Ann Vasc Surg 2012; 26 (7) Originals

1. Ann Vasc Surg. 2012 Oct;26(7):1014-21. doi: 10.1016/j.avsg.2012.05.014.

Endovascular chimney technique of aortic arch pathologies: a systematic review.

Yang J, Xiong J, Liu X, Jia X, Zhu Y, Guo W. Source Department of Vascular Surgery, Clinical Division of Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China. Abstract BACKGROUND: The aim of this review was to determine the safety and efficacy of endovascular chimney technique for aortic arch pathologies by performing a systematic and pooled analysis of the relevant literature. METHODS: Electronic searches were performed in database Medline between 1994 and 2011 to identify studies on endovascular chimney technique for aortic arch pathology. The extracted variables and outcomes were synthesized through pooled analyses. RESULTS: Eight articles with 51 patients who underwent endovascular chimney technique for aortic arch pathologies met the inclusion criteria. Chimney grafts were deployed in innominate (n = 11), left common carotid (n = 32), and left subclavian (n = 12) arteries. Single-stent chimney in the deployed artery was used in 37 patients, whereas doublestent chimney was utilized in 14 patients. The overall technical success rate was 90.2%. The overall perioperative mortality and morbidity were 5.9% and 13.7%, respectively. The stroke rate was 7.8%, and the fatal stroke rate accounted for 50%. The rates of primary early endoleaks and type-Ia endoleaks were 21.6% and 11.8%, respectively. The overall late mortality and morbidity were 4.4% and 15.5%, respectively. Of 5 late endoleaks, no secondary type-Ia endoleak occurred. No studies had adequate follow-up to reliably evaluate the long-time durability. CONCLUSIONS: Endovascular chimney technique is technically feasible with the high initial technical success rate and relatively favorable rates of perioperative outcomes for aortic arch pathologies. However, further establishment of the role of endovascular chimney necessitates the accumulation of more cases and comparative study with other management as well as prolonged follow-up.

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944571 [PubMed - in process] Related citations

2. Ann Vasc Surg. 2012 Oct;26(7):1002-10. doi: 10.1016/j.avsg.2012.05.011.

High glucose-induced dysfunction of endothelial cells can be restored by HoxA9EC.

Zhang N, Gong L, Zhang H, Cao C. Source Department of Endocrinology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China. doczkm@yahoo.com.cn Abstract BACKGROUND: High glucose (HG)-induced endothelial dysfunction is a common pathologic process of vascular disease in patients with diabetes. HoxA9EC is a transcriptional regulator of genes involved in the stabilization of endothelial function. We sought to elucidate the effect of HG on HoxA9EC expression in human umbilical venous endothelial cells (HUVECs), and the potential role of HoxA9EC in antagonizing HG-induced endothelial dysfunction. METHODS: HUVECs treated with HoxA9EC transfection were cultured in media with HG, and those treated either by HG or HoxA9EC knockdown were incubated without HG. These cells were then subjected to experiments including mRNA expression analysis for eNOS, VEGFR-2, and HoxA9EC by quantitative RT-PCR; protein level analysis for eNOS, VEGFR-2, and HoxA9EC by Western blot; detection of nitric oxide (NO) concentration; and migration assay. RESULTS: Expression levels of eNOS, VEGFR-2, and HoxA9EC, as well as cell migration and NO concentration, decreased rapidly in HUVECs with HoxA9EC knockdown or under HG conditions. Overexpression of HoxA9EC significantly repaired expression of eNOS and VEGFR-2, cell migration, and NO release of endothelial cells under HG conditions. CONCLUSIONS:

Inhibition of HoxA9EC induced by HG contributed to endothelial cell dysfunction, which could be rescued by augmentation of HoxA9EC under HG conditions. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944570 [PubMed - in process] Related citations

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Research Support, Non-U.S. Gov't

3. Ann Vasc Surg. 2012 Oct;26(7):977-81. doi: 10.1016/j.avsg.2012.03.013.

Late follow-up of saphenofemoral junction ligation combined with ultrasound-guided foam sclerotherapy in patients with venous ulcers.
Figueiredo M, de Araujo SP, Figueiredo MF. Source Universidade Federal de drmarcondes@gmail.com Abstract BACKGROUND: Venous ulcers are a frequent complication of venous disease, and a variety of healing methods have been proposed for these lesions. The objective of this study was to provide late follow-up data for a group of patients with venous ulcers who presented with advanced chronic venous insufficiency and were treated with saphenofemoral junction ligation combined with ultrasound-guided foam sclerotherapy. METHODS: This was a prospective study of 35 patients. Patients were classified as CEAP6 and were followed during a 45- to 68-month period. The following variables were assessed: wound healing, ultrasound findings, and venous clinical severity scores. RESULTS: So Paulo (UNIFESP), So Paulo, Brazil.

The following ultrasound findings were observed: total and partial recanalization in 19 patients (treatment failure) and occlusion in 13 patients (treatment success). Two patients were lost to follow-up, and one patient died. Ulcers healed between 30 and 70 days and remained closed for a mean period of 48 months (Kaplan-Meyer method). The analysis of clinical severity scores (pain, edema, pigmentation, lipodermatosclerosis, and inflammation) revealed significant improvement when comparing pre- and post-treatment results. CONCLUSION: Our preliminary findings suggest that saphenofemoral junction ligation combined with ultrasound-guided foam sclerotherapy is a feasible and simple palliative treatment method for this group of patients. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944569 [PubMed - in process] Related citations

4. Ann Vasc Surg. 2012 Oct;26(7):946-56. doi: 10.1016/j.avsg.2012.02.014.

Common femoral artery endarterectomy for lower-extremity ischemia: evaluating the need for additional distal limb revascularization.
Malgor RD, Ricotta JJ 2nd, Bower TC, Oderich GS, Kalra M, Duncan AA, Gloviczki P. Source Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA. Abstract BACKGROUND: The role of common femoral artery endarterectomy (CFE) and the need for distal revascularization is challenging in certain clinical scenarios. For some patients with claudication or rest pain CFE alone may suffice, however, some surgeons advocated that in-line flow must be re-established in patients with major tissue loss for wound healing purposes. The decision when to perform CFE with or without distal revascularization is sometimes difficult. The objective of this study was to evaluate the outcomes of common femoral artery endarterectomy (CFE) to define predictive factors for additional distal revascularization. METHODS:

Retrospective review of 262 consecutive CFEs in 230 patients with lower-extremity ischemia between 1997 and 2008. Patients were divided into two groups: group A (n = 169; CFE alone) and group B (n = 93; CFE + distal revascularization). Concomitant iliac intervention was included only if performed by endovascular approach. Patients were analyzed by Rutherford category (RC) and TransAtlantic InterSociety Consensus (TASC) II classification. Primary end points were mortality, patency, reintervention, and limb salvage. RESULTS: Demographics, preoperative Society for Vascular Surgery score assessment, and TASC II classification did not differ between groups. Mean follow-up was 75 months (range: 1-128 months). Technical success was obtained in all patients. RC (3 1.2 vs. 5 1.4; P = 0.001), diabetes (33% vs. 52%; P = 0.005), mean operative time (+154 minutes; P < 0.001), and length of hospital stay (+1.7 days; P = 0.03) were higher in group B. Reintervention rates were higher in group B than group A (12% vs. 3%; P = 0.015). For patients with RC 5/TASC D lesions and patients with RC 6 regardless of TASC, initial distal revascularization (group B) was associated with fewer reinterventions or major amputations (29%) than CFE alone (67%) (P = 0.002). The cumulative 5-year primary patencies for groups A and group B were 96% and 92%, respectively. Secondary patency was 100% at both time points. Limb salvage was also lower in patients with RC 5 and 6 (P = 0.01; P = 0.02). Overall survival was 93% at 1 year and 77% at 5 years. Independent predictors for distal revascularization were RC 5 or 6 (P < 0.001), TASC D lesions (P < 0.0001), diabetes (P = 0.04), and being on anticoagulation (P = 0.003). There was no difference in survival between the two groups for RC 1 to 5 (P = 0.2), but for patients with RC 6, survival was improved in group B (39% vs. 67%; P = 0.9). CONCLUSION: CFE alone is sufficient for patients with lower-extremity ischemia who present with lifelimiting claudication regardless of TASC lesion and for those with RC 5 and TASC lesions A to C. Patients with RC 5 and TASC D lesions and those with major tissue loss (RC 6) regardless of TASC lesion are better served with additional distal revascularization to improve limb salvage, reintervention, and survival rates. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944568 [PubMed - in process] Related citations

5. Ann Vasc Surg. 2012 Oct;26(7):929-36. doi: 10.1016/j.avsg.2012.04.022.

Significance of combining distal filter protection and a guiding catheter with temporary balloon occlusion for carotid artery stenting: clinical results and evaluation of debris capture.

Harada K, Morioka J, Higa T, Saito T, Fukuyama K. Source Department of Neurosurgery, Fukuoka Wajiro Hospital, Heart and Neurovascular Center, Fukuoka, Japan. keihara@f-wajirohp.jp Abstract BACKGROUND: Carotid artery stenting (CAS) with distal filter protection allows for continuous cerebral perfusion. However, this procedure has been reported to be associated with a greater risk of debris migrating into the cerebral arteries. To improve the extent of debris capture, we used a guiding catheter with temporary balloon occlusion and temporary aspiration from the common carotid artery. METHODS: Eighty-one stenoses were treated with CAS using distal filter protection; simple distal filter protection (conventional group, n = 50) or distal filter protection with temporary proximal flow control and blood aspiration was performed using a 9-F guiding catheter with a temporary balloon occlusion positioned at the common carotid artery (proximal occlusion group, n = 31). Clinical outcomes, rates of capturing visible debris, and new ischemic signals on diffusion-weighted magnetic resonance imaging (DWI) were evaluated. RESULTS: Events involving procedure-related emboli causing neurological deficits occurred in 6.0% (3/50) and 3.2% (1/31) of patients in the conventional and proximal occlusion groups, respectively (P = 1.0). The rates of visible debris capture by using the distal filter were 64.0% (32/50) and 29.0% (9/31) in the convention and proximal occlusion groups, respectively, being significantly lower in the proximal occlusion group (P < 0.01). New ischemic signals on DWI were detected in 44.0% (22/50) and 12.9% (4/31) of cases in the conventional and proximal occlusion groups, respectively, being significantly lower in the proximal occlusion group (P < 0.01). CONCLUSIONS: Combining distal filter protection and a guiding catheter with temporary balloon occlusion in CAS significantly reduced visible debris captured by the distal filter and occurrence of small postprocedural cerebral infarctions detected by DWI. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944567 [PubMed - in process] Related citations

6. Ann Vasc Surg. 2012 Oct;26(7):918-23. doi: 10.1016/j.avsg.2012.01.023.

Female and elderly abdominal aortic aneurysm patients more commonly have concurrent thoracic aortic aneurysm.
Hultgren R, Larsson E, Wahlgren CM, Swedenborg J. Source Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Rebecka.hultgren@karolinska.se Abstract BACKGROUND: A recent report unexpectedly revealed that one-fourth of abdominal aortic aneurysm (AAA) patients also have an aneurysm in the thoracic aorta (TAA). It remains to be investigated which AAA patients have a higher risk of also developing TAAs. The aim of this study was to identify possible differences in the risk factor profile in AAA patients with or without a TAA. METHODS: All AAA patients attending an outpatient clinic and investigated using an abdominal and thoracic computed tomography scan were included (n = 354). Image analysis and hospital chart review were conducted. The association between comorbidity and TAA was estimated by logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs). Gender-specific and neutral criteria were used. Validation of excluded patients was performed. RESULTS: Ninety-four (27%) of 354 AAA patients had a concurrent descending TAA (AAA/TAA). AAA/TAA patients were older than AAA patients (76 vs. 73 years). More women were identified in the AAA/TAA group (39% vs. 16%, P < 0.001). In the univariate logistic regression model, female gender (OR: 3.3, 95% CI: 1.9-5.6), hypertension (OR: 1.8, 95% CI: 1.1-3.0), and age (70-79 years-OR: 2.4, 95% CI: 1.3-4.6; 80-89 years-OR: 3.0, 95% CI: 1.5-6.0) were associated with concurrent TAA. In the multivariate model, only female gender and age were associated with TAA. CONCLUSIONS: AAA patients, in general, should be offered examination of the thoracic aorta, and special attention needs to be paid to female AAA patients and AAA patients at high age, if the AAA patient is considered operable. Surveillance of AAA patients must improve to enhance identification of the large group of patients who have developed, or will develop, TAAs. Future strategies will, of course, address pathophysiological aspects of aneurysmal development in the thoracic and infrarenal aorta.

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944566 [PubMed - in process] Related citations

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Research Support, Non-U.S. Gov't

7. Ann Vasc Surg. 2012 Oct;26(7):895-905. doi: 10.1016/j.avsg.2012.06.001.

Transfemoral intraluminal graft implantation for abdominal aortic aneurysms: two decades later.
Yao JS, Eskandari MK. Source Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. jyao65@gmail.com PMID: 22944565 [PubMed - in process] Related citations

8. Ann Vasc Surg. 2012 Oct;26(7):889-94. doi: 10.1016/j.avsg.2012.07.003. Vascular surgery in China. Yao JS. Source Division of Vascular Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. jyao65@gmail.com PMID:

22944564 [PubMed - in process] Related citations

9. Ann Vasc Surg. 2012 Oct;26(7):887-8. doi: 10.1016/j.avsg.2012.07.002.

Editor's commentary.
Sullivan TM. PMID: 22944563 [PubMed - in process] Related citations

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Editorial

10. Ann Vasc Surg. 2012 Oct;26(7):957-63. doi: 10.1016/j.avsg.2012.04.008. Epub 2012 Aug 1.

Effect of supervised exercise therapy for claudication in patients with diabetes mellitus.

intermittent

van Pul KM, Kruidenier LM, Nicola SP, de Bie RA, Nieman FH, Prins MH, Teijink JA. Source Department of Surgery, Atrium Medical Center Parkstad, Heerlen, The Netherlands. Abstract BACKGROUND: Primary treatment for patients with intermittent claudication is exercise therapy. Diabetes mellitus (DM) is a frequently occurring comorbidity in patients with intermittent claudication, and in these patients, exercise tolerance is decreased. However, there is little literature about the increase in walking distance after supervised exercise therapy (SET) in patients with both intermittent claudication and DM. The objective of this study was to determine the effectiveness of SET for intermittent claudication in patients with DM.

METHODS: Consecutive patients with intermittent claudication who started SET were included. Exclusion criteria were Rutherford stage 4 to 6 and the inability to perform the standardized treadmill test. SET was administered according to the guidelines of the Royal Dutch Society for Physiotherapy. At baseline and at 1, 3, and 6 months of followup, a standardized treadmill exercise test was performed. The primary outcome measurement was the absolute claudication distance (ACD). RESULTS: We included 775 patients, of whom 230 had DM (29.7%). At 6 months of follow-up, data of 440 patients were available. Both ACD at baseline and at 6 months of follow-up were significantly lower in patients with DM (P < 0.001). However, increase in ACD after 6 months of SET did not differ significantly (P = 0.48) between the DM group and the non-DM group (270 m and 400 m, respectively). CONCLUSION: In conclusion, SET for patients with intermittent claudication is equally effective in improving walking distance for both patients with and without DM, although ACD remains lower in patients with DM. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22858162 [PubMed - in process] Related citations

11. Ann Vasc Surg. 2012 Oct;26(7):1052-5. doi: 10.1016/j.avsg.2012.03.008. Epub 2012 Jul 25.

Technique of aortic replacement through endovascular stenting before aortic wall resection for primary leiomyosarcoma of the abdominal aorta.
Presti C, Casella IB. Source Hospital Srio Libans, So Paulo, Brazil. Abstract Tumors involving the aorta represent a challenging situation because the surgical approach can lead to blood loss and/or clamping-related complications such as

ischemia, thrombosis, or reperfusion syndromes. We describe the technique of aortic endograft placement to cover part of the abdominal aorta and provide conditions for extensive aortic wall resection, without clamping or blood loss, followed immediately by aortic reconstruction with bovine pericardium. This technique also allows the surgeon to wait for the results of freeze biopsy without additional clamping time, thus avoiding the risk of leaving residual tumor cells in the aortic wall. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22840341 [PubMed - in process] Related citations

12. Ann Vasc Surg. 2012 Oct;26(7):985-95. doi: 10.1016/j.avsg.2012.04.003. Epub 2012 Jul 25.

Nonsuture anastomosis of arteries and veins using the magnetic pinned-ring device: a histologic and scanning electron microscopic study.
Liu SQ, Lei P, Cao ZP, Lv Y, Li JH, Cui XH. Source Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China. Abstract BACKGROUND: The goal of this study was to evaluate the performance of the magnetic pinned-ring device for nonsuture vascular anastomosis. METHODS: The magnetic pinned-ring device consists of paired magnetic rings that are coated with titanium nitride and embedded in a polypropylene shell; the rings are equipped with alternately spaced holes and titanium pins. The vascular anastomosis procedure using the novel magnetic pinned-ring device was performed on 14 mongrel dogs, and the traditional hand-sewing technique was used on 14 additional dogs. In situ end-to-end anastomoses were performed in the femoral artery and the inferior vena cava. Patency was confirmed through ultrasonographic scans at different time points as late as 24 weeks after surgery. Gross observation, histological staining, and scanning electron microscopy were used to evaluate the results at 24 weeks postoperatively. RESULTS:

The time required to perform the vascular anastomosis was significantly shorter for the magnetic device than for hand sewing. A continuity of re-endothelialization was confirmed in all anastomotic stomas after 24 weeks, and neither formation of aneurysms nor thickening of the vascular wall was noted. The re-endothelialization was smooth at the anastomotic site of the magnetic device, whereas hand sewing resulted in rough and uneven re-endothelialization and the presence of visible sutures. Moreover, the endothelial cells were regularly arranged at the anastomotic site of the magnetic device, whereas different-sized and irregularly aligned endothelial cells were present at the hand-sewn anastomotic site. Use of the magnetic device was associated with significantly decreased deposition of fibrotic collagen and depressed infiltration of inflammatory cells compared with use of the hand-sewing technique. CONCLUSIONS: The magnetic pinned-ring device offers a simple, fast, reliable, and efficacious technique for nonsuture vascular anastomosis. Use of this device shortens operation time, maintains a high patency rate, and improves the healing of vascular tissue. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22835565 [PubMed - in process] Related citations

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Research Support, Non-U.S. Gov't

13. Ann Vasc Surg. 2012 Oct;26(7):1022-9. doi: 10.1016/j.avsg.2012.03.006. Epub 2012 Jul 25.

Open surgical and endovascular conduits for difficult access during endovascular aortic aneurysm repair.
Oderich GS, Picada-Correa M, Pereira AA. Source Division of Vascular and Endovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. oderich.gustavo@mayo.edu Abstract

Endovascular aortic aneurysm repair has gained widespread acceptance as the primary method of treatment of abdominal and thoracic aortic aneurysms. Difficult access because of small, narrowed, tortuous, or severely calcified iliac and femoral arteries poses a significant challenge and remains a common cause of inadvertent arterial disruption and conversion to open repair. Vascular complications associated with difficult access are associated with major morbidity and mortality. This article summarizes open surgical and endovascular alternatives to dealing with difficult iliofemoral access during endovascular aortic interventions. Copyright 2012. Published by Elsevier Inc. PMID: 22835562 [PubMed - in process] Related citations

14. Ann Vasc Surg. 2012 Oct;26(7):996-1001. doi: 10.1016/j.avsg.2012.02.004. Epub 2012 Jul 21.

Dramatic decrease of aortic longitudinal elastic strength in a rat model of aortic dissection.
Zhang L, Pei YF, Wang L, Liao MF, Lu QS, Zhuang YF, Zhang SM, Jing ZP. Source Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China. Abstract BACKGROUND: This study aimed to evaluate thoracic aortic longitudinal elastic strength in a rat model of aortic dissection (AD). METHODS: Young Sprague Dawley rats were fed 0.25% -aminopropionitrile (BAPN). Biomechanical and biochemistry properties of the aorta were analyzed. Elasticity modulus, maximum stretching length, draw ratio, maximum load, maximum strength, and maximum extensibility were measured. RESULTS: More than one-half of BAPN-treated rats (52.9%) died of aortic rupture secondary to AD during the experiment. The diameter of the aneurysms was 6.33 1.17 mm and the length was 9.33 4.95 mm. The maximum diameter was significantly increased in BAPN-treated rats with AD (group B2) compared with rats without AD (group B1) and

control group (group A) (P = 0.001 and P < 0.001, respectively), but was not different between group B1 and group A (P = 0.108). Thickness of media and initial area in aorta of BAPN-treated rats were significantly increased compared with control group (P = 0.001 and P < 0.001, respectively), but no difference in initial area was observed between group B1 and group B2 (P = 0.54). Maximum stretching length, draw ratio, maximum load, maximum strength, maximum extensibility, and elasticity modulus were dramatically decreased in group B2 compared with group B1 and group A (group B2 vs. group B1: P < 0.001; group B1 vs. group A: P < 0.001). CONCLUSIONS: We successfully established a rat model of AD with a high incidence of rupture and mortality. Examinations of strain and stress parameters as well as elasticity modulus of the dissected and the nondissected aorta help understand pathogenesis of AD. Crown Copyright 2012. Published by Elsevier Inc. All rights reserved. PMID: 22819525 [PubMed - in process] Related citations

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Research Support, Non-U.S. Gov't

15. Ann Vasc Surg. 2012 Oct;26(7):964-72. doi: 10.1016/j.avsg.2011.12.016. Epub 2012 Jun 29.

Low incidence of pulmonary embolism associated with upperextremity deep venous thrombosis.
Levy MM, Albuquerque F, Pfeifer JD. Source Division of Vascular Surgery and Peripheral Vascular Laboratory, Virginia Commonwealth University Health System, Richmond, VA 23298, USA. mlevy@mcvhvcu.edu Abstract BACKGROUND:

Most recent Chest 2008 guidelines counsel at least 3 months of anticoagulation for acute upper-extremity deep venous thrombosis (UEDVT). These guidelines are inconsistently followed, perhaps owing to relatively limited information regarding clinical outcomes among patients with UEDVT. Our institution maintains an UEDVT registry of consecutively encountered patients with sonographically confirmed UEDVT. We analyzed patient characteristics, treatment, and outcomes among these patients. METHODS: Between April 2005 and November 2008, 300 consecutively encountered peripheral vascular laboratory patients with UEDVTs were identified. Data on UEDVT sonographic characteristics, patient demographics, anticoagulation treatment, pulmonary embolism (PE) incidence and diagnostic modality, hemorrhagic complications, and mortality were then extracted. RESULTS: Among the 300 patients, there was deep venous obstruction in the distal innominate (n = 69), internal jugular (n = 146), subclavian (n = 161), axillary (n = 107), and brachial (n = 91) veins. Two hundred forty-six patients (82%) had UEDVTs identified as clearly acute or acute on chronic, based on sonographic appearance. Most patients with UEDVTs were symptomatic (n = 265, 88%). One hundred six patients had documented malignancy (35%), 92 were postoperative or trauma patients (31%), and 76 patients were obese (body mass index: >30, 25%). Additionally, 240 patients had associated or previous indwelling central venous lines or leads (80%). One hundred twenty-eight patients (43%) were initially anticoagulated with heparin, whereas 121 of these patients were converted to warfarin therapy (40%) for variable lengths of time. One hundred sixty-seven patients were not treated with anticoagulation (56%), of whom 16 had documented contraindication to anticoagulation. Although the anticoagulated subset of patients tended to be younger, the decision to anticoagulate patients correlated significantly with the sonographically documented acute nature of the deep venous thrombosis, and its extent. Six patients (2%) suffered PE in association with their UEDVT diagnosis. There was no PE-related mortality. However, among anticoagulated UEDVT patients, there were four patients who suffered intracranial hemorrhage resulting in three deaths, and an additional three patients who required rehospitalization for upper gastrointestinal (n = 2) or stomal (n = 1) hemorrhage. CONCLUSIONS: Anticoagulation therapy is inconsistently used to treat UEDVT and most often used for patients with multiple vein segments involved and with sonographically acute UEDVT components. However, regardless of the decision to anticoagulate, the incidence of PE attributable to UEDVT is small (2%), regardless of treatment with anticoagulation. Given the observed mortality associated with anticoagulation in this fragile patient cohort, the risk-benefit analysis for anticoagulation does not favor routine anticoagulation among these patients. Copyright 2012. Published by Elsevier Inc. PMID: 22749742 [PubMed - in process] Related citations

16. Ann Vasc Surg. 2012 Oct;26(7):973-6. doi: 10.1016/j.avsg.2012.01.014. Epub 2012 Jun 28.

Pulmonary embolism without deep venous thrombosis.

Schwartz T, Hingorani A, Ascher E, Marks N, Shiferson A, Jung D, Jimenez R, Jacob T. Source Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA. tschwartz@maimonidesmed.org Abstract BACKGROUND: To identify patients with pulmonary embolism (PE) without deep venous thrombosis (DVT), and to compare them with those with an identifiable source on upper (UED) and lower-extremity venous duplex scans (LED). METHODS: We performed a retrospective review of 2700 computed tomography angiograms of the chest between January 2008 and September 2010 and identified 230 patients with PE. We then evaluated the results of UED and LED and divided the patients into four groups based on the results of their duplex studies. We compared patients with PE and DVT with those with PE and no DVT in terms of age, gender, size and location of PE, critical illness, malignancy, and in-hospital mortality. RESULTS: We identified 152 women and 78 men (mean age, 68 years) with PE. One hundred thirty-one patients had a documented source of PE (group 1). Fifty-three patients had negative LED results, but did not undergo UED (group 2). Thirty-one patients did not undergo either LED or UED (group 3). Seven men and eight women had no documented source of PE on UED and LED (group 4). Ten of 15 patients in group 4 had a documented malignancy listed as one of their diagnoses. Because patients in groups 2 and 3 did not undergo complete duplex studies, we excluded them from our analysis. We then reviewed the discharge summaries of patients in groups 1 and 4. There was no statistically significant difference in age and gender distribution, size and location of PE, critical illness, smoking status, cardiovascular disease, trauma, and inhospital mortality between patients in group 1 and 4. Patients in group 4 had a statistically significant increased prevalence of malignancy (67% vs. 40%, P = 0.046). Patients in group 4 also had a higher percentage of active cancer than those in group 1 (47% vs. 24%, P = 0.084), although not statistically significant. We defined active cancer as either a metastatic disease or a malignancy diagnosed shortly before or after the diagnosis of PE. Patients who were undergoing treatment for cancer at the time of diagnosis of PE were also considered to have active cancer.

CONCLUSION: We demonstrated a statistically significant increased prevalence of malignancy in patients with PE without DVT. However, pathophysiology and clinical significance are the aspects that remain to be understood after accrual of more patients and further research. Possibilities such as de novo thrombosis of pulmonary arteries, complete dislodgement of thrombi from peripheral veins, or false-negative venous duplex need to be explored. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22749324 [PubMed - in process] Related citations

17. Ann Vasc Surg. 2012 Oct;26(7):982-4. doi: 10.1016/j.avsg.2012.01.009. Epub 2012 Jun 26.

Clinical experience with office-based duplex-guided balloonassisted maturation of arteriovenous fistulas for hemodialysis.
Gallagher JJ, Boniscavage P, Ascher E, Hingorani A, Marks N, Shiferson A, Jung D, Jimenez R, Novak D, Jacob T. Source Maimonides Medical Center, Brooklyn, NY, USA. jgallagher03@yahoo.com Abstract BACKGROUND: To examine the effect of office-based duplex-guided balloon-assisted maturation (DGBAM) on arteriovenous fistula (AVF), we retrospectively analyzed our experience. METHODS: Over the past 10 months, we performed 185 DG-BAMs (range, 1-8 procedures; mean, 3.7) in 45 patients (29 male, 16 female; mean age, 68.2 12.8 years) with 31 radialcephalic, 7 brachial-cephalic, and 7 brachial-basilic AVFs. Balloon sizes (3-10 mm) were chosen based on duplex measurements (1-2 mm larger than minimal vein diameter). Forearm AVFs were dilated to 8 mm, and arm AVFs were dilated to 10 mm. RESULTS: All cases but one (99.5%) were successfully dilated. This exception was a large AVF rupture that required surgical repair. AVFs failed to mature in seven of the remaining 44

patients (16%) despite DG-BAM because of proximal vein stenoses (PVS). Four patients had cephalic arch stenoses, and three had proximal subclavian vein stenoses. Arm AVFs were more commonly associated with PVS (6 of 14 patients, 43%) as compared with the ones placed in the forearm (1 of 30 patients, 3.3%), with a P value of 0.0024. All these seven AVFs subsequently matured after successful balloon angioplasty of the venous outflow. CONCLUSIONS: These data suggest that office-based DG-BAM of AVFs is feasible, safe, and averts nephrotoxic contrast and radiation. PVS appear to be the most common cause of failure for AVFs subjected to BAM. Because arm AVFs are at increased risk of PVS, we suggest that a careful duplex evaluation of the outflow be performed in these cases and in all AVFs that fail to mature. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22743218 [PubMed - in process] Related citations

18. Ann Vasc Surg. 2012 Oct;26(7):937-45. doi: 10.1016/j.avsg.2011.12.010. Epub 2012 Jun 19.

Impact of gender and age on outcomes of tibial artery endovascular interventions in critical limb ischemia.
Domenick N, Saqib NU, Marone LK, Rhee RY, Makaroun MS, Chaer RA. Source Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. Abstract BACKGROUND: Female sex and older age are known risk factors for adverse outcomes in peripheral artery disease. This study reports on the outcomes of tibial artery endovascular intervention (TAEI) by age and gender in patients treated for critical limb ischemia. METHODS: All TAEIs for tissue loss or rest pain (Rutherford classes 4, 5, and 6) from 2004 to 2010 were retrospectively reviewed. Patient demographics, comorbidities, intervention sites, complications, and outcome measurements, including limb salvage, wound healing,

and patency, were recorded for each patient. Data were analyzed by gender and age using Fisher exact test, multivariate logistic regression, and Cox proportional hazards regression. RESULTS: Two hundred twenty-one limbs (201 patients, 40% female) were treated for critical limb ischemia (74% with tissue loss, 26% with rest pain). Mean age of the patients was 73.3 years (39% were aged 80 years). Comorbidities and indications for intervention were comparable. Isolated TAEI was performed in 46% of the limbs, whereas multilevel interventions were performed in 54%. Mean follow-up period was 8.7 7.3 months. Complications were comparable between genders and ages (P = not significant [NS]). Limb salvage rate was 88% and was comparable by gender (P = NS). Major amputation was less frequent in octogenarians (6% vs. 16%, P = 0.03). Neither gender nor age was a predictor of limb loss (P = NS), but renal insufficiency was (hazard ratio = 2.81, 95% confidence interval = 1.14-6.90, P = 0.02). Age 80 years was a predictor of impaired wound healing (hazard ratio = 1.57, 95% confidence interval = 1.04-2.37, P = 0.03), but gender was not (P = NS). Overall primary patency rate was 62% at 1 year and was similar in women and octogenarians (P = NS). Overall reintervention rate was 53% at 1 year and was higher in women (65% vs. 46%, P = 0.03), but was not affected by age (P = NS). CONCLUSIONS: TAEI outcomes do not appear to be adversely affected by gender or age. Limb salvage appears equivalent in octogenarians, with amputations occurring less frequently. Women also appear to have outcomes similar to men after TAEIs, but may require repeat interventions to achieve equivalent limb salvage rates. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22717357 [PubMed - in process] Related citations

19. Ann Vasc Surg. 2012 Oct;26(7):1039-51. doi: 10.1016/j.avsg.2012.04.001. Epub 2012 Jun 15.

Basic data related to endovascular management of peripheral arterial disease in critical limb ischemia.
Venkatachalam S, Shishehbor MH, Gray BH. Source Department of Medicine, Cleveland Clinic, Cleveland, OH, USA.

Abstract Chronic critical limb ischemia occurs in the setting of severe peripheral arterial disease that is often characterized by advanced atherosclerosis at multiple levels in the lower extremity. Despite the challenges posed by the complexity of arterial disease in such patients, endovascular intervention is a less invasive alternative to infrainguinal bypass graft surgery in most patients, with low procedural morbidity and mortality. Continual advances in percutaneous techniques have made it possible to revascularize lesions considered nonamenable for endovascular intervention. For example, the development of dedicated peripheral wires, balloons, stents, and catheters allows the recanalization and revascularization of almost any anatomy. Pharmaceutical advances in risk factor modification for recurrent stenosis impact results. Such evolution makes data comparison difficult. This review aims to present the available data on endovascular therapy in critical limb ischemia patients reported over the past 2 decades. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22704191 [PubMed - in process] Related citations

20. Ann Vasc Surg. 2012 Oct;26(7):906-12. doi: 10.1016/j.avsg.2011.09.013. Epub 2012 Apr 24.

The Kaiser Permanente experience with ultrasound-guided percutaneous endovascular abdominal aortic aneurysm repair.
Sarmiento JM, Wisniewski PJ, Do NT, Slezak JM, Tayyarah M, Aka PK, Vo TD, Hsu JH. Source Division of Biomedical Sciences, University of California, Riverside, CA, USA. Abstract BACKGROUND: This study was conducted to determine the effect of ultrasound (US)-guided percutaneous access for percutaneous endovascular abdominal aortic aneurysm repair (PEVAR) on conversion to open repair by femoral cutdown. We also sought to identify other risk factors associated with failure of percutaneous access and conversion to femoral cutdowns. METHODS:

This is a single-center, retrospective review of 101 patients who underwent PEVAR between January 1, 2005 and July 31, 2009 (56 months). Risk factors that were evaluated for unsuccessful PEVAR included gender, age (65 and 66 years), USguided percutaneous access, mechanical failure, abdominal aortic aneurysm size, and the following comorbidities: diabetes, hypertension, vessel calcification, and obesity (body mass index: 30 kg/m(2)). RESULTS: There were 10 (9.9%) conversions from percutaneous to femoral cutdown, yielding a success rate of 90.1% for a total percutaneous approach. Each converted patient had one groin converted, resulting in a cutdown rate per groin of 10/202 (5%). There were no 30-day mortalities. Univariate analysis showed that hypertension (P = 0.261), age 66 years (P = 0.741), current smoking history (P = 0.649), past smoking history (P = . 093), diabetes (P = 0.908), vessel calcification (P = 0.8281), and body mass index 30 kg/m(2) (P = 0.052) did not significantly predict conversion to endovascular aortic aneurysm repair (EVAR). Mechanical failure significantly predicted conversion to cutdown EVAR (P = 0.0002), whereas US-guided percutaneous access influenced successful PEVAR (P = 0.030). Multivariate analysis showed that mechanical failure significantly predicted conversion to cutdown EVAR (P = 0.003) and US-guided percutaneous access influenced successful PEVAR (P = 0.040) after adjusting for smoking history and obesity. CONCLUSION: PEVAR is a viable option for aortic aneurysm repair that may be improved with USguided percutaneous access by reducing the rate of femoral cutdowns. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22534260 [PubMed - in process] Related citations

21. Ann Vasc Surg. 2012 Oct;26(7):1030-8. doi: 10.1016/j.avsg.2011.11.029. Epub 2012 Apr 11.

The chimney graft, a systematic review.

Tolenaar JL, van Keulen JW, Trimarchi S, Muhs BE, Moll FL, van Herwaarden JA. Source Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Abstract

BACKGROUND: Approximately 20% to 30% of the patients are considered not eligible for standard endovascular aneurysm repair because of aortic neck morphology. Most of these patients have an aortic neck situated in the vicinity of the aortic side branches, requiring extensive open surgery. The introduction of fenestrated and branched stent grafts has made endovascular branch preservation possible, but these procedures are time-consuming and expensive. The chimney procedure offers a readily available endovascular alternative for the treatment in patients with acute aneurysms and challenging anatomy. We conducted a systematic review to evaluate the short- and long-term results of the chimney procedure. METHODS: A comprehensive literature search for studies describing the chimney procedure was performed using MEDLINE and Excerpta Medica Database. All articles were critically appraised and included, based on relevance, validity, and outcome measures. Patient characteristics, details of the surgical intervention, and short- and long-term outcomes were studied. RESULTS: A total of 75 patients were included who underwent a chimney procedure for the preservation of a total of 96 branches. Used operating techniques differed considerably between all studies, with an overall technical success rate of 98.9%. Three perioperative deaths were reported, of which one patient died from intervention-related complication. The follow-up duration ranged from 2 days to 54 months. Late complications included three deaths, none of which was device or aneurysm related. Three chimney grafts occluded during follow-up, of which two required reintervention. CONCLUSION: The chimney procedure appears as an acceptable alternative for patients in an emergency setting, although data regarding long-term follow-up are not yet available. Copyright 2012 Annals of Vascular Surgery Inc. All rights reserved. PMID: 22498342 [PubMed - in process] Related citations

22. Ann Vasc Surg. 2012 Oct;26(7):924-8. doi: 10.1016/j.avsg.2011.09.011. Epub 2012 Apr 10.

Eversion carotid endarterectomy--our experience after 20 years of carotid surgery and 9897 carotid endarterectomy procedures.

Radak D, Tanaskovi S, Mati P, Babi S, Aleksi N, Ilijevski N. Source Cardiovascular Institute Dedinje, Department of Vascular Surgery, School of Medicine, University of Belgrade, Belgrade, Republic of Serbia. Abstract BACKGROUND: The aim of this article is to review our experience in surgical treatment of carotid atherosclerosis using eversion carotid endarterectomy (eCEA) in 9,897 patients performed in the last 20 years, with particular attention to diagnostic approach, surgical technique, medical therapy, and final outcome. METHODS: From January 1991 to December 2010, 9,897 primary eCEAs were performed for highgrade carotid stenosis. Patients treated for restenosis after previous carotid surgery were excluded from the analysis. Follow-up included routine clinical evaluation and noninvasive surveillance, with duplex scanning, 1 and 6 months after surgery, and annually afterward. RESULTS: The majority of the patients were symptomatic (stroke, 42.8%; transient ischemic attack, 55.1% [focal cerebral and retinal ischemia]), whereas only 2.1% of the patients were asymptomatic. For the final diagnosis, duplex scanning was performed in 83.4% of patients and angiography in only 16.3% (P < 0.001). Average carotid artery clamping time was 11.9 3.2 minutes, and the majority of the patients were operated under general anesthesia (99.4%). Intraoperative shunting and local anesthesia were rarely performed; 0.6% of the patients were operated under local anesthesia, and in 0.5% of the patients, intraluminal shunt was used. Neurological and total morbidity showed a steady decline over time, with rate of neurological morbidity of 1.1% and total morbidity of 3.9% at the end of 2010. Neurological mortality and total mortality also showed a steady decline over time, with rate of neurological mortality of 0.3% and total mortality of 0.8% at the end of 2010. There was a low rate of both, nonsignificant restenosis (<50%), which was verified in 2.1% of the patients, and significant restenosis (>50%), which was observed in 4.3% of the patients. CONCLUSION: Our data show that eCEA is a reliable surgical technique for the treatment of atherosclerotic carotid disease, with low morbidity and mortality. The specificity of our experience is the significant number of patients with preoperative stroke, but despite this fact, results are comparable with previously published series. It also highlights the importance of comprehensive surgical training in reducing complications. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID:

22494931 [PubMed - in process] Related citations

23. Ann Vasc Surg. 2012 Oct;26(7):913-7. doi: 10.1016/j.avsg.2011.11.028. Epub 2012 Mar 28.

Intraoperative factors affecting renal outcome after open repair of suprarenal aortic aneurysms.
Godier S, Dusseaux MM, David N, Roux N, Veber B, Dureuil B, Plissonnier D. Source Department of Anesthesiology, Rouen University Hospital, Rouen, France. Abstract BACKGROUND: The open repair of suprarenal aortic aneurysm requires supraceliac aortic crossclamping and separate renal artery reconstruction. The aim of this study was to determine the intraoperative factors responsible for postoperative renal dysfunction. METHODS: Between January 1, 2000 and May 31, 2010, 54 suprarenal aortic aneurysms were repaired at our center (mean age of the patients, 66 8 years). All cases were operated through a left retroperitoneal approach without left renal vein division. Acute kidney injury was defined as a 50% increase of serum creatinine level from the preoperative baseline concentration. Perioperative variables were tested to be correlated with renal dysfunction (Spearman rank). RESULTS: The ischemic time was 28 8 minutes for the mesentery and the right kidney and 63 16 minutes for the left kidney. The total aortic clamping time was 115 27 minutes. The volume of autologous transfusion was 957 479 mL, allogeneic transfusion was 936 473 mL, and colloids and crystalloids was 7,194 2,201 mL. Two patients died. Acute kidney injury occurred in 15 patients, with complete recovery at discharge. The autologous blood transfusion volume (P = 0.009, r = 0.36) and the total aortic clamping time (P = 0.04, r = 0.30) were correlated with renal dysfunction. CONCLUSION: Postoperative renal dysfunction based on the variation in creatinine serum level was transient and requires further investigation using sensitive biomarkers for tubular ischemia.

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22459284 [PubMed - in process] Related citations

Ann Vasc Surg 2012; 26 (7) Case Reports

1. Ann Vasc Surg. 2012 Oct;26(7):1013.e9-1013.e12. doi: 10.1016/j.avsg.2012.02.026.

Spontaneous rupture of autogenous saphenous vein graft in bypass surgery for peripheral arterial disease possibly associated with collagen disease.
Komai H, Shigematsu H, Obitsu Y, Ogawa T, Nagao T. Source Department of Vascular Surgery, Tokyo Medical University, Tokyo, Japan. hkomai@tokyo-med.ac.jp Abstract We encountered two cases of spontaneous rupture of a saphenous vein bypass graft for lower-leg peripheral arterial disease possibly associated with collagen disease. Rupture occurred 5 and 14 days postoperatively. Neither case had any signs of infection, graft degeneration, or evident injury, but both were associated with collagen disease diagnosed at another hospital. We believe that an association with collagen disease might have contributed to vein wall fragility in the present cases. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944580 [PubMed - in process] Related citations

2. Ann Vasc Surg. 2012 Oct;26(7):1013.e5-8. doi: 10.1016/j.avsg.2012.02.021.

Endovascular treatment of bronchial artery aneurysm with aortic stent-graft placement and coil embolization.
Guzzardi G, Cerini P, Fossaceca R, Commodo M, Micalizzi E, Carriero A. Source

Institute of Interventional Radiology, Maggiore della Carit Hospital, A. Avogadro University, Novara, Italy. guz@libero.it Abstract Bronchial artery aneurysm (BAA) represents a rare, but dangerous, pathology because its rupture can cause a life-threatening hemorrhage; opportune treatment is mandatory when a definite diagnosis is obtained. There are several reports of endovascular treatment of BAA with transcatheter arterial embolization and only few cases treated with aortic stent-graft exclusion. We report a case of mediastinal BAA close to thoracic aorta treated with a combined approach of stent-graft occlusion of the inflow and coil embolization of the outflow arteries. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944579 [PubMed - in process] Related citations

3. Ann Vasc Surg. 2012 Oct;26(7):1013.e1-4. doi: 10.1016/j.avsg.2012.02.015.

Leiomyosarcoma of the deep femoral vein. A rare cause of venous obstruction in lower limbs and an alternative diagnosis to chronic venous thrombus.
Gil-Sales J, Vicente S, Martnez N, Doblas M, Orgaz A, Flores A, Leal JI, Rodrguez R, Fontcuberta J, Peinado FJ. Source Servicio de Ciruga Vascular, Complejo Hospitalario de Toledo, Hospital Virgen de la Salud, Toledo, Spain. josepgil22@hotmail.com Abstract Primary venous leiomyosarcoma of the extremities is an uncommon, but aggressive, tumoral entity with a high rate of local recurrence and early hematogenous metastasis. In the present article, we report a case of leiomyosarcoma of the vena profunda femoris. This pathology causes deep venous thrombosis-like symptoms. No improvement in lower limb status and a significant and progressive increase in the diameter of the vein as seen using ultrasonography could indicate tumor disease. Particular care must be taken to avoid biopsies due to the possible dissemination. We must complete the medical study with imaging techniques, and the tumor must be removed as soon as possible for histopathological diagnosis. After a follow-up of 12 months, there was no evidence of local or metastatic recurrence in our patient.

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944578 [PubMed - in process] Related citations

4. Ann Vasc Surg. 2012 Oct;26(7):1012.e9-1012.e11. doi: 10.1016/j.avsg.2012.02.017.

Ruptured abdominal aortic aneurysm with left-sided inferior vena cava.

Niino T, Unosawa S, Shimura K. Source Department of Cardiovascular Surgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan. tetsuyan77@gmail.com Abstract We present a case of ruptured abdominal aortic aneurysm with left-sided inferior vena cava. An 82-year-old man was admitted to our hospital with a sudden onset of severe abdominal pain and loss of consciousness. Computed tomography revealed rupture of an infrarenal abdominal aortic aneurysm and a left-sided inferior vena cava. At surgery, the inferior vena cava was found to cross anteriorly over the abdominal aorta at the usual level of the renal vein. Graft replacement was successfully performed, with careful mobilization and retraction of the inferior vena cava. The patient had an uneventful postoperative course without any deterioration of renal function. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944577 [PubMed - in process] Related citations

5. Ann Vasc Surg. 2012 Oct;26(7):1012.e5-8. doi: 10.1016/j.avsg.2012.04.009.

Carotid-brachial bypass and simultaneous radiocephalic fistula for a patient on hemodialysis.

Yankovic W, Mallios A, Rafati F, Costanzo A, Boura B, Combes M. Source Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France. wallabass@yahoo.com Abstract Patients undergoing long-term hemodialysis often suffer from obliterative arterial disease, which may lead to hand ischemia and/or access failure. We present the case of a 54-year-old female patient with multiple failures in obtaining vascular access. Computed tomography angiogram revealed a long occlusion of the axillary artery. Vein mapping through duplex scanning demonstrated a suitable cephalic vein in the left forearm. A left carotid-brachial bypass was performed with simultaneous radiocephalic arteriovenous fistula formation. Immediate results were excellent, and the postoperative course was uneventful. To our knowledge, this is the first report of such a combined approach. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944576 [PubMed - in process] Related citations

6. Ann Vasc Surg. 2012 Oct;26(7):1012.e17-20. doi: 10.1016/j.avsg.2012.02.024.

Endovascular strategy for recanalization of long-segment central vein occlusion with concomitant arteriovenous fistula creation.
Malgor RD, Wood EA, Gasparis AP, Hashisho M. Source Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY 11794-8191, USA. afael.malgor@stonybrook.edu Abstract Recanalization of long-segment central vein flush occlusion in hemodialysis patients has been advocated in lieu of central vein bypass and thoracotomy to restore arteriovenous access availability. We report a challenging case of complex central venous flush occlusion in a 50-year-old woman on hemodialysis who presented with right arm and facial swelling. A concise step-by-step description of endovascular strategy with retrograde and antegrade balloon angioplasty techniques for central vein recanalization with concomitant arteriovenous fistula creation is provided.

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944575 [PubMed - in process] Related citations

7. Ann Vasc Surg. 2012 Oct;26(7):1012.e13-5. doi: 10.1016/j.avsg.2012.02.016.

Primary aortoduodenal fistula supplied by type II endoleak.

Lind BB, Jacobs CE. Source Department of Cardiothoracic Vascular Surgery, Rush University Medical Center, Chicago, IL, USA. Benjamin.Lind@gmail.com Abstract Aortoenteric fistulas are a rare but potentially lethal condition. Here we present an unusual case of a fistula between the excluded portion of an infrarenal aneurysm repaired by stent-grafting and the duodenum. The fistula was supplied by a type II endoleak. The patient was successfully treated by extra-anatomic bypass grafting and removal of the aneurysm sac and the stent-graft. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944574 [PubMed - in process] Related citations

8. Ann Vasc Surg. 2012 Oct;26(7):1011.e7-1011.e10. doi: 10.1016/j.avsg.2012.03.015.

Chronic contained abdominal aortic aneurysm rupture after suprarenal fixation fatigue fracture.
Pitoulias GA, Mavros DM, Pappas EA, Atmatzidis SK, Papadimitriou DK. Source

Division of Vascular Surgery, Second Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece. pitoulias@yahoo.com Abstract Chronic contained rupture (CCR) of an abdominal aortic aneurysm is a rare condition, and differential diagnosis might be difficult. We present a clinical case of a hemodynamically stable octogenarian who presented with intermittent pain in the left lower abdomen. The patient had a history of diverticulitis, and 6 years ago, he had undergone endovascular abdominal aortic aneurysm repair (EVAR) with a Talent bifurcated prosthesis. Additionally, 20 days before his admission to our hospital, he had undergone a secondary iliac limb extension for treatment of post-EVAR rupture. On admission, abdominal plain radiography identified suprarenal fixation fracture as a possible reason for CCR, but computed tomographic angiography failed to confirm any endoleak or "active" bleeding and rupture. The patient received medication treatment for possible diverticulitis and was kept under close monitoring for suspected failure of recently performed secondary endovascular procedure and CCR. A day later, the abdominal pain symptoms worsened, and a new computed tomographic angiography confirmed the suspected CCR. The patient was treated successfully by "open" repair using a Y prosthesis. To our knowledge, this is the first reported case of post-EVAR CCR due to suprarenal fixation fatigue fracture. Lifelong post-EVAR follow-up with high level of both clinical and imaging diagnostic accuracy is essential for the early recognition and proper treatment of EVAR pitfalls. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944573 [PubMed - in process] Related citations

9. Ann Vasc Surg. 2012 Oct;26(7):1011.e1-5. doi: 10.1016/j.avsg.2012.02.023.

Modification of the sandwich technique to preserve flow in the hypogastric artery after endovascular repair of aortoiliac aneurysmal disease: our initial experience with two cases.
Hennedige T, Chua B, Taneja M. Source Department of Radiology, Singapore General Hospital, Outram Road, Singapore. tiffany_hennedige@hotmail.com Abstract BACKGROUND:

To describe modification of the sandwich technique to preserve flow in the hypogastric artery after endovascular repair of aortoiliac aneurysmal disease in patients with challenging anatomy. METHODS AND RESULTS: The sandwich technique has been proposed as an option in patients with aortoiliac aneurysmal disease, in whom standard iliac branch device may not be technically feasible. We feel that even with the sandwich technique, there are issues with adequately treating these aneurysms in patients with short common iliac arteries with critical landing zones and in those with narrow-caliber external iliac arteries. We describe our experience with two patients we operated on using a modification of the originally described technique and their follow-up. CONCLUSIONS: The modification of the sandwich technique is a promising alternative technique that would be useful in situations where standard endovascular grafts cannot be used in patients with challenging anatomy. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22944572 [PubMed - in process] Related citations

10. Ann Vasc Surg. 2012 Oct;26(7):1012.e1-4. doi: 10.1016/j.avsg.2012.01.017. Epub 2012 Jul 13.

Acute hepatic failure associated with arteriovenous fistulae for hemodialysis.

Carlson T, Sanders JP, Madar C, Davis K, Katras T, Gagliano RA Jr. Source Department of Surgery, Tripler Army Medical Center, Honolulu, HI 96859-5000, USA. Abstract We present the case of a 63-year-old woman who was admitted to the intensive care unit for altered mental status and hypotension 3 weeks after creation of an arteriovenous fistula (AVF). She was found to have high-output heart failure and evidence of acute hepatic failure. High-output heart failure is a known complication of AVF creation, but hepatic failure after AVF has not been previously described. We present such a case.

Published by Elsevier Inc. PMID: 22795943 [PubMed - in process] Related citations

11. Ann Vasc Surg. 2012 Oct;26(7):1011.e11-3. doi: 10.1016/j.avsg.2012.01.015. Epub 2012 Jun 28.

Endovascular repair of a ruptured type II renal artery aneurysm using an endograft.

Bloemsma GC, van Oostayen JA, Reijnen MM. Source Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands. Abstract BACKGROUND: The purpose of this study was to describe a case of an endovascular exclusion of a ruptured type II renal artery aneurysm in a hemodynamically unstable patient using an endograft. METHODS AND RESULTS: A 73-year-old woman, with an extensive medical history, presented with a sudden onset of abdominal pain and hypovolemic shock. A computed tomography scan showed a massive right-sided retroperitoneal hematoma and a type II aneurysm of the right renal artery just proximal to the bifurcation. Angiography demonstrated active contrast extravasation from the aneurysm. The aneurysm was excluded using a 5-cm long, 6-mm wide endograft. After a 6-month interval, duplex ultrasonography showed a patent endograft and normal perfusion of the renal parenchyma in the lower and middle pole, with a glomerular filtration rate of 75 mL/min. CONCLUSION: Endovascular exclusion using an endograft may provide a safe and rapid alternative to surgery to treat ruptured renal artery aneurysms in a selected group of patients. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22749321 [PubMed - in process]

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