 14.46%), simple liver cysts (32, 13.22%), contrast-enhancing liver lesion (7, 2.89%), renal mass (7, 2.89%), and pancreatic mass (5, 2.06%). Subsequent diagnostic tests were recommended for 63 findings in 55 (22.72%) patients, which revealed 11 (4.5%) patients had metastatic disease-six primary lung cancer, one metastatic lesion (mets) to the lung, one renal cell carcinoma with mets in the lung, one primary pancreatic adenocarcinoma with mets in the liver, one unknown primary with mets in the liver, and one other poorly differential metastatic carcinoma with lesions in the pancreas, adrenal glands, kidneys, and small bowel with unknown primary. CONCLUSION: CTA evaluation in patient with aortic pathology may reveal a high rate of malignant lesions. Attention to the incidental finding of suspicious lesion on computed tomographic scans in the chest and abdomen and appropriate follow-up by the requesting surgeon is important in patients undergoing surveillance for aortic pathologies. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22321476 [PubMed - indexed for MEDLINE] Related citations

3. Ann Vasc Surg. 2012 Apr;26(3):322-9. doi: 10.1016/j.avsg.2011.08.015. Epub 2012 Feb 4.

Intraluminal thrombus has a selective influence on matrix metalloproteinases and their inhibitors (tissue inhibitors of matrix metalloproteinases) in the wall of abdominal aortic aneurysms.
Khan JA, Abdul Rahman MN, Mazari FA, Shahin Y, Smith G, Madden L, Fagan MJ, Greenman J, McCollum PT, Chetter IC. Source Academic Vascular Surgical Unit, Hull York Medical School and University of Hull, Hull, UK. junaid.khan@hey.nhs.uk Abstract BACKGROUND: The influence of intraluminal thrombus (ILT) on the proteolytic environment within the wall of an abdominal aortic aneurysm (AAA) is unknown. This is the first study to

examine the correlation between ILT thickness and the levels of matrix metalloproteinases (MMPs) and their natural inhibitors (tissue inhibitors of matrix metalloproteinases [TIMPs]) within the adjacent AAA wall. METHODS: Thirty-five patients undergoing elective repair of AAAs were studied. A single fullthickness infrarenal aortic sample was obtained uniformly from the arteriotomy site from each patient. All samples were snap frozen and analyzed for total and active MMP 2, 8, and 9 and TIMP 1 and 2. Thrombus thickness at the specimen site was measured on the preoperative contrast computed tomographic angiograms. RESULTS: There was a statistically significant correlation between ILT thickness, concentration of TIMP 1, and active concentration of MMP 9. MMP 2 (active and total) and TIMP 2 demonstrated a positive correlation with ILT thickness, although not statistically significant. CONCLUSION: In this novel study, we found a significant positive correlation of ILT thickness with active MMP 9 and TIMP 1 concentration in the adjacent AAA wall, and this may have implications for AAA expansion and eventual rupture. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22305865 [PubMed - indexed for MEDLINE] Related citations

4. Ann Vasc Surg. 2012 Apr;26(3):434-42. doi: 10.1016/j.avsg.2011.11.003. Epub 2012 Feb 2.

Randomized trials in angioplasty and stenting of the renal artery: tabular review of the literature and critical analysis of their results.
Escobar GA, Campbell DN. Source Department of Surgery, University of Michigan Health System, Ann Arbor, MI 48109, USA. guiescob@umich.edu Abstract

As the incidence of hypertension (HTN) continues to rise, finding the optimal treatment of this multifactorial disease is critical. Renal artery stenosis (RAS) is a known etiology for HTN and is associated with declining renal function. Other than medications, the original gold standard for treatment of HTN from RAS was with an open surgical revascularization or nephrectomy. Since then, endovascular interventions for RAS have been reported to be technically possible, but their efficacy over medications or surgery has yielded conflicting results in case series and randomized trials. This tabular review summarizes the results of randomized trials that compared the outcomes of endovascular renal artery interventions with nonendovascular techniques (including medical and surgical treatments) for the treatment of HTN and renal dysfunction. Based on these data, the strengths and weaknesses of individual trials are critically analyzed to better define the methods to identify and treat patients with RAS. Published by Elsevier Inc. PMID: 22305685 [PubMed - indexed for MEDLINE] Related citations

5. Ann Vasc Surg. 2012 Apr;26(3):424-33. doi: 10.1016/j.avsg.2011.05.037. Epub 2012 Feb 3.

Endovenous laser ablation: a review of mechanisms of action.

Vuylsteke ME, Mordon SR. Source Department of Vascular marc.vuylsteke@me.com Abstract BACKGROUND: The aim of this article is to summarize and review the proposed theories on the laser action during endovenous ablation. METHODS: Laser mechanics and laser-tissue interaction are summarized from articles found in literature. Several theories, like the "steam bubble theory," the "direct contact theory," the "heat pipe," and "direct light energy absorption" are discussed. RESULTS: The laser light emitted intraluminally can be absorbed, scattered, or reflected. Reflection is negligible in the near-infrared spectrum. By combining absorption and Surgery, Sint-Andriesziekenhuis, Tielt, Belgium.

scattering, the optical extinction of different wavelengths related to different biological tissues can be determined. The direct contact of the fiber tip and the vein wall may be a way of destroying the vein wall, but results in ulcerations and perforations of the vein wall. Avoiding this contact, and allowing direct light absorption into the vein wall, results in a more homogenous vein wall destruction. If the energy is mainly absorbed by the intraluminal blood, the laser fiber will act as a heat pipe. Histological studies show that a more circumferential vein wall destruction can be obtained when the vein is emptied of its intraluminal blood. The use of tumescent liquid reinforces spasm of the vein and protects the perivenous tissue. CONCLUSION: Several factors play an important role in the mechanism of endovenous laser ablation. Direct energy absorption by the vein wall is the most efficient mechanism. It is important to empty the vein of its intraluminal blood and to inject tumescent liquid around the vein. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. Comment in

Comment to Vuylsteke ME and Mordon SR. Endovenous laser ablation: a review of mechanisms of action. Ann Vasc Surg 2012;26:424-33. [Ann Vasc Surg. 2012]

PMID: 22305475 [PubMed - indexed for MEDLINE] Related citations

6. Ann Vasc Surg. 2012 Apr;26(3):396-403. doi: 10.1016/j.avsg.2011.08.013. Epub 2012 Jan 27.

Outcome of infrainguinal single-segment great saphenous vein bypass for critical limb ischemia is superior to alternative autologous vein bypass, especially in patients with high operative risk.
Arvela E, Venermo M, Sderstrm M, Albck A, Lepntalo M. Source Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland. eva.arvela@hus.fi Abstract

BACKGROUND: Single-segment great saphenous vein (ssGSV) is the conduit of choice in infrainguinal bypass for critical limb ischemia (CLI). The aim of this study was to assess results of other autologous vein grafts and risk factors for graft stenosis development and graft failure. The purpose was also to evaluate outcome of patients with high operative risk undergoing infrainguinal alternative autologous vein bypass for CLI. METHODS: We retrospectively reviewed 1,109 consecutive infrainguinal bypasses performed between 2000 and 2007 for CLI. Rate and type of operations needed to maintain graft patency were evaluated. Outcome of different types of vein grafts in terms of primary patency, assisted primary patency, secondary patency, and limb salvage was assessed using Kaplan-Meier method. Predictors of poor outcome as well as patientand graft-related risk factors for graft revision and graft failure were analyzed using multivariate analysis. RESULTS: Median follow-up period was 37 (0-121) months. Primary patency, assisted primary patency, secondary patency, and limb salvage at 1 and 3 years were significantly better in ssGSV graft group than in alternative autologous vein graft (AAVG) group74.4% and 67.1% versus 53.7% and 42.0% (P < 0.0001), 82.8% and 78.2% versus 67.2% and 57.8% (P < 0.0001), 84.8% and 80.8% versus 69.9% and 61.4% (P < 0.0001), and 88.9% and 86.9% versus 83.0% and 77.2% (P < 0.0001), respectively. In multivariate analysis, non-ssGSV graft was the only independent risk factor for the graft stenosis development (relative risk [RR]: 2.62, 95% confidence interval [CI]: 1.56-4.38, P < 0.0001), for graft occlusion (RR: 2.27, 95% CI: 1.52-3.40, P < 0.0001), and for graft failure (stenosis or occlusion) (RR: 2.00, 95% CI: 1.39-2.88, P < 0.0001). Revision rate of non-ssGSV conduits was higher than that of ssGSV grafts (18% vs. 12%, P = 0.007). High-risk patients (age of >80 years, coronary artery disease, estimated glomerular filtration rate of <30 mL/min/1.73 m(2)) who underwent bypass with arm vein or spliced vein had extremely poor outcome (1-year leg salvage rate and survival rate of 71.4% and 28.6%, respectively). CONCLUSION: The ssGSV graft is superior to any other autologous vein graft in terms of midterm patency and leg salvage. It also needs less maintenance procedures than AAVGs. Non-ssGSV graft is independent predictor of both graft stenosis development and graft failure. Acceptable patency and leg salvage rates can also be achieved with AAVGs. However, patients with high operative risk and non-ssGSV graft bypass have poor outcome. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22285375 [PubMed - indexed for MEDLINE] Related citations

7. Ann Vasc Surg. 2012 Apr;26(3):404-10. doi: 10.1016/j.avsg.2011.10.011. Epub 2012 Jan 30.

Reliability and repeatability of toe pressures measured with laser Doppler and portable and stationary photoplethysmography devices.
Widmer LW, Vikatmaa P, Aho P, Lepntalo M, Venermo M. Source Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland. Abstract BACKGROUND: There are two principally different methods for measuring toe pressures (TP)photoplethysmography (PPG) and laser Doppler (LD). PPG is based on detecting changes in the blood filling of the digital arteries and arterioles, and the LD perfusion signal is derived from the Doppler shift undergone by the emitted infrared laser light after reflection from moving particles (red blood cells). The aim of the study was to compare two PPG devices and one LD device in TP measurement. The PPG devices used were the Nicolet VasoGuard (Nicolet Vascular Inc, Madison, WI; PPG1) and Systoe (Atys Medical, France; PPG2), and the LD device was the Perimed system 5000 (Perimed, Stockholm, Sweden). MATERIALS AND METHODS: TPs were measured from 54 nonselected consecutive patients who visited the vascular surgical outpatient clinic or underwent an endovascular procedure owing to chronic lower limb ischemia. A total of 107 toes were measured. The symptoms were claudication in 51.4% (n = 55), rest pain in 4.7% (n = 5), and ulcer or gangrene in 14.0% (n = 15) of the legs. Of the measured legs, 29.9% (n = 32) were asymptomatic. Forty patients had undergone endovascular revascularization immediately before the TP measurement. The limits of agreement show the estimated range within which the differences between measurements by the two devices would fall in approximately 95% of the measurements. The approximate 95% limits of agreement were calculated as the mean difference 2 standard deviation and presented in the Bland-Altman scatter plots. RESULTS: For PPG1 versus LD, the mean difference between two measurements was 14 mm Hg and the limits of agreement were 38 mm Hg. In 47% of the toes, the difference was 10 mm Hg, and in 37% of the toes, it was 15 mm Hg. For PPG2 versus LD, the mean difference between the TPs was 12 mm Hg and the limits of agreement were 24 mm Hg. In 44% of the cases, the difference was 10 mm Hg, and in 30%, it was 15 mm Hg. For PPG1 versus PPG2, the mean difference between two measurements was

14 mm Hg and the limits of agreement were 24 mm Hg. In 50% of the cases, the difference between the two machines was 10 mm Hg, and in 33%, it was 15 mm Hg. Repeatability measured with LD, PPG1, and PPG2 showed that the difference between the first and second measurement was <10 mm Hg in 93%, 86%, and 78% of the cases, respectively, and <15 mm Hg in 98%, 94%, and 88% of the cases, respectively. CONCLUSIONS: TP values vary greatly depending on the device used. However, the repeatability seemed to be acceptable with LD and PPG1. We recommend using same device when circulation is repeatedly assessed in the same patient. Also, we emphasize the importance of clinical examination and low threshold for angiography and revascularization especially in diabetics with wound healing problems. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22285350 [PubMed - indexed for MEDLINE] Related citations

8. Ann Vasc Surg. 2012 Apr;26(3):344-52. doi: 10.1016/j.avsg.2011.10.010. Epub 2012 Jan 30.

Role of statin therapy and angiotensin blockade in patients with asymptomatic moderate carotid artery stenosis.
Durham CA, Ehlert BA, Agle SC, Mays AC, Parker FM, Bogey WM, Powell CS, Stoner MC. Source Department of Surgery, East Carolina University, Greenville, NC 27858-4354, USA. durhamch@ecu.edu Abstract BACKGROUND: The purpose of this study was to evaluate the 10-year outcome of patients presenting with asymptomatic moderate carotid artery stenosis, and to determine which factors correlate with progression of disease to stroke or revascularization. METHODS: A retrospective review of all new patients presenting with asymptomatic moderate carotid artery stenosis from July 1998 to December 2001 was undertaken. Patients were consecutively identified and included by using duplex ultrasonography to identify

moderate carotid disease. Variables were recorded for all patient encounters through June 2010. The primary end point was occurrence of ipsilateral cerebrovascular stroke or revascularization event (SORE). Statin therapy and angiotensin blockade (STAB) were categorized as follows: STAB(0)-medical treatment with neither statin therapy nor angiotensin blockade, STAB(1)-treatment with only one of the two, STAB(2)-treatment with both. An amortized cost model analyzed the cost of SORE-free survival. RESULTS: Over a 42-month period, 468 carotids in 366 patients with an average age of 69.0 8.7 years were evaluated. Over a mean follow-up of 6.6 2.7 years, SORE occurred in 150 (32.1%) carotid arteries. Hyperlipidemia was predictive of SORE (hazard ratio [HR]: 1.543, 95% confidence interval [CI]: 1.053-2.262, P = 0.03). Medical therapies protective against SORE were beta-blockade (HR: 0.612, 95% CI: 0.435-0.861, P < 0.05), STAB(1) (HR: 0.487, 95% CI: 0.336-0.706, P < 0.01), and STAB(2) (HR: 0.149, 95% CI: 0.089-0.248, P < 0.01). At 10 years, SORE-free survival in STAB(2) was 82.7% 4.6%, STAB(1) was 56.3% 5.0%, and STAB(0) was 29.3% 5.4% (P < 0.01). The cost per SORE-free year in STAB(2) was $1,695.40 $275.60, STAB(1) was $3,916.80 $605.44, and STAB(0) was $4,126.40 $427.23 (P < 0.01). CONCLUSION: These data demonstrate the clinical and financial advantage of using both statin therapy and angiotensin pathway blockage in patients with asymptomatic moderate carotid artery stenosis. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22285349 [PubMed - indexed for MEDLINE] Related citations

9. Ann Vasc Surg. 2012 Apr;26(3):338-43. doi: 10.1016/j.avsg.2011.11.008. Epub 2012 Jan 30.

Accuracy of digital subtraction angiography, computed tomography angiography, and magnetic resonance angiography in grading of carotid artery stenosis in comparison with actual measurement in an in vitro model.
Smith JC, Watkins GE, Smith DC, Palmer EW, Abou-Zamzam AM, Zhao CX, Zhang WW. Source

Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA. Abstract BACKGROUND: The aim of this study was to investigate the accuracy of digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) in grading of carotid stenosis compared with actual measurement in an in vitro model. METHODS: Various grades of stenosis were created by adhering different amounts of silicone rubber sealant onto the inner wall of clear, radiolucent tubes. After DSA, CTA, and MRA, the tubes were transected with 1-mm interval through the plaques. The crosssectional areas were digitally photographed, and the percentage of area reduction of every single slide was measured with ImageJ planimetric software. The maximum actual area reduction (AAR) stenosis of each tube was recorded. The differences among DSA, CTA, MRA, and AAR were compared statistically using paired Student t test. RESULTS: Overall, CTA and MRA significantly underestimated the degrees of stenosis compared with AAR (P = 0.001 and P = 0.0009, respectively), and no significant difference was found between DSA and AAR (P = 0.40). In the subgroup with stenosis of <70%, there was no significant difference between DSA, CTA, and MRA versus AAR (P = 0.18, P = 0.16, and P = 0.08, respectively). In the subgroup with severe stenosis of >70%, CTA and MRA significantly underestimated the stenosis versus AAR (P = 0.004, and P = 0.007 respectively), and DSA significantly overestimated the stenosis (P = 0.0007). CONCLUSIONS: This in vitro model study demonstrated that CTA and MRA underestimate the lesions in severe stenosis of >70%. DSA tends to overestimate the disease. The accuracy of DSA is affected by plaque morphology, such as mountain-shaped lesions. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22285345 [PubMed - indexed for MEDLINE] Related citations

10. Ann Vasc Surg. 2012 Apr;26(3):330-7. doi: 10.1016/j.avsg.2011.06.012. Epub 2012 Jan 30.

Experience and outcomes after a decade of endovascular abdominal aortic aneurysm repair: a retrospective study from a community-based single center.
Kalteis M, Haller F, Artmann A, Ratzenbck M, Hartl P, Lugmayr H. Source Departments of Cardiac, Vascular and Thoracic Surgery, Klinikum Wels-Grieskirchen, Wels, Austria. manfred.kalteis@klinikum-wegr.at Abstract BACKGROUND: The purpose of this study is to report the results of endovascular abdominal aortic aneurysm treatment based on the Zenith stent-graft from a community-based single center over a period of 9 years. METHODS: We retrospectively analyzed immediate technical and clinical results as well as longterm outcomes in patients treated with endovascular aneurysm repair between 2001 and 2010. The study was performed in accordance with the recommendations of the ad hoc committee for standardized reporting practice in vascular surgery. RESULTS: A total of 106 patients were treated in a period of 9 years. A Zenith stent-graft was used in 95% of cases. No deaths occurred during the first 30 days postsurgery. The complication rate was 4.7% (n = 5). The overall clinical and technical success rate at 30 days was 93.4%. After a mean follow-up period of 52 months (range, 13-112 months), the overall mortality rate was 25.4%. Aneurysm-related mortality was 2.1%. Rupture of the aneurysm occurred in four cases (4.3%). The final clinical failure rate was 13.8%. During the follow-up period, the mean diameter of the aneurysm decreased from 58.0 to 52.3 mm. However, expansion of the aneurysm was registered in 10 cases. Eleven patients had a primary endoleak, and another 11 secondary endoleaks occurred during the follow-up. The reintervention rate was 16.3%. The main reasons for repeat interventions were iliac limb occlusion (n = 5) and type 3 endoleak/limb disconnection (n = 4). Graft migration occurred in 3% of cases. A negative impact on sexual function after endovascular repair was reported by 20% of patients. CONCLUSION: Endovascular repair is the treatment of choice for high-risk patients. A small but significant number of clinical failures were observed during the long-term follow-up. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22285344

[PubMed - indexed for MEDLINE] Related citations

11. Ann Vasc Surg. 2012 Apr;26(3):387-95. doi: 10.1016/j.avsg.2011.08.014. Epub 2012 Jan 30.

Clinical outcome after extended endovascular recanalization in Buerger's disease in 20 consecutive cases.
Graziani L, Morelli L, Parini F, Franceschini L, Spano P, Calza S, Sigala S. Source Invasive Cardiology Unit, Istituto Clinico Citt di Brescia, Brescia, Italy. langrazi@tin.it Abstract BACKGROUND: To present our experience of extended endovascular management for thromboangiitis obliterans (Buerger's disease) patients with critical limb ischemia (CLI). METHODS: Between January 2005 and July 2010, a consecutive series of 17 Buerger's disease patients with CLI in 20 limbs were admitted and the diagnosis confirmed. The mean age of the patients was 41.5 years (standard error: 1.7). All patients presented with history of smoking, one patient presented with hypertension, and eight patients presented with dyslipidemia. According to Rutherford classification, all patients were found to be between grades 3 and 5. Ultrasonography first, and angiography examination later, confirmed a severe arterial disease involving almost exclusively below-the-knee and foot arteries in all cases. A new approach for revascularization, defined as extended angioplasty of each tibial and foot artery obstruction, was performed to achieve direct perfusion of at least one foot artery. RESULTS: An extensive endovascular treatment was intended in all patients with success in 19 of 20 limbs, achieving a technical success in 95%. No mortality or complication related to the procedure was observed. During a mean follow-up of 23 months (standard error: 4.05), amputation-free survival with no need of major amputation in any case and sustained clinical improvement was achieved in 16 of the 19 limbs (84.2%) successfully treated, resulting in a 100% limb salvage rate (19/19). CONCLUSION: In this first experience, in patients with thromboangiitis obliterans, extended endovascular intervention was a feasible and effective revascularization procedure in

case of CLI. High technical success, amputation-free survival, and sustained clinical improvement rates were achieved at midterm follow-up was achieved. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22285343 [PubMed - indexed for MEDLINE] Related citations

12. Ann Vasc Surg. 2012 Apr;26(3):411-8. doi: 10.1016/j.avsg.2011.10.012. Epub 2012 Jan 30.

Hormone replacement therapy is associated with a decreased prevalence of peripheral arterial disease in postmenopausal women.
Rockman CB, Maldonado TS, Jacobowitz GR, Adelman MA, Riles TS. Source Division of Vascular Surgery, New York University Medical Center, New York, NY 10016, USA. Caron.rockman@nyumc.org Abstract BACKGROUND: The effect of hormone replacement therapy (HRT) in postmenopausal women on the development of peripheral atherosclerosis remains in question. The goal of this study was to analyze the use of HRT in a large population of postmenopausal women and to determine its association with the prevalence of peripheral arterial disease (PAD). METHODS: A prospective database of patients who underwent voluntary vascular screening was used. Identification of patients as postmenopausal, and their use of HRT, was based on patient questionnaires. PAD was defined to be present if either lower extremity ankle-brachial index was 0.9. RESULTS: Analysis was performed on data from 847,982 postmenopausal women; 433,178 (51.1%) reported having used HRT. HRT subjects were slightly older than patients who had not used HRT (64.5 years vs. 63.6 years). Caucasian women were significantly more likely to have used HRT than non-Caucasian women (52.4% vs. 47.6%). HRT subjects were significantly more likely to have smoked cigarettes (42.8% vs. 40.6%), to

have hypertension (47.9% vs. 45.1%), and to have hypercholesterolemia (55% vs. 51.5%) than women who had not used HRT (all P < 0.001). However, HRT subjects were significantly less likely to have diabetes mellitus (8.6% vs. 10.2%, P < 0.001). Despite the increased prevalence of several atherosclerotic risk factors among women who used HRT, they were significantly less likely to have PAD (3.3% vs. 4.1%, P < 0.001). Multivariate analysis adjusting for age, race, and medical comorbidities that predispose toward the development of atherosclerosis confirmed that HRT was independently associated with a decreased risk of PAD (odds ratio: 0.8, 95% confidence interval: 0.78-0.82). In subsets of postmenopausal women with known atherosclerotic risk factors, the significant effect of HRT on the prevalence of PAD was maintained; in women with either a smoking history, hypertension, hypercholesterolemia, diabetes, or age of 70 years, the odds ratio of HRT use with regard to PAD remained approximately 0.8. CONCLUSIONS: The use of HRT in postmenopausal women appears to be associated with a significant reduction in the prevalence of PAD in this population-based study. This association appeared to be significant even in postmenopausal women with known atherosclerotic risk factors. These observational data may suggest a relationship between HRT and the prevalence of PAD that has not been the specific subject of previous randomized prospective studies. Copyright 2012. Published by Elsevier Inc. PMID: 22285341 [PubMed - indexed for MEDLINE] Related citations

13. Ann Vasc Surg. 2012 Apr;26(3):383-6. doi: 10.1016/j.avsg.2011.06.020. Epub 2012 Jan 27.

How to avoid a difficult groin in redo arterial surgery: eversion endarterectomy of the proximal superficial femoral artery versus profunda femoris artery as inflow for distal bypass.
Cavallaro A, Sterpetti AV, Sapienza P, Dimarzo L. Source I Isituto Clinica Chirurgica, Universit di Roma La Sapienza, Roma, Italia. Abstract BACKGROUND:

The aim of the study was to describe and analyze the results of a technique in which the inflow for distal bypasses is provided by the proximal superficial femoral artery, reopened through an eversion endarterectomy, to avoid a "difficult groin." MATERIAL AND METHODS: Twenty-one patients who underwent distal bypass for severe lower-limb ischemia and in whom the proximal superficial femoral artery was reopened with an eversion endarterectomy to provide inflow for the bypass itself were included in the study. As a comparison group, 20 patients in whom the inflow for a distal bypass was obtained by the distal deep femoral artery were randomly selected. In all 41 patients, the groin was considered "difficult" because of multiple previous operations. RESULTS: Five-year cumulative patency rates were 53% for femoropopliteal bypasses and 40% for femorotibial bypasses. Similar patency rates were obtained when the distal deep femoral artery was used as inflow. CONCLUSIONS: Eversion endarterectomy of the proximal superficial femoral artery provides a valid source of inflow for distal bypasses, and it should be kept in the armamentarium of the vascular surgeon, to be used in selected cases. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22284775 [PubMed - indexed for MEDLINE] Related citations

14. Ann Vasc Surg. 2012 Apr;26(3):299-305. doi: 10.1016/j.avsg.2011.08.011. Epub 2011 Dec 20.

Renal function in patients treated with abdominal aortic stentgraft implantation with an intentional occlusion of accessory renal artery.
Dzieciuchowicz L, Espinosa G, Diaz CV, Lavilla Roya FJ, Lostao JA. Source Department of Angiology and Vascular Surgery, University Navarra, Pamplona, Spain. ldzieciuchowicz@gmail.com Abstract

BACKGROUND: The purpose of this study was to analyze renal function in patients who underwent endovascular aneurysm repair with intentional occlusion of accessory renal artery (ARA). MATERIAL AND METHODS: A prospective study of six patients with abdominal aortic aneurysm who underwent an abdominal stentgraft implantation with intentional occlusion of at least one ARA was performed. The mean age of the patients was 71 (53-84) years. None of the patients had an estimated glomerular filtration rate (according to Modification of Diet in Renal Disease equation 4) lower than 60 mL/min/m(2). Before the intervention, a possible influence of the occlusion of ARA was assessed with a renal scintigraphy and percentage value of a renal mass at risk. After the intervention, a control renal scintigraphy was performed, and percentage value of lost renal mass was determined. Data on the renal function before the intervention and 1, 3, 10, 30, and 90 days after the intervention were collected. RESULTS: There were no deaths, and none of the patients required hemodialysis in the follow-up period. In an early postoperative period, five patients had pain in the lumbar region that ceased with analgesics. An increase of the serum creatinine concentration occurred between 24 and 72 hours after the procedure and, except for 1 patient, started to decrease thereafter. After 30 and 90 days, all the patients presented serum creatinine concentrations similar to the basal values. The mean value of renal mass at risk was 18.5% (13.5-26%), and the mean value of lost renal mass was 18.4% (9.6-22.5%). CONCLUSION: The endovascular aneurysm repair with an intentional occlusion of ARA is a safe therapeutic option of treatment of abdominal aortic aneurysm in the patients without preexisting renal disease. The renal scintigraphy seems to be useful in determining loss of functional renal mass. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22188941 [PubMed - indexed for MEDLINE] Related citations

15. Ann Vasc Surg. 2012 Apr;26(3):312-21. doi: 10.1016/j.avsg.2011.08.003. Epub 2011 Nov 12.

Socioeconomic position, comorbidity, and mortality in aortic aneurysms: a 13-year prospective cohort study.

Ohrlander T, Merlo J, Ohlsson H, Sonesson B, Acosta S. Source Vascular Center Malm-Lund, Malm University Hospital, Malm, Sweden. Abstract BACKGROUND: To evaluate factors associated with incidence and 3-year all-cause mortality in patients with aortic aneurysm (AA). The design is sex and age-stratified (60-79 and 80-90 years) prospective cohort. By using the population register, we constituted a cohort of all men and women born between 1900 and 1930 and living in Scania by 1991, and followed them for 13 years. Identification of AA was based on hospital discharge diagnosis obtained from the Swedish Patient Register or from the information on death certificates from the Cause of Death Register. METHODS: We applied stepwise Cox regression and investigated both AA incidence (1991-2003) as well as 3-year survival after the first hospitalization for AA. RESULTS: We found an inverse relation between AA incidence and previous hospitalization by diabetes mellitus in women (hazard ratio [HR]: 0.41; 95% confidence interval [CI]: 0.190.88) and in men (HR: 0.38; 95% CI: 0.24-0.61) aged 60-79 years. Three-year allcause mortality after diagnosis of AA was 58.6% in women, 50.2% in men, 72.9% in octogenarians, and 43.7% for nonoctogenarians. Low income, chronic respiratory diseases, cerebrovascular diseases, dementia, systemic connective tissue disorders, renal failure, and malignant neoplasms were independent factors for mortality in 60-79year-old men with AA. CONCLUSIONS: Inferior socioeconomic position is associated with increased 3-year all-cause mortality in 60-79-year-old men with AA. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22079461 [PubMed - indexed for MEDLINE] Related citations

16. Ann Vasc Surg. 2012 Apr;26(3):373-82. doi: 10.1016/j.avsg.2011.07.012. Epub 2011 Nov 6.

Quality of life in perspective to treatment of postoperative edema after peripheral bypass surgery.
ztrk , te Slaa A, Dolmans DE, Ho GH, de Vries J, Mulder PG, van der Laan L. Source Department of Surgery, Amphia Hospital, Breda, The Netherlands. Abstract BACKGROUND: To examine the effects of peripheral bypass surgery on patients' quality of life (QoL) as well as to compare two treatment modalities to reduce postoperative edema with regard to patients' QoL. METHODS: This was a randomized controlled trial set in the department of vascular surgery in a nonacademic teaching hospital. Ninety-three patients (mean age, 70 years; 33% Rutherford 5-6), enrolled between August 2006 and September 2009, who underwent peripheral bypass surgery (autologous 57, polytetrafluoroethylene 36). Patients were assigned to intermittent pneumatic compression (n = 46) or to compression stockings (n = 47). The main outcome measure was QoL, measured with the World Health Organization Quality of Life assessment instrument (short form: WHOQOL-BREF). RESULTS: QoL improved on the domain of Physical Health by 7.18 points (P < 0.001 [range, 0100]) after 2 weeks and by 10.03 points (P < 0.001) after 3 months. Patients who received a polytetrafluoroethylene bypass scored 0.45 points (P = 0.0008 [range, 1-5]) lower at baseline on Global QoL than patients who received an autologous bypass. Type of bypass or edema treatment method did not affect the improvements. Edema did not correlate with QoL. CONCLUSION: Improvement in QoL on the domain Physical Health following femoropopliteal bypass surgery was found as soon as 2 weeks after surgery. Improvement in QoL domains was not influenced by the type of bypass reconstruction. No specific effects of edema on QoL were detected. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22063233 [PubMed - indexed for MEDLINE] Related citations

17. Ann Vasc Surg. 2012 Apr;26(3):365-72. doi: 10.1016/j.avsg.2011.08.002. Epub 2011 Nov 4.

An interdisciplinary approach to the prevention and treatment of groin wound complications after lower extremity revascularization.
Reiffel AJ, Henderson PW, Karwowski JK, Spector JA. Source Division of Plastic Surgery, Weill Cornell Medical College, New York, NY 10065, USA. Abstract BACKGROUND: If not effectively treated, groin wound infections revascularization (LER) may result in graft or limb loss. METHODS: A retrospective review was performed of all patients who underwent muscle flap transposition by a single surgeon after LER between 2006 and 2010. RESULTS: Twenty-nine muscle transposition flaps were performed in 24 patients (21 sartorius, 6 rectus femoris, and 2 gracilis). Nineteen were for treatment of groin wound infections, two for treatment of lymphocele, one for coverage of exposed graft in the setting of pyoderma gangrenosum, and seven for infection prophylaxis. Two graft losses followed flap placement. The limb loss rate was 4%. When performed for therapeutic purposes, graft salvage rates were 100% for autogenous and 92% for synthetic grafts. CONCLUSIONS: Muscle transposition flaps are an effective means of graft salvage in the setting of groin wound complications following LER and should be considered for infection prophylaxis in high-risk patients. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22055159 [PubMed - indexed for MEDLINE] Related citations

following

lower

extremity

18. Ann Vasc Surg. 2012 Apr;26(3):359-64. doi: 10.1016/j.avsg.2011.04.011. Epub 2011 Nov 1.

Femorofemoral bypass as an alternative to a direct aortic approach in daily practice: appraisal of its current indications and midterm results.
Rinckenbach S, Guelle N, Lillaz J, Al Sayed M, Ritucci V, Camelot G. Source Vascular Surgery Unit, University Hospital of Besancon, Besancon, France. srinckenbach@chu-besancon.fr Abstract BACKGROUND: To assess our current practice concerning the indications and the immediate and midterm results of femorofemoral bypass. METHODS: We retrospectively included all patients, from 1997 to 2008, operated on for aortoiliac occlusive disease using an extra-anatomical bypass from a donor iliac artery or a femoral artery to the contralateral femoral artery (common or profunda artery). Demographic data, initial clinical status, characteristics of the interventions, and shortand midterm results were collected. Elective surgery was distinguished from urgent surgery (critical limb ischemia, acute ischemia, vascular infection). RESULTS: One hundred twenty-four femorofemoral bypasses were performed (103 male), mean age 68 (12) years. Indications were critical limb ischemia (47.1%), intermittent claudication (38.8%), acute ischemia (12.1%), and vascular infections (1.7%). Perioperative outcomes were 5.6% mortality (elective surgery 0.0%, urgent surgery 9.7%, P = 0.02) and 27.4% morbidity without any secondary graft infections (elective surgery 22.5%, urgent surgery 31.9%, P = 0.17). Mean follow-up period was 3 years, and overall survival was 69.4% (elective surgery 88.7%, urgent surgery 56.7%, P = 0.08). At 3 years, primary patency was 81.8% and secondary patency was 89.3% (elective surgery 96.4%, urgent surgery 84.2%, P = 0.68). No significant risk factors for immediate and secondary thromboses were found. CONCLUSION: In our current practice, femorofemoral bypasses are applied mainly for urgent procedures when avoiding a direct aortic approach is mandatory, with good midterm results. Although indications are limited for good-fit patients, femorofemoral bypass has confirmed safety (no perioperative deaths, no infections) and high durability (good secondary patency).

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. Comment in

Femorofemoral bypass in addition to femoropopliteal bypass. [Ann Vasc Surg. 2012]

PMID: 22050878 [PubMed - indexed for MEDLINE] Related citations

Ann Vasc Surg 2012; 26(3) Case Reports

1. Ann Vasc Surg. 2012 Apr;26(3):419.e11-4. doi: 10.1016/j.avsg.2011.11.007. Epub 2012 Feb 11.

Delayed hypogastric artery pseudoaneurysm following blunt trauma without evidence of pelvic fracture.
Al-Khatib WK, Lee GK, Casey K, Lee JT. Source Division of Vascular and Endovascular Surgery, Stanford University, Stanford, CA 94305-5642, USA. alkhatib@stanford.edu Abstract Arterial pelvic bleeding caused by bony fragments is a common finding in patients with pelvic fractures after blunt trauma (Durkin et al., Am J Surg 2006;192:211-23). However, arterial injury in the absence of bony fracture is extremely rare, and in the event that it does occur, is immediately discovered on cross-sectional imaging. We present an unusual case of a 15-year-old boy who was involved in a bicycle accident, and who, a week after his injury, developed a delayed hypogastric branch artery pseudoaneurysm causing sciatic nerve compression with a right foot drop. Initial magnetic resonance imaging scan and pelvic X-ray at the time of the injury showed no evidence of pelvic fracture or vascular damage. The pseudoaneurysm was successfully treated with selective coil embolization and hematoma evacuation. This study represents only the second reported case of delayed pelvic pseudoaneurysm in the absence of pelvic fracture. Published by Elsevier Inc. PMID: 22326296 [PubMed - indexed for MEDLINE] Related citations

2. Ann Vasc Surg. 2012 Apr;26(3):419.e1-4. doi: 10.1016/j.avsg.2011.09.007. Epub 2012 Feb 8.

Aberrant right subclavian artery or arteria lusoria: a rare cause of dyspnea in children.
Derbel B, Saaidi A, Kasraoui R, Chaouch N, Aouini F, Ben Romdhane N, Manaa J.

Source Service de Chirurgie Vasculaire Priphrique et de Transplantation d'Organes, Tunis, Tunisie. bilelderbel@yahoo.fr Abstract Aberrant right subclavian artery or arteria lusoria (AL) is the most frequent anomaly of the aortic arch, secondary to abnormal embryogenesis. It is usually asymptomatic and fortuitously discovered. It can compress neighboring structures and cause dysphagia or, more rarely, dyspnea. In symptomatic cases or in the presence of an aneurysm of the AL origin, it should be surgically treated. The case herein reported concerns a child presenting with respiratory symptomatology related to an AL that was surgically treated by right supraclavicular approach. Crown Copyright 2012. Published by Elsevier Inc. All rights reserved. PMID: 22321486 [PubMed - indexed for MEDLINE] Related citations

3. Ann Vasc Surg. 2012 Apr;26(3):423.e1-4. doi: 10.1016/j.avsg.2011.07.021. Epub 2012 Feb 8.

Aortic graft wrapping.

preservation

by

debridement

and

omental

Jamieson RW, Burns PJ, Dawson AR, Fraser SC. Source Edinburgh Vascular Surgical Service, Royal Infirmary of Edinburgh, Little France, Edinburgh, Scotland, UK. russelljamieson@doctors.org.uk Abstract BACKGROUND: Aortic graft infection is a rare, but grave, complication in vascular surgery. Graft removal together with extra-anatomical bypass or in situ graft replacement is usually advocated, but these procedures are associated with significant morbidity and mortality. METHODS AND RESULTS: Two cases of aortic graft infection in high-risk surgical candidates managed by open debridement and omental wrapping with graft preservation are described. Both remain well at 3 years without any adjunctive procedures.

CONCLUSION: Debridement and omental wrapping may offer an alternative to graft removal and revascularization in selected patients. This relatively low-risk procedure may allow long-term survival. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22321485 [PubMed - indexed for MEDLINE] Related citations

4. Ann Vasc Surg. 2012 Apr;26(3):419.e5-6. doi: 10.1016/j.avsg.2011.08.021. Epub 2012 Feb 8.

A case of extrinsic chronic cerebrospinal venous insufficiency in a patient with multiple sclerosis.
Radak D, Tanaskovic S, Sagic D, Antonic Z, Kolar J. Source Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia. drslobex@yahoo.com Abstract We aim to present a very rare case of chronic cerebrospinal venous insufficiency due to both brachiocephalic vein obstruction by aberrant right subclavian artery and internal jugular vein distal compression by first cervical vertebra transverse process, demonstrated by multislice computerized tomography in a patient with multiple sclerosis. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22321478 [PubMed - indexed for MEDLINE] Related citations

5. Ann Vasc Surg. 2012 Apr;26(3):419.e7-9. doi: 10.1016/j.avsg.2011.10.015. Epub 2012 Feb 8.

Modified "stent-graft sandwich" technique for treatment of isolated common iliac artery aneurysm in patient with Marfan syndrome.
Yoshida Rde A, Yoshida WB, Kolvenbach R, Vieira PR. Source Department of Vascular and Endovascular Surgery, Botucatu School of Medicine, So Paulo State University UNESP, Botucatu, SP, Brazil. ricardoyoshida@gmail.com Abstract Isolated iliac artery aneurysms are rare in the general population (0.03%) and represent 2% of all abdominal aneurysms, and the association with Marfan syndrome is even rarer. We report a Marfan syndrome case with an isolated common iliac artery aneurysm treated by using a modified "stent-graft sandwich" technique, with preservation of the internal iliac artery perfusion. The modified "stent-graft sandwich" technique involves building an appropriate proximal neck just in the common iliac artery for fittingly housing two new stent-grafts inside, both deployed simultaneously and each one going to both distal iliac arteries (internal and external). Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. Comment in

Modified "stent-graft sandwich" technique for treatment of isolated common iliac artery aneurysm in patient with Marfan syndrome. [Ann Vasc Surg. 2012]

PMID: 22321477 [PubMed - indexed for MEDLINE] Related citations

6. Ann Vasc Surg. 2012 Apr;26(3):420.e9-12. doi: 10.1016/j.avsg.2011.05.042. Epub 2012 Feb 7.

Nonoperative management of contained retrohepatic caval injury.

Khan IR, Hamidian Jahromi A, Khan FM, Youssef AM. Source Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103-4228, USA.

Abstract Traumatic inferior vena cava (IVC) injuries are associated with high mortality rates, despite all improvements in the technical skills and prehospital and hospital care. Selective conservative management of the penetrating abdominal injuries involving IVC has not been widely discussed before. Here, we report a case of a young female with a single gunshot wound to her abdomen, who presented to our level 1 trauma center 10 minutes after injury and was hemodynamically stable. A computed tomographic scan revealed a large liver laceration with a trajectory through the liver and the IVC. The IVC was surrounded by a moderate amount of fluid, consistent with a contained retroperitoneal hematoma. We discuss the outcome of nonoperative management of this patient along with a review of the literature. Published by Elsevier Inc. PMID: 22321473 [PubMed - indexed for MEDLINE] Related citations

7. Ann Vasc Surg. 2012 Apr;26(3):421.e1-5. doi: 10.1016/j.avsg.2011.05.041. Epub 2012 Jan 30.

Management of traumatic aortic isthmus rupture in case of aberrant right subclavian artery (arteria lusoria).
Ktenidis K, Lioupis A, Giannopoulos A, Ginis G, Kiskinis D. Source First Department of Surgery and Vascular Surgery, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. kirktenidis@gmail.com Abstract BACKGROUND: To present an unusual case of blunt aortic injury in a 30-year-old male patient with an aberrant right subclavian artery. METHODS AND RESULTS: Driven by the complicated and challenging nature of the case, we decided to treat the patient by a combined approach-right subclavian artery transposition and endograft implantation at the isthmus level. During the 24-month follow-up (clinical examination, angiogram, computed tomographic scan), we registered no complaints; normal perfusion of the right arm; and adequate sealing of the aortic tear. CONCLUSIONS:

We believe that the hybrid management of such trauma is a feasible, effective, and less-invasive option. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22285352 [PubMed - indexed for MEDLINE] Related citations

8. Ann Vasc Surg. 2012 Apr;26(3):420.e5-7. doi: 10.1016/j.avsg.2011.07.016. Epub 2012 Jan 30.

Massive pulmonary embolism caused by internal iliac vein thrombosis with free-floating thrombus formation in the inferior vena cava.
Brodmann M, Gary T, Hafner F, Tiesenhausen K, Deutschmann H, Pilger E. Source Division of Angiology, Department of Medicine, Medical University Graz, Graz, Austria. marianne.brodmann@medunigraz.at Abstract Nowadays, compression ultrasonography (CUS) is the gold standard for the routine diagnosis of deep venous thrombosis (DVT). The drawback of CUS is the low sensitivity concerning the diagnosis of isolated pelvic vein thrombosis, especially referring to isolated internal iliac vein and ovarian vein thromboses. Therefore, magnetic resonance (MR) venography has become a valuable alternative. We present the case of a 45-year-old female patient with a massive pulmonary embolism with the indication for thrombolytic therapy due to severe right ventricular overload. We were not able to detect a DVT in the lower limbs of this patient with CUS. However, further DVT workup by MR venography showed a free-floating thrombus formation originating from the right internal iliac veins into the inferior vena cava. Owing to the fact that this thrombus was free floating, surgical removal of the thrombus was scheduled and performed successfully. In some patients it might be important to look for so-called rare causes of pulmonary embolism, even when CUS of the lower limbs does not reveal any DVTs. The diagnostic procedure of choice for these patients seems to be MR phlebography, as iliac and pelvic veins can be evaluated without radiation exposure with this procedure. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22285351

[PubMed - indexed for MEDLINE] Related citations

9. Ann Vasc Surg. 2012 Apr;26(3):421.e11-5. doi: 10.1016/j.avsg.2011.06.014. Epub 2012 Jan 30.

Pull-through technique with pincer tactics for stent placement in severe superior vena cava syndrome.
Matsushita J, Morita S, Suzuki K, Inoue H, Yokomizo H, Yoshimatsu K, Aoshima H, Mae M, Ueno E. Source Department of Radiology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan. Abstract The pull-through technique is an interventional radiological procedure used when an occluded lesion cannot be traversed from one direction. To pass the lesion, a long guidewire is traversed from the opposite side and pulled through the ipsilateral sheath using a snare wire. The present report describes a case of severe superior vena cava syndrome treated by stent placement using a pull-through technique with pincer tactics. We successfully placed a stent in the occluded right internal jugular vein to the superior vena cava using a bilateral approach by snaring a guidewire in the right subclavian vein. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22285347 [PubMed - indexed for MEDLINE] Related citations

10. Ann Vasc Surg. 2012 Apr;26(3):422.e9-12. doi: 10.1016/j.avsg.2011.06.017. Epub 2012 Jan 30.

Nonanastomotic pseudoaneurysm with complete disruption of an expanded polytetrafluoroethylene axillofemoral bypass graft.
Shibutani S, Obara H, Kakefuda T, Kitagawa Y.

Source Department of Vascular Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan. shibutani@kmh.gr.jp Abstract Rupture of an expanded polytetrafluoroethylene (ePTFE) vascular graft is rare. We report a nonanastomotic pseudoaneurysm associated with complete disruption of an ePTFE graft that occurred 6 years after an axillofemoral bypass. The 81-year-old patient had undergone neither trauma nor infection. The aneurysmal segment was resected, and a new ePTFE graft was interposed. The patient recovered uneventfully and was well 4 years later. Histologic analysis revealed a torn graft edge, consistent with a rupture due to excessive force, but scanning electron microscopy showed that the internal structure of the prosthesis was intact. The cause of the midgraft rupture remains unknown. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22285346 [PubMed - indexed for MEDLINE] Related citations

11. Ann Vasc Surg. 2012 Apr;26(3):420.e1-4. doi: 10.1016/j.avsg.2011.10.008. Epub 2012 Jan 30.

Hybrid repair of aortic arch aneurysm.

Bhamidipati CM, Irvine JN, Hagspiel KD, Matsumoto AH, Tracci MC, Kern JA. Source Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, USA. Abstract Hybrid repair of thoracic aortic aneurysm has been used with increasing frequency over the past decade, as indications for endovascular therapy have continued to expand. Hybrid techniques may avoid and limit the morbidity and mortality associated with sternotomy or thoracotomy, mechanical circulatory support, and hypothermic arrest. We present the case of a patient with extensive aortic aneurysmal disease initially needing open ascending aortic and subsequent thoracoabdominal repair. However, owing to continued enlargement of the aortic arch, hybrid extrathoracic, extra-anatomic complete aortic arch debranching and transcatheter endografting was ultimately pursued with favorable midterm results.

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22285342 [PubMed - indexed for MEDLINE] Related citations

12. Ann Vasc Surg. 2012 Apr;26(3):422.e13-6. doi: 10.1016/j.avsg.2011.07.018. Epub 2012 Jan 27.

Aortoenteric fistula treated with endovascular aortic stent-graft and bilateral chimney stent-grafts to renal arteries.
Tan GW, Wong D, Punamiya S, Tan BP, Vu C, Ang B, Foo D, Chia KH. Source Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore. glenntanwl@gmail.com Abstract We report a patient with secondary aortoenteric fistula (AEF) presenting with a rectal bleeding. The patient had multiple comorbidities, precluding major open vascular surgery. We opted to perform a two-stage procedure, where an endovascular stentgraft was first deployed to exclude the AEF from the systemic circulation. As the AEF was at the proximal anastomosis of the previous Dacron graft and close to the renal artery ostia, chimney stent-grafts were placed in both renal arteries to maintain their patency. The second stage of the procedure involved a laparotomy to repair the defect in the duodenum to prevent further contamination from bowel contents. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22284779 [PubMed - indexed for MEDLINE] Related citations

13. Ann Vasc Surg. 2012 Apr;26(3):422.e5-8. doi: 10.1016/j.avsg.2011.06.018. Epub 2012 Jan 27.

Combined revascularization and free-tissue transfer for limb salvage in a Buerger disease patient.
Ikeda K, Yotsuyanagi T, Arai K, Suda T, Saito T, Ezoe K. Source Department of Plastic and Reconstructive Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan. peugeot206ccred@yahoo.co.jp Abstract Buerger disease is a limb-threatening condition occurring in young smokers, and its treatment has been a challenging problem, although a large number of medical and surgical options have been suggested. Combined surgery for revascularization and free-tissue transfer for Buerger disease is an aggressive and attractive option. This complex surgery enables successful treatment of tissue loss caused by ischemia. We performed revascularization and free-tissue transfer to the critically ischemic limb in a patient with Buerger disease. In this case, the procedure is attempted to salvage a limb from amputation. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22284776 [PubMed - indexed for MEDLINE] Related citations

14. Ann Vasc Surg. 2012 Apr;26(3):421.e17-9. doi: 10.1016/j.avsg.2011.06.016. Epub 2012 Jan 27.

Surgical removal of a knotted and entrapped subclavian hemodialysis catheter guidewire.

Altnta G, Diken A, Ula MM, iek F, zen A, kten S, Bardak H. Source Department of Cardiovascular Surgery, Trkiye Yksek Ihtisas Hospital, Ankara, Turkey. Abstract Many mechanical complications associated with insertion, maintenance, and removal of the hemodialysis catheters have been reported in the literature. A 47-year-old man was consulted to our hospital because of an entrapped hemodialysis catheter guidewire. Computed tomographic scan revealed that the right subclavian vein was

perforated by the guidewire and the wire was knotted over itself, one loop inside the vein and two loops in the extravascular site. Guidewire is pulled out from a 3-cm incision over the wire loops lateral to the right sternocleidomastoid muscle. He was discharged home on postoperative day 2 without any complication. Our suggestion is that any abnormal resistance should be immediately evaluated for the presence of any potential knots using the most appropriate imaging technique. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22284774 [PubMed - indexed for MEDLINE] Related citations

15. Ann Vasc Surg. 2012 Apr;26(3):421.e1-4. doi: 10.1016/j.avsg.2011.07.017. Epub 2012 Jan 27.

Retrograde approach for infrapopliteal vein bypass.

endovascular

salvage

of

an

Cenizo Revuelta N, Gastambide V, San-Norberto EM, Ibez MA, Martn-Pedrosa M, Taylor J, Gutirrez V, Vaquero C. Source Hospital Clnico Universitario de Valladolid, Valladolid, Spain. noecen@yahoo.es Abstract Endovascular treatment through femoropopliteal and infragenicular percutaneous transluminal angioplasty, both in native vessels and in bypass salvage, has been an emerging technique in recent years. However, in some cases, a difficult anterograde access in distal occlusions has limited the technical success of this procedure. Combined subintimal arterial flossing with antegrade-retrograde intervention is used as a resource technique to obtain precise recanalization in these cases. Here, we present the case of a retromalleolar access of the posterior tibial artery, based on subintimal arterial flossing with antegrade-retrograde intervention technique, to achieve femoralposterior tibial bypass salvage. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22284773 [PubMed - indexed for MEDLINE] Related citations

16. Ann Vasc Surg. 2012 Apr;26(3):422.e1-4. doi: 10.1016/j.avsg.2011.05.044. Epub 2012 Jan 27.

Spontaneous resolution of cystic adventitial disease: a word of caution.

Zhang L, Guzman R, Kirkpatrick I, Klein J. Source Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada. Abstract Spontaneous resolution of cystic adventitial disease has been occasionally reported in the literature. It is unclear, however, whether this resolution is permanent. In this case report, we describe recurrence of a popliteal artery cystic adventitial disease after spontaneous resolution, which was successfully treated with surgery. The underlying mechanism is proposed. Without definitive treatment, the patients with spontaneous resolution of cystic adventitial disease may need long-term follow-up, given the risk of recurrence. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22284772 [PubMed - indexed for MEDLINE] Related citations

17. Ann Vasc Surg. 2012 Feb;26(2):280.e5-8. doi: 10.1016/j.avsg.2011.06.015.

Successful treatment for infected aortic aneurysm using endovascular aneurysm repairs as a bridge to delayed open surgery.
Fukunaga N, Hashimoto T, Ozu Y, Yuzaki M, Shomura Y, Fujiwara H, Nasu M, Okada Y. Source Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan. naotowakimachi@hotmail.co.jp

Abstract Management of infected aortic aneurysms, which can be life-threatening, remains challenging. Open surgical treatments, including debridement of the infected aorta and the surrounding tissue and either in situ reconstruction or extra-anatomic bypass covering with omentum or muscle flap, are the mainstay of therapy. However, increasing advances in technology have made endovascular treatment of infected aneurysms feasible. The present study describes the first clinical report of successful treatment of an infected aneurysm using endovascular techniques in the acute phase, followed by delayed open surgery. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22304872 [PubMed - indexed for MEDLINE] Related citations