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Ann Vasc Surg 2012; 26(4) Originals

1. Ann Vasc Surg. 2012 May;26(4):566-70. doi: 10.1016/j.avsg.2012.01.004.

Protective effect of antithrombin III against lung and myocardial injury in lower-limb ischemia-reperfusion syndrome.
Zambas NA, Karkos CD, Kambaroudis AG, Karamanos DG, Spyridis CT, Gerassimidis TS. Source 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece. Abstract BACKGROUND: Restoration of blood flow to an acutely ischemic limb can trigger systemic inflammation. We investigated whether antithrombin III (AT-III) exerts a protective action against remote lung and myocardial injury in an experimental animal model of lower-limb ischemia-reperfusion. METHODS: Ischemia was induced by lower-limb arterial occlusion for 6 hours in 60 male Wistar rats. Animals were divided into those receiving AT-III (dose, 250 mg/kg) 30 minutes before the reperfusion (group A, n = 30) and those receiving placebo (group B, n = 30). Animals were then sacrificed, and lung and myocardial tissue samples were taken at baseline, 30 minutes, and 4 hours after reperfusion. Levels of malondialdehyde (MDA), a compound used as indirect index of oxygen free radicals, were estimated in lung and myocardium, and the two groups were compared at different time points using the independent sample t test. RESULTS: Animals administered AT-III had significantly lower levels of lung MDA compared with the placebo group at baseline and at 30 minutes, but not at 4 hours (P = 0.001, P = 0.01, and P = 0.9, respectively), indicating a protective action of AT-III against remote lung injury early in the reperfusion phase. With regard to myocardial MDA levels, no statistically significant differences existed between the AT-III and placebo groups at baseline, at 30 minutes, and at 4 hours (P = 0.07, P = 0.07, and P = 0.2, respectively) after reperfusion. CONCLUSIONS: In this experimental animal model, AT-III appears to exert a protective effect against remote ischemia-reperfusion injury in the lung tissue, but not in the myocardium.

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22520394 [PubMed - indexed for MEDLINE] Related citations

2. Ann Vasc Surg. 2012 May;26(4):549-58. doi: 10.1016/j.avsg.2012.01.005.

Lysophosphatidic acid pretreatment prevents micromolar atorvastatin-induced endothelial cell death and ensures the beneficial effects of high-concentration statin therapy on endothelial gene expression.
Garrido JM, Esteban M, Roda O, Alaminos M, Snchez-Montesinos I. Source Department of Cardiac Surgery, josemanuel.garrido@med.ucm.es Abstract Because of the pleiotropic effects of statins, it may potentially be used as a locoregional adjuvant in vascular revascularization, tissue engineering, and regenerative procedures. Electron probe X-ray microanalyses and oligonucleotide microarrays were used to identify the global effects of micromolar concentrations of atorvastatin on the gene expression and cell viability of endothelial cells in different states of lysophosphatidic acid (LPA)-induced activation. Treatment with 1-M atorvastatin for 24 hours significantly reduced the viability of human vascular endothelial cells (HUVECs). However, the same treatment of LPA-preactivated HUVECs produced elevated cell viability levels and an optimal vascular gene expression profile, including endothelial nitric oxide synthase overexpression, endothelin-1 repression, an anti-inflammatory genetic pattern, and upregulation of molecules involved in maintaining the endothelial barrier (vascular endothelial cadherin, claudin 5, tight junction protein 1, integrin 4). The atorvastatin treatment also produced a repression of microRNA 21 and genes involved in cell proliferation and neointimal formation (vascular endothelial growth factor [VEGF] A, VEGF receptor 1, VEGFC). Results obtained suggest that micromolar atorvastatin therapy can enhance global endothelial function, but its effects on cell viability vary according to the baseline state of cell activation (preactivated, postactivated, or not activated). Preactivation with LPA protects HUVECs against atorvastatin-induced apoptosis and delivers optimal levels of cell viability and functionality. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: Ramn y Cajal Hospital, Madrid, Spain.

22520393 [PubMed - indexed for MEDLINE] Related citations

3. Ann Vasc Surg. 2012 May;26(4):537-48. doi: 10.1016/j.avsg.2011.12.002.

Hyperspectral image measurements of skin hemoglobin compared with transcutaneous PO2 measurements.
Jafari-Saraf L, Wilson SE, Gordon IL. Source Department of Surgery, St. Mary's Hospital, Waterbury, CT, USA. Abstract BACKGROUND: Objective measurements of skin blood flow would have predictive value in assessing the potential for wound healing. In this study, we evaluated the relationship between transcutaneous PO(2) (tcPO(2)) measurements and hyperspectral reflectance spectroscopy measurements of oxygenated hemoglobin (OxyHgb), deoxygenated hemoglobin (DeOxyHgb), total hemoglobin (Sum = OxyHgb + DeOxyHgb), and hemoglobin saturation (Sat = 100 OxyHgb/Sum). The effect of varying tcPO(2) probe temperatures (37 C, 41 C, and 45 C) was also assessed. METHODS: A Hypermed Oxy-Vu system was used for hyperspectral imaging, with measurements performed 2 minutes after removing tcPO(2) probes (Radiometer). Twenty-three sections of foot or wrist skin in four healthy volunteers were measured at 37 C, 41 C, and 45 C using both modalities. RESULTS: TcPO(2) at 37 C was 23.1 24.8 mm Hg, increasing to 63.0 27.3 mm Hg at 45 C. OxyHgb levels increased from 52.4 25.4 at 37 C to 101.3 23.8 at 45 C. Linear regression analysis of the HSI data at 37 C showed a positive correlation between tcPO(2) and OxyHgb (r(2) = 0.35, P = 0.003), tcPO(2) and DeOxyHgb (r(2) = 0.63, P < 0.0001), and tcPO(2) and Sum (r(2) = 0.60, P < 0.0001), but not Sat (r(2) = 0.001, P = 0.92). As the probe temperature increased, the correlations of tcPO(2) with OxyHgb, DeoxyHgb, and Sum became progressively much weaker. CONCLUSION: A marked increase in the HSI measurements of OxyHgb in skin exposed to heated tcPO(2) probes was observed, with tcPO(2), Sat, and Sum measurements also observed to increase with temperature. These measurements were influenced by heat

inducing vasodilatation in the superficial skin layers. HSI measurements may be clinically useful for measuring wound healing potential, as they correlate with tcPO(2) levels under normal physiological conditions. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22520392 [PubMed - indexed for MEDLINE] Related citations

4. Ann Vasc Surg. 2012 May;26(4):527-36. doi: 10.1016/j.avsg.2012.01.003.

A modular branched stent-graft system for sutureless anastomoses in extensive aortic arch replacement--a porcine study.
Chen CC, Tseng YC, Lin CC, Li CF, Yeh ML. Source Chi-Mei Medical Center, Tainan, Taiwan. Abstract BACKGROUND: We developed a modular branched stent-graft system to test whether it is feasible for sutureless anastomoses in extensive aortic arch replacement. METHODS: Extensive aortic arch replacement was performed using the three-branched stent-graft system in eight pigs. Under deep hypothermic circulatory arrest, sutureless anastomoses were established at the distal aortic arch and the two supra-aortic arteries with the modular branched stent-graft system. External bandings on the distal arches were applied in six pigs (banding group) and not applied in two pigs (control group). No external banding was applied on the two supra-aortic arteries. RESULTS: Successful procedures were achieved in all pigs in the banding group, whereas failures were seen in the control group owing to leakage from the distal arch anastomoses. The anastomosis at each distal aortic arch was completed in 10 minutes in the banding group and in 5 minutes in the control group; the anastomosis of each supra-aortic artery was achieved in 5 minutes. Median durations of the circulatory arrest, aortic cross-clamping, and cardiopulmonary bypass were 30, 67, and 174 minutes,

respectively. The postoperative computed tomography revealed adequate alignment of the stents and appropriate size matching between stent-graft and native aorta. Histological examinations revealed no pressure necrosis at the sutureless anastomotic sites. CONCLUSIONS: This study confirmed the technical feasibility of sutureless anastomoses with the modular branched stent-graft system in porcine extensive aortic arch replacement. An external banding is essential for the secure hemostasis of the distal arch anastomosis, but it is not required for the supra-aortic arteries. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22520391 [PubMed - indexed for MEDLINE] Related citations

5. Ann Vasc Surg. 2012 May;26(4):500-5. doi: 10.1016/j.avsg.2011.05.047.

Relationship between plasma homocysteine and the morphological and immunohistochemical study of carotid plaques in patients with carotid stenosis over 70%.
Alvarez B, Yugueros X, Fernndez E, Luccini F, Gen A, Matas M. Source Servicio de Angiologa, Ciruga Vascular y Endovascular, Hospital Universitari Vall d'Hebron, Universitat Autnoma de Barcelona, Barcelona, Spain. 30908bag@comb.cat Abstract BACKGROUND: Several clinical and epidemiological studies describe hyperhomocysteinemia as an independent cardiovascular risk factor. Implication of cellular immunity in atherosclerosis also seems clear. This study aimed to analyze the association among plasma hyperhomocysteinemia, neurological clinical events, and the morphology and immunocytology of carotid plaques in patients with carotid stenosis >70% receiving surgical treatment. METHODS: Sixty-two patients with carotid stenosis >70% receiving surgical treatment were studied; 58% had a history of stroke in the ipsilateral carotid territory. Plasma

homocysteine concentrations were determined by considering pathological values >12.4 mol/L. Histopathological (stable and unstable plaques) and immunohistochemical (macrophages, T lymphocytes, and active T lymphocytes counts) studies were performed. Hyperhomocysteinemia prevalence was calculated in this population, as were the possible relationships between homocysteine plasma concentrations, and the carotid plaque type and the cell types in it. The relationship between this risk factor and the presence of a neurological event relating to carotid stenosis was also investigated. RESULTS: Hyperhomocysteinemia prevalence was 43.5%, with a mean value (median; range = 2-41.8 mol/L). No significant differences were homocysteine levels and the plaque's morphological characteristics, cell types analyzed. Elevated concentrations of homocysteine were higher in patients with a history of stroke. CONCLUSION: The present study confirms high hyperhomocysteinemia prevalence in patients with extracranial cerebrovascular disease, although no relationship between plaque complication phenomena and this cardiovascular risk factor was observed. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22520390 [PubMed - indexed for MEDLINE] Related citations

of 11.8 mol/L found between or between the not significantly

6. Ann Vasc Surg. 2012 May;26(4):559-65. doi: 10.1016/j.avsg.2012.01.006. Epub 2012 Mar 22.

Assessment of protective effects of methylprednisolone and pheniramine maleate on reperfusion injury in kidney after distant organ ischemia: a rat model.
Bayrak S, Yurekli I, Gokalp O, Kiray M, Bademci MS, Ozcem B, Besir Y, Yilik L, Kestelli M, Gurbuz A. Source Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey. Abstract BACKGROUND:

Ischemia/reperfusion (I/R) injury of tissues is a common problem that cardiovascular surgeons are faced with. Suppression of inflammation, which plays an important role in the pathogenesis of I/R injury, may reduce this damage. The aim of this study is to investigate the protective effects of methylprednisolone (MP)--a potent antiinflammatory agent--and pheniramine maleate (FM)--an antihistamine that also has some anti-inflammatory effects--on reperfusion injury of kidneys developing after ischemia of the left lower extremity of rats. METHODS: Twenty-eight randomly selected male Sprague-Dawley rats weighing 320 to 370 g were divided into four groups, each consisting of seven rats. Group 1 was the control group. Group 2 was the sham group. Rats in group 3 were subjected to I/R and given FM, and rats in group 4 were subjected to I/R and given MP. A tourniquet was applied at the level of the left groin to subjects in group 2 after induction of anesthesia. One hour of ischemia was performed, and no drug was administered. In group 3, half of a total dose of 10 mg/kg FM was administered before ischemia, and the remaining half was given intraperitoneally before reperfusion. In group 4, subjects received a single dose of 50 mg/kg MP intraperitoneally in the 30th minute of ischemia. Kidneys of all subjects were removed after 24 hours. Extracted tissues were investigated regarding histological and biochemical parameters. RESULTS: Malondialdehyde--the end product of lipid peroxidation as an important indicator of I/R injury--levels were significantly lower in group 3 than in group 2 (P < 0.05). Malondialdehyde levels were also lower in group 4 than in group 2, but this difference was insignificant (P > 0.05). Superoxide dismutase and glutathione peroxidase enzyme activities were found to be significantly higher in group 3 than in group 2 (P < 0.05). However, there was no difference between group 4 and group 2 in terms of these activities. Histological examination demonstrated that both MP and FM had protective effects against I/R injury, but this effect was more potent for FM than for MP. CONCLUSIONS: FM has a protective effect against reperfusion injury in rat kidney after distant organ ischemia. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22445244 [PubMed - indexed for MEDLINE] Related citations

7. Ann Vasc Surg. 2012 May;26(4):476-82. doi: 10.1016/j.avsg.2011.11.026. Epub 2012 Mar 19.

Selective use of percutaneous endovascular aneurysm repair in women leads to fewer groin complications.
Al-Khatib WK, Zayed MA, Harris EJ, Dalman RL, Lee JT. Source Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA 94305, USA. Abstract BACKGROUND: Endovascular aneurysm repair (EVAR) in women is often technically limited by smaller access vessel anatomy, particularly at the femoral and iliac artery levels. Percutaneous femoral artery access and closure using the "Preclose" technique (PERC) is a less invasive alternative to open surgical femoral arterial exposure and has been reported to be technically feasible, particularly in male cohorts. The purpose of this study was to evaluate the efficacy and access-related outcomes of PERC in women undergoing EVAR. METHODS: We identified female patients in a prospectively maintained EVAR database from 2000 to 2009. An all-percutaneous approach was adopted in 2007 if technically feasible, based on preoperative computed tomography angiogram criteria including a femoral diameter >7 mm, <25% posterior plaque and lack of circumferential calcification/disease. All percutaneous EVAR procedures were performed using two Perclose Proglide devices in a standardized manner for sheath sizes ranging between 12F and 26F. RESULTS: In period 1 (2000-2006), most cases were performed with open femoral exposure. In period 2 (2007-2009), our group adopted a percutaneous-first approach. Of 736 EVARs performed during the study period, 120 (16.3%) were in women, leading to 178 femoral arteries requiring large sheath access. Period 1 included 90 women and period 2 included 30 women who were evaluated for percutaneous access. During period 2, of the 47 eligible femoral arteries for possible PERC, 24 (51%) met appropriate criteria, and the Preclose technique was employed. The remaining 23 femoral arteries during period 2 were accessed with surgical exposure (OPEN). Technical success rate of PERC in period 2 was 96%, with one device pulling through a thin anterior arterial wall requiring open femoral conversion. During period 2, the OPEN cohort had a higher rate of total wound complications compared with PERC (34.8% vs. 8.3%, P = 0.02), including hematomas (8.7% vs. 0%), wound breakdowns (8.7% vs. 0%), and pseudoaneurysms (4.3% vs. 0%). There were two cases of femoral artery thrombosis in the PERC group requiring repair in the immediate postoperative period; however, this was not significantly different compared with the OPEN group (8.7% vs. 8.3%). CONCLUSIONS:

Selective percutaneous access of the femoral arteries for EVAR is safe and effective in the female population, with fewer wound complications than open exposure. Approximately one-half of femoral arteries in women are eligible for PERC access, and complications can be limited with careful selection based on preoperative imaging. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22437069 [PubMed - indexed for MEDLINE] Related citations

8. Ann Vasc Surg. 2012 May;26(4):576-90. doi: 10.1016/j.avsg.2011.09.009. Epub 2012 Mar 10.

Updated systematic review and meta-analysis of randomized clinical trials comparing carotid artery stenting and carotid endarterectomy in the treatment of carotid stenosis.
Liu ZJ, Fu WG, Guo ZY, Shen LG, Shi ZY, Li JH. Source Department of General Surgery, Sir Run Run Shaw Hospital, Hangzhou, People's Republic of China. Abstract BACKGROUND: To compare carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in the treatment of carotid stenosis, including two recently published, large, prospective, randomized trials of these therapies. METHODS: We searched electronic databases for prospective, randomized, controlled trials involving carotid stenosis patients who underwent CAS or CEA, focusing on studies published in 1995 to 2010. Primary outcomes were death, stroke, and myocardial infarction. RESULTS: Thirteen trials containing 7,501 patients were analyzed, and odds ratios (ORs) were calculated for CAS versus CEA. The risk of stroke or death within 30 days was higher after CAS than CEA (OR = 1.57; 95% confidence interval [CI] = 1.11-2.22), especially in previously symptomatic patients (OR = 1.89; 95% CI = 1.48-2.41). However, the risk

of stroke or death within 1 year was comparable (OR = 1.12; 95% CI = 0.55-2.30). In a subgroup analysis, the risk of death and disabling stroke at 30 days did not differ significantly between CEA and CAS (death: OR = 1.43; 95% CI = 0.85-2.40; disabling stroke: OR = 1.28; 95% CI = 0.89-1.83), whereas the rate of nondisabling stroke within 30 days was much higher in the CAS group (OR = 1.87; 95% CI = 1.40-2.50). The risks of myocardial infarction within 30 days and 1 year were significantly less for CAS. CONCLUSION: CAS is inferior to CEA with regard to the incidence of stroke or death for periprocedural outcomes, especially in symptomatic patients. However, CAS was associated with a lower incidence of myocardial infarction. These procedures may be considered complementary rather than competing modes of therapy, each of which can be optimized with careful patient selection. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22410144 [PubMed - indexed for MEDLINE] Related citations

9. Ann Vasc Surg. 2012 May;26(4):521-6. doi: 10.1016/j.avsg.2011.05.046. Epub 2012 Mar 10.

Long-term results of stenting of the aortic bifurcation.


Abello N, Kretz B, Picquet J, Magnan PE, Hassen-Khodja R, Chevalier J, Rosset E, Feugier P, Fleury M, Steinmetz E; Association Universitaire de Recherche en Chirurgie Vasculaire (AURC). Source Service de Chirurgie Cardiovasculaire, CHU Le Bocage, et Universit de Bourgogne, Dijon, France. Abstract BACKGROUND: To evaluate the long-term results in a multicentric continuous series of narrowing lesions of the aortic bifurcation treated with a kissing stent. METHODS: From January, 1st 1999 to the December, 31st 2001, all of the patients (n = 80) presenting with stenosis of the aortic bifurcation (n = 15) and/or the 2 common iliac arteries (n = 65), treated with a kissing stent, in 8 teaching hospitals were collected retrospectively. The risk factors were smoking (91%), dyslipidemia (60%), arterial

hypertension (42%) and diabetes (27%). In 84% of cases, the indication for treatment was claudication. The lesions were stenotic < 70% (n = 76) and/or thrombotic (n = 18). The associated lesions were external iliac stenoses (n = 21), common femoral stenoses (n = 19), femoro-popliteal stenoses (n = 42), arteriopathy in the leg (n = 35). Follow-up was clinical examination and Doppler US scan. RESULTS: The success rate of the technique was 89%. There were 4 cases (5.3%) of residual stenosis and 4 cases (5.3%) of dissection. The length of the lesions treated in the aorta and the iliac arteries was respectively 17.1 7 and 17.3 9 mm. The stents were all placed as kissing stents, and had a mean diameter and a mean length of 13.75 mm and 56 mm in the aorta and 9 mm and 48 mm in the iliac arteries, respectively. At 5 years, 19 patients had required repeat angioplasty in the treated area, and 13 had undergone open surgery. Primary and assisted primary patency at 5 years were 64.5% and 81.8%, respectively. CONCLUSION: Long-term follow-up of endovascular treatment with kissing stents for stenosis of the aortic bifurcation shows that this technique gives good results, though it does not justify doing away with classical revascularisation surgery, in a population with major cardiovascular risk factors. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22410142 [PubMed - indexed for MEDLINE] Related citations

10. Ann Vasc Surg. 2012 May;26(4):468-75. doi: 10.1016/j.avsg.2011.08.022. Epub 2012 Mar 10.

Adoption of endovascular repair of abdominal aortic aneurysm in California: lessons for future dissemination of surgical technology.
Chang DC, Easterlin MC, Montesa C, Kaushal K, Wilson SE. Source Department of Surgery, University of California San Diego, San Diego, CA 921038400, USA. dchang1@ucsd.edu Abstract BACKGROUND:

Knowledge of the pattern of adoption of endovascular approach (endovascular aortic repair [EVAR]) to abdominal aortic aneurysm (AAA) could direct future dissemination of complex surgical technology. METHODS: Retrospective longitudinal analysis of the California Office of Statewide Health Planning and Development inpatient database from 2001 to 2008, accompanied by a crosssectional survey of surgeons. The setting was all inpatient hospitals in California. Patients were those who underwent repair of AAA. The main outcome measure was the endovascular repair of AAA and the training experience of the surgeons. RESULTS: Of the 33,277 patients with AAA, 11,755 (35%) underwent endovascular repair; 76% were men, mean age was 73 (median, 75) years, 13% of aneurysms were ruptured, and 20% were treated at teaching hospitals. The rate of EVAR increased from 19% in 2001 to 55% in 2008. On multivariate analysis, calendar year, older age, male gender, nonruptured status, teaching hospitals, and high-volume hospitals, but not race or insurance status, were identified as independent predictors of EVAR. The survey revealed that surgeons with 15 years of experience obtained their training primarily from the manufacturer (58.8%), whereas those with <15 years of experience obtained their training primarily during residency or fellowship (96.7%). CONCLUSION: Between 2001 and 2008, there was a 290% increase in the rate of EVAR for AAA in California. The early adopters obtained their training directly or indirectly from the manufacturers. Training programs did not begin to offer formal training in this technology until the rapid growth was already taking place. This suggests that academic medical centers and/or professional organizations should develop plans to play a stronger and earlier role in educating physicians about a new technology. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22410141 [PubMed - indexed for MEDLINE] Related citations

11. Ann Vasc Surg. 2012 May;26(4):511-5. doi: 10.1016/j.avsg.2011.11.025. Epub 2012 Mar 10.

Resection of carotid body tumors and the additional choice of intraoperative shunt in complicated tumors.
Zeng G, Zhao J, Ma Y, Huang B.

Source Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China. Abstract BACKGROUND: The purpose of this article is to describe an additional choice of intraoperative shunt in the surgical repair of complicated carotid body tumors (CBTs). METHODS: Between January 2005 and August 2010, 47 CBT resections were performed at our division. Thirty-seven patients underwent routine tumor resection (78.7%). However, 10 of the tumor resections were complicated because of severe adhesions and involvement of the carotid artery. It was difficult to excise the tumors using routine methods. Intraoperative shunts were used for resection of these 10 complicated tumors (21.3%). RESULTS: All patients underwent successful resection of the CBTs. No severe intraoperative or postoperative complication was observed in the shunted group. There were two cases with hypotension and one case with blood pressure fluctuation in the unshunted group. The mean follow-up duration was 35.3 (range, 12-60) months. CONCLUSION: Surgical resection is the treatment of choice for CBTs. Shunts are not routinely used in the repair and represent just an additional choice for the resection of complicated CBTs. In this study, shunts have been shown to maintain cerebral circulation, decrease the size of tumor by excluding the vascular supply of the external carotid artery, and guide the resection when the tumors were complicated and difficult to excise. Shunt insertion was found to be safe and not associated with severe cerebrovascular complications. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22410139 [PubMed - indexed for MEDLINE] Related citations

12. Ann Vasc Surg. 2012 May;26(4):506-10. doi: 10.1016/j.avsg.2011.11.012. Epub 2012 Feb 8.

A comparison between the treatments of functional and nonfunctional carotid body tumors.
Zeng G, Zhao J, Ma Y, Huang B, Yang Y, Feng H. Source Division of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China. Abstract BACKGROUND: It is well known that carotid body tumors (CBTs) are rare and almost nonfunctional, and that functional CBTs are even less frequently seen, with or without catecholamineinduced symptoms. Objective of this study is to make comparison between the treatment effects on functional and nonfunctional CBTs. METHODS: The medical records of 46 patients (16 men and 30 women) of our unit who underwent surgical intervention for CBTs were retrospectively reviewed from January 2005 to July 2010. Patients were divided into two groups by function: group A (n = 5, functional CBTs) and group B (n = 41, nonfunctional CBTs). Perioperative and postoperative details were compared accordingly. RESULTS: All the patients successfully underwent tumor resection. Although symptoms were nonspecific, intraoperative hypertension (5/5, 100%) and persistent postoperative hypotension (3/5, 60%) were found in group A. No statistical difference was found in perioperative details and complications between two groups. No recurrence occurred in two groups during the follow-up period for a mean of 35.3 months (with a range of 1260 months). CONCLUSION: Surgical resection is safe and effective even if the CBT is functional. Besides routine preparation, preoperative measurement of serum catecholamine, treatment with - and -adrenergic blockade and gentle manipulation during operation are necessary. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22321481 [PubMed - indexed for MEDLINE] Related citations

13. Ann Vasc Surg. 2012 May;26(4):483-90. doi: 10.1016/j.avsg.2011.08.018. Epub 2012 Feb 2.

Surgically relevant aortic arch mapping using computed tomography.


Finlay A, Johnson M, Forbes TL. Source Department of Anatomy and Cell Biology, The University of Western Ontario, London, Ontario, Canada. Abstract BACKGROUND: Recent advances in surgical repair of aortic arch pathologies have increasingly used endovascular stent-graft technology. The purpose of this study was to map the aortic arch diameters, branch orientations, and center line distances using a commercially available three-dimensional computed tomography-based software package and to propose a prototype design. METHODS: TeraRecon 3D imaging software was used for morphological assessment of computed tomography scans from 45 patients (mean age: 68 years; 26 males, 19 females). In each patient, 13 measurements were made in relation to the center line, including diameters at several preset points, distances, and branch vessel orientations. RESULTS: The mode of the proximal diameters (2 cm and 4 cm distal to coronary artery) was 32 mm and 34 mm. The mode of the distance between the innominate and left common carotid arteries was 5 mm and 6 mm, and the mode of the distance between the left common carotid artery and left subclavian artery was 8 mm. Most commonly, the left common carotid artery was anterior to the other arch branches by 3 to 5 mm. CONCLUSIONS: These anatomic measurements provide useful information for the advancement of minimally invasive and safer surgical repair of the aortic arch. Based on the most commonly observed measurements, a standardized off-the-shelf stent-graft is proposed that would be appropriate for the majority of patients. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22305684 [PubMed - indexed for MEDLINE]

Related citations

14. Ann Vasc Surg. 2012 May;26(4):454-61. doi: 10.1016/j.avsg.2011.09.004. Epub 2012 Jan 27.

Endovascular stent-graft placement or open surgery for the treatment of acute type B aortic dissection: a meta-analysis.
Zhang H, Wang ZW, Zhou Z, Hu XP, Wu HB, Guo Y. Source Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China. Abstract BACKGROUND: Acute type B aortic dissection (ATBAD) is a life-threatening condition. Open chest surgical repair using a prosthetic graft has been a conventional treatment for ATBAD. During the past decade, thoracic endovascular aortic repair (TEVAR), which is considered as a less invasive and potentially safer technique, has been increasingly used to treat this condition. Evidence is needed to support the use of TEVAR for these patients. The aim of this review was to assess the efficacy of TEVAR versus conventional open surgery in patients with ATBAD. METHODS: For this review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched: 2010, issue 4), MEDLINE, EMBASE, CINAHL, Web of Science, and the Chinese Biomedicine Database for clinical trials until January 18, 2011. Controlled trials in which patients with ATBAD were assigned to TEVAR or open surgical repair were included. For each outcome, we evaluated the quality of the evidence with reference to the Grading of Recommendations Assessments, Development, and Evaluation criteria. At the end, we used RevMan 5.0 software to analyze the datum. RESULTS: Five trials (318 participants) are included in this review. As determined by the Grading of Recommendations Assessments, Development, and Evaluation approach, the result quality was low for 30-day mortality and very low for other variables. TEVAR can significantly reduce the short-term mortality for ATBAD (Mantel-Haenszel fixed odds ratio [95% confidence interval]: 0.19 [0.09-0.39], P < 0.001). TEVAR cannot significantly improve postoperative complications or long-term mortality. CONCLUSIONS:

TEVAR can be weakly recommended as an alternative for the selective treatment of ATBAD but cannot always be used in case of surgery. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22285374 [PubMed - indexed for MEDLINE] Related citations

15. Ann Vasc Surg. 2012 May;26(4):462-7. doi: 10.1016/j.avsg.2011.06.021. Epub 2012 Jan 27.

Increased pulse wave velocity and arterial hypertension in young patients with thoracic aortic endografts.
Tzilalis VD, Kamvysis D, Panagou P, Kaskarelis I, Lazarides MK, Perdikides T, Prassopoulos P, Boudoulas H. Source Department of Vascular Surgery, 401 General Army Hospital, Athens, Greece. vtzil@yahoo.gr Abstract BACKGROUND: Hypertension after thoracic endovascular aortic repair (TEVAR) is a medical complication not widely investigated. The aim of the study was to test the hypothesis that TEVAR in young patients suffering from thoracic aortic transection alters pulse wave velocity (PWV) and reflected wave velocity and induces arterial hypertension. METHODS: The data concerning 11 young patients (all men with a mean age of 26.9 years [range: 18-33]) treated with TEVAR for thoracic aortic transection were retrospectively collected and analyzed. PWV, systolic blood pressure (SBP), and pulse pressure (PP) were evaluated and compared with those recorded in 11 healthy young individuals matched for age and gender. RESULTS: Nine patients had postoperative arterial hypertension after TEVAR, and four had durable hypertension during the follow-up period (13-66 months after TEVAR). The SBP, the PP, and the PWV of the patients were greater compared with those of the control group (SBP: 134.1 13.7 vs. 121.36 7.1 mm Hg, P = 0.016; PP: 60.45

19.42 vs. 44.1 4.37, P = 0.020; and PWV: 10.41 2.85 vs. 7.45 0.66 m/sec, P = 0.006). CONCLUSIONS: Aortic endografts could produce a discontinuation of the pulsatile waves with a subsequent increase of aortic PWV. Increased PWV is an important risk factor for future cardiovascular events and should be evaluated in all patients after TEVAR. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22284778 [PubMed - indexed for MEDLINE] Related citations

16. Ann Vasc Surg. 2012 May;26(4):447-53. doi: 10.1016/j.avsg.2011.11.006. Epub 2012 Jan 27.

Short-term outcomes for open revascularization of chronic mesenteric ischemia.


Davenport DL, Shivazad A, Endean ED. Source Department of Surgery, University of Kentucky College of Medicine, Lexington, KY 40536-0298, USA. Abstract BACKGROUND: Surgical bypass as treatment for chronic mesenteric ischemia (CMI) is performed to alleviate symptoms of weight loss and postprandial pain and to prevent catastrophic intestinal necrosis. Among the studies that report outcomes for mesenteric bypass, few focus on the type of conduit. The purpose of this study was to evaluate contemporary short-term outcomes of patients who underwent aortomesenteric bypass for CMI, with specific attention given to the conduit used--prosthetic versus vein. METHODS: Data from the American College of Surgeons National Surgical Quality Improvement Program Participant Use File were analyzed for demographic and clinical risk variables, mortality, and 22 defined complications (morbidity) between 2005 and 2009 from more than 200 participating hospitals. The database was queried for patients undergoing aortomesenteric bypass with vein (Current Procedural Terminology [CPT] 35531) or nonvein (CPT 35631) whose preoperative diagnosis was CMI (International

Classification of Diseases, 9th Revision code 557.1). Outcomes and risk variables were compared using univariate analysis and independent sample t tests for continuous variables. RESULTS: One hundred fifty-six patients underwent mesenteric revascularization--119 (76%) women and 37 (24%) men with an average age of 65 13 years. The conduit used was vein in 44 (28%) and prosthetic graft in 112 (72%). There were no statistically significant differences between the two groups in mean age, smoking history, recent weight loss, obesity (body mass index: >25) rates, length of operation, reoperation frequency, and early graft failure. More patients undergoing bypass with vein had an associated bowel resection and preoperative sepsis or systemic inflammatory response syndrome. Additionally, patients with a vein graft had a higher percentage of a contaminated surgical site (30% vs. 7%, P = 0.001) and underwent emergent surgery more frequently (16% vs. 4%, P = 0.012). Mortality was higher in patients in whom a vein graft was used (16% vs. 5%, P = 0.039). There were no differences noted between the two groups in length of stay or postoperative complications, including infectious complications, renal insufficiency, myocardial infarction, and stroke. CONCLUSIONS: Thirty-day mortality was higher in patients who underwent mesenteric bypass with vein. However, this group also had a higher incidence of emergent surgery, bowel resection, and contaminated operative field. This suggests that vein grafts were preferentially used when bowel infarction was suspected. The higher mortality is likely due to patient factors, such as the extent of bowel ischemia at the time of operation, rather than the type of conduit used. If expeditious revascularization is done before development of bowel infarction, vein or prosthetic conduit would be expected to function equally well. Copyright 2012. Published by Elsevier Inc. PMID: 22284770 [PubMed - indexed for MEDLINE] Related citations

17. Ann Vasc Surg. 2012 May;26(4):491-9. doi: 10.1016/j.avsg.2011.05.038. Epub 2011 Dec 23.

A positron emission tomography/computed tomography (PET/CT) evaluation of asymptomatic abdominal aortic aneurysms: another point of view.
Palombo D, Morbelli S, Spinella G, Pane B, Marini C, Rousas N, Massollo M, Cittadini G, Camellino D, Sambuceti G. Source

Division of Vascular and Endovascular Surgery, IRCCS San Martino University Hospital-IST, University of Genoa, Genoa, Italy. Abstract BACKGROUND: To assess the prevalence of increased (18)F-fluorodeoxyglucose (FDG) uptake in aneurysmal walls, adopting a case-control approach in a population of asymptomatic patients with abdominal aortic aneurysm (AAA). METHODS: This study included 40 males (mean age: 74 years, range: 59-93 years), consecutive, white Caucasian patients, with asymptomatic infrarenal AAA. The mean diameter of AAA was 4.9 cm (range: 4.8-5.4 cm), detected by computed tomography (CT) scan. Control Subjects: 44 age-matched controls subjects (mean age: 71 years, range: 59-85 years, 24 males, 20 females) who were selected according to a case-control criterion among a population of patients without any clinical evidence of atherosclerotic disease. Patients and controls underwent simultaneous FDG-positron emission tomography (PET) and CT imaging from the skull base to the femoral neck by using an integrated PET/CT scanner. PET/CT studies were analysed both visually and quantitatively. For quantitative analysis, circular CT-based regions of interest (ROIs) were drawn on the AAA, on all the aortic segments, and on the large vessel included in the study (carotid, subclavian, and iliac arteries). FDG uptake was quantified by calculating the mean and maximum standardized uptake values (SUVs) within each ROI and normalizing for the blood-pool SUV to obtain the final target-to-background ratio. Arterial calcium load was graded according to a semiquantitative five-point scale based on calcification of the arterial ring. RESULTS: Metabolic activity in the aneurysmal aortic segment was even lower with respect to both the adjacent--nonaneurysmal--samples of patient group and the corresponding arterial segments of control subjects (P < 0.001 and P < 0.01, respectively). In visual analysis, no patients showed an increased focal uptake of degree adequate to identify the aneurysmal arterial wall. AAA patients showed significantly higher values of total calcium load (ACL) than controls in ascending aorta and subclavian and iliac arteries (P < 0.01), and only in AAA patient group, a significant correlation was present between values of ACL in both iliac arteries and abdominal aorta on one side and wall metabolic activity in the same arteries on the other (P < 0.05). CONCLUSIONS: In conclusion, our results suggest that FDG hot spot, as well an increased diffuse uptake of FDG, in PET/CT studies is an extremely rare finding in patients with AAA of diameter close to surgical indications. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22197524 [PubMed - indexed for MEDLINE]

Related citations

18. Ann Vasc Surg. 2012 May;26(4):600-5. doi: 10.1016/j.avsg.2011.11.002. Epub 2011 Dec 20.

Open surgical repair of thoracoabdominal aortic aneurysms.


Piazza M, Ricotta JJ 2nd. Source Clinica di Chirurgia Vascolare ed Endovascolare, Universita' degli Studi di Padova, Padova, Italy. Abstract Despite much advancement in preoperative evaluation and perioperative care of patients with thoracoabdominal aortic aneurysms (TAAA), open surgical repair of TAAAs remains a formidable challenge for the vascular surgeon. It requires extensive dissection and mobilization of the aorta and its branches, as well as cross-clamping of the aorta above intercostal and visceral arteries. Over the past decade, the mortality and morbidity associated with open TAAA repair have improved significantly. However, it remains one of the most complex, extensive surgical procedures performed in the field of vascular surgery. Recently, there has been much attention directed at less invasive methods such as the so-called "hybrid" or "debranching" procedure, or complete endovascular repair with fenestrated and branched endografts for repairing TAAAs. However, the gold standard for repair of TAAA remains open surgery, and this article summarizes the clinical outcomes of open surgical repair of TAAAs during the past decade (2000-2010) to provide a benchmark for comparison with results from previous decades and also with which to compare the results of modern-day hybrid and/or complete endovascular techniques. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22188939 [PubMed - indexed for MEDLINE] Related citations

19. Ann Vasc Surg. 2012 May;26(4):516-20. doi: 10.1016/j.avsg.2011.07.011. Epub 2011 Nov 1.

Endovascular treatment for acute aortic syndrome.

Arajo PV, Joviliano EE, Ribeiro MS, Dalio MB, Piccinato CE, Moriya T. Source Division of Vascular and Endovascular Surgery, Department of Surgery and Anatomy, Ribeiro Preto School of Medicine, University of So Paulo, So Paulo, Brazil. Abstract BACKGROUND: The term "acute aortic syndrome" (AAS) includes conditions of high mortality, such as ruptured aneurysm, pseudoaneurysm and, aortic dissection. Open surgery for these cases has demonstrated unsatisfactory results, and endovascular treatment has become an excellent alternative. METHODS: We performed a retrospective review of patients with AAS who underwent endovascular treatment in our emergency department from July 2009 to February 2011. They represent 64% (16 of 25) of all patients with AAS seen during this period. RESULTS: Sixteen patients underwent endovascular treatment: eight ruptured aneurysms, six aortic dissections, one nonruptured painful aneurysm, and one pseudoaneurysm. No intramural hematoma or penetrating atherosclerotic ulcer was found. The mean age was 64.3 years, and arterial hypertension (100%) and smoking (64.7%) were the major comorbidities. Technical success rate was 93%, and overall 30-day mortality was 6.25%. CONCLUSION: Endovascular treatment for AAS was feasible. Technical success, 30-day mortality, hospital stay, and procedure time were similar to those of the other series reported in the literature, and the endovascular approach has became the main technique for AAS in our hospital. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22050883 [PubMed - indexed for MEDLINE] Related citations

20. Ann Vasc Surg. 2012 May;26(4):591-9. doi: 10.1016/j.avsg.2011.06.008. Epub 2011 Nov 1.

Lower-limb ischemia in the young patient: management strategies in an endovascular era.


Morbi A, Gohel MS, Hamady M, Cheshire NJ, Bicknell CD. Source Department of Surgery and Cancer, Imperial College London, London, UK. Abstract BACKGROUND: The aim of this paper is to review the potential role of endovascular interventions for young patients with lower-limb ischaemia. METHODS: A literature search was performed of PubMed and Medline databases using appropriate search terms and limits. Case reports, retrospective studies, and prospective studies evaluating treatment of lower-limb ischemia in patients aged <50 years were scrutinized. Articles published between 1966 and 2010 were included in this review. RESULTS: Premature atherosclerosis is likely to represent the commonest cause of lower-limb ischemia in patients aged <50 years, although the incidence of nonatherosclerotic causes such as popliteal entrapment syndrome, cystic adventitial disease, and arteritis in these patients is greater than in older patients. As with older patients, endovascular interventions may be beneficial for patients with symptoms secondary to atherosclerosis. At present, the perceived durability of open surgery may be more preferable to patients aged <50 years, but the development of new endovascular technology is challenging this view. Endovascular interventions such as catheterdirected thrombolysis have specific roles in the treatment of lower-limb ischemia due to nonatherosclerotic causes. CONCLUSION: The use of angioplasty and stenting procedures to treat young patients with lower-limb ischemia is increasing and has specific roles. However, many developmental causes and nonatherosclerotic conditions still require primary surgical correction. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22050881 [PubMed - indexed for MEDLINE] Related citations

Ann Vasc Surg 2012; 26(4) Case Reports


1. Ann Vasc Surg. 2012 May;26(4):575.e1-3. doi: 10.1016/j.avsg.2011.08.024.

Hybrid repair of a hepatic artery aneurysm.


Yankovic W, Febrer G, Couture T, Mallios A, Koskas F. Source Department of Vascular Surgery, University Hospital Piti-Salptrire, Paris, France. wallabass@yahoo.com Abstract Visceral arterial aneurysm is a rare pathology. Currently, there are no sufficient data to support the superiority of surgical or endovascular treatment. The choice depends mainly on patient characteristics and the anatomy of the aneurysm. We present a case of a 12-cm fusiform aneurysm of the common hepatic artery. A combined approach including endovascular exclusion of the celiac trunk and surgical closure of the aneurysm was chosen. The postoperative course was uneventful. To our knowledge, this is the first case in the literature describing this combined approach. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22520395 [PubMed - indexed for MEDLINE] Related citations

2. Ann Vasc Surg. 2012 May;26(4):574.e1-7. doi: 10.1016/j.avsg.2011.08.023. Epub 2012 Mar 22.

Hybrid stent-graft repair of an iatrogenic complex proximal right common carotid artery injury.
Marine L, Sarac TP. Source Department of Vascular Surgery, Pontificia Universidad Catolica, Santiago, Chile. marinepolo@yahoo.com Abstract

BACKGROUND: Iatrogenic carotid trauma requires early diagnosis and adequate treatment. Classic open repair may be technically challenging if trauma is in base of the neck. We present a case of an iatrogenic carotid pseudoaneurysm treated with endovascular repair. METHODS: An 87-year-old woman presented with a pulsatile neck mass 10 days after coronary artery bypass graft surgery. A computed tomographic angiogram showed a 1.6 1.0 2.0-cm pseudoaneurysm arising from the posterior wall of the proximal right common carotid artery. Endovascular management was considered, and a percutaneous angiogram demonstrated an arteriovenous fistula in addition to the pseudoaneurysm. Through a cervical cut-down, retrograde percutaneous access was obtained through the common carotid artery, which allowed easier access to the area of trauma owing to vessel tortuosity. Subsequently, a 5 mm 2-cm Viabahn was deployed. The postdilation angiogram showed a significant endoleak that kept filling the pseudoaneurysm. A second 6 mm 5-cm Viabahn was placed and successfully postdilated with a 6 mm 4-cm balloon. No endoleaks or fistulas were noted on the completion angiogram. RESULTS: The patient remains asymptomatic after 15 months. Follow-up images showed thrombosis of pseudoaneurysm. CONCLUSION: Endovascular treatment with self-expanding stent-grafts and open cut-down access are excellent options to treat major vessel injuries at the base of the neck, where anatomy and cumbersome access make open surgery a more difficult option. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22445243 [PubMed - indexed for MEDLINE] Related citations

3. Ann Vasc Surg. 2012 May;26(4):575.e5-9. doi: 10.1016/j.avsg.2011.08.025. Epub 2012 Mar 19.

Endovascular management of iliac vein rupture percutaneous interventions for occlusive lesions.
Adams MK, Anaya-Ayala JE, Davies MG, Bismuth J, Peden EK. Source

during

Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center and The Methodist Hospital Research Institute, The Methodist Hospital, Houston, TX 77030, USA. Abstract Iatrogenic Iliac vein rupture is a rare and potentially lethal complication. We present herein two different clinical scenarios of iatrogenic iliac vein rupture that resulted from performing percutaneous endoluminal interventions to treat symptomatic venoocclusive lesions. The first case was due to the presence of surgical clips from the patient's previous gynecologic surgery, which caused iliac vein compression and eventually led to acute deep vein thrombosis. The second case resulted from central venous outflow obstruction ipsilateral to a lower extremity arteriovenous dialysis access site. Both Iliac vein ruptures were the result of percutaneous attempts to correct the outflow lesion (delayed in the first case and acute in the second case). Hemorrhage was successfully controlled in both cases using a self-expandable Viabahn (W. L. Gore and Associates, Flagstaff, AZ) covered stent while maintaining vessel patency and resolving symptoms related to veno-occlusive disease. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22437071 [PubMed - indexed for MEDLINE] Related citations

4. Ann Vasc Surg. 2012 May;26(4):574.e15-7. doi: 10.1016/j.avsg.2011.10.018. Epub 2012 Mar 19.

Perforation of the aorta by a rib edge: an unusual complication after chest wall resection.
El Husseiny M, Karam L, Haddad F, Tabet G. Source Department of Vascular and Thoracic Surgery, Htel Dieu de France University Hospital, Beirut, Lebanon. majdi.elhusseiny@gmail.com Abstract Thoracic aortic perforation in the context of a minor trauma is extremely rare. In this article, we describe a case of an 80-year-old man who presented with an aortic perforation after a fall from his height during his hospitalization. The patient had previously undergone a left superior lobectomy, a partial chest wall resection, and reconstruction for a locally invasive lung cancer. He was directly transferred to the operating room, as he presented with hemodynamic instability. A 4-mm laceration in the descending thoracic aorta was identified and repaired. The postoperative course

was uneventful. This case illustrates the importance of applying a solid fixation to the rib stumps when performing a chest wall resection, irrespective of the size of the wall defect. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22437070 [PubMed - indexed for MEDLINE] Related citations

5. Ann Vasc Surg. 2012 May;26(4):573.e9-12. doi: 10.1016/j.avsg.2011.04.015. Epub 2012 Mar 10.

A rare case of visceral arterial stenoses in Williams-Beuren syndrome treated by complex revascularization.
Roux N, David N, Godier S, Plissonnier D. Source Department of Vascular Surgery, Rouen University Hospital, Charles Nicolle, Rouen, France. Nicolas.Roux@chu-rouen.fr Abstract Williams-Beuren syndrome is a rare neurodevelopmental disorder. We present the case of a 27-year-old patient with Williams-Beuren syndrome and a juxtarenal abdominal aorta coarctation. As arterial hypertension (AHT) was not controlled, bilateral renal artery bypasses were performed at the age of 2 years by means of a hepatorenal bypass and a splenorenal bypass. Twenty years later, the patient presented with abdominal pain, diarrhea, and recurrence of AHT, and severe celiac artery and superior mesenteric artery stenoses were discovered. The distal arterial complications of this syndrome are uncommon. After 5 years of medical treatment, aggravation of the patient's symptoms prompted us to consider possible surgical management. The patient was successfully treated using a complex direct and indirect procedure that consisted of a bypass between the celiac aorta and infrarenal aorta, associated with a celiac artery bypass. Instead of endovascular management, this surgical procedure could be considered effective and long lasting for treating this rare cause of renal AHT. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22410145 [PubMed - indexed for MEDLINE] Related citations

6. Ann Vasc Surg. 2012 May;26(4):574.e9-13. doi: 10.1016/j.avsg.2011.09.010. Epub 2012 Mar 10.

Symptomatic fibromuscular dysplasia of the external iliac artery.


Rastogi N, Kabutey NK, Kim D, Farber A. Source Department of Radiology, Boston Medical Center, Boston, Massachusetts 02118, USA. neerajrastogi@hotmail.com Abstract The aim of this article is to report a case of symptomatic fibromuscular dysplasia (FMD) involving the external iliac arteries (EIAs). An 88-year-old woman was admitted to the vascular service, with a painful right posterior ankle ulcer that had progressively worsened during the course of a month. Her medical history included diabetes and hypertension. Bilateral lower-extremity pulses were absent, and femoral and tibial Doppler waveforms were monophasic. Pelvic and bilateral lower-extremity angiograms were obtained, which revealed findings in both EIAs consistent with a diagnosis of extrarenal FMD. Percutaneous transluminal angioplasty with subsequent stenting of the right EIA was performed, using a self-expanding stent. Completion digital subtraction angiography demonstrated a widely patent right EIA with brisk flow of contrast across the stent. Postprocedural arterial duplex scan showed a biphasic waveform pattern in the common femoral artery. FMD can involve the EIA and be associated with critical limb ischemia. FMD of the EIA responds well to endovascular management. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22410140 [PubMed - indexed for MEDLINE] Related citations

7. Ann Vasc Surg. 2012 May;26(4):571.e11-6. doi: 10.1016/j.avsg.2011.08.019. Epub 2012 Feb 8.

Rupture of chronic type B aortic dissection in a Jehovah's Witness: successful surgical repair without blood transfusion.

Yamamoto H, Yamamoto F, Yamaura G, Motokawa M, Tanaka F, Sato H, Ishibashi K, Shiroto K. Source Department of Cardiovascular Surgery, Akita University School of Medicine, Akita, Japan. Abstract The patient, a 55-year-old female Jehovah's Witness who had suffered type B aortic dissection since the age of 53 years, presented with enlargement of the false lumen in the distal aortic arch and was subsequently admitted to our hospital. While hospitalized, her enlarged false lumen ruptured and she underwent replacement of the distal aortic arch and descending thoracic aorta without blood transfusion. Blood conservation strategies for this patient included the following: 1) meticulous hemostasis when incising muscle or soft tissue, 2) minimal use of gauze and discard suckers, 3) exclusive use of a cell salvage device "from skin to skin," 4) low-prime cardiopulmonary bypass, 5) minimal laboratory blood sampling, and 6) preoperative and postoperative erythropoietin treatment. Hemoglobin (Hb) values were 12.5, 15.5, 10.0, and 9.7 g/dL on admission, before rupture, after rupture, and just after the operation, respectively. The patient had an uneventful postoperative course, except for prolonged rehabilitation. The postoperative lowest Hb value was 5.2 g/dL on postoperative day 5, and the Hb value at hospital discharge (postoperative day 55) was 11.0 g/dL. Our experience with blood conservation surgery on this Jehovah's Witness patient suggests that ruptured chronic type B aortic dissection can be safely repaired on bypass through a left thoracotomy with no blood transfusion if the preoperative Hb value is >10.0 g/dL. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22321490 [PubMed - indexed for MEDLINE] Related citations

8. Ann Vasc Surg. 2012 May;26(4):571.e1-6. doi: 10.1016/j.avsg.2011.07.023. Epub 2012 Feb 8.

Middle colic artery aneurysm: a case report and review of the literature.
Huo CW. Source Department of Vascular Surgery, St. Vincent's Hospital, Melbourne, Australia. wanchen.huo@svhm.org.au

Abstract We report a case of a ruptured middle colic artery (MCA) aneurysm in a 48-year-old previously healthy man. Coil embolization was attempted without success. The patient then underwent resection of the MCA and the transverse colon with a satisfactory outcome. Twenty-six previously published cases dating back to 1930 were reviewed, revealing the cause of the MCA aneurysm to be idiopathic in most cases. However, necrotizing arteritis, polyarteritis nodosa, and hypertension have been associated. The aneurysm is commonly managed with laparotomy, as well as arterial resection with or without transverse colectomy, although transcatheter arterial embolization has been successful in four published cases. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22321489 [PubMed - indexed for MEDLINE] Related citations

9. Ann Vasc Surg. 2012 May;26(4):571.e7-9. doi: 10.1016/j.avsg.2011.07.022. Epub 2012 Feb 8.

Combined emergency abdominal aortic aneurysm repair and valve replacement in a patient with severe aortic stenosis.
McMahon GS, Rayt HS, Galianes M, Nasim A. Source Department of Vascular and Endovascular Surgery, University Hospitals of Leicester, Leicester, UK. gregmcmahon@hotmail.com Abstract Simultaneous open surgery has been advocated in the elective management of abdominal aortic aneurysm patients with significant ischemic heart disease, as staged procedures risk worsening myocardial ischemia or aortic rupture, depending on which is the first intervention. The argument for combined aneurysm and valve repair is less established. We describe the case of a 70-year-old female who while awaiting aortic valve replacement suffered rupture of an abdominal aortic aneurysm. The patient was successfully managed with emergency combined open abdominal aortic aneurysm repair and open aortic valve replacement. We would advocate that such a strategy be considered as a salvage technique in similarly difficult management dilemmas. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID:

22321488 [PubMed - indexed for MEDLINE] Related citations

10. Ann Vasc Surg. 2012 May;26(4):572.e1-3. doi: 10.1016/j.avsg.2011.09.006. Epub 2012 Feb 8.

Challenging treatment of multiple late complications after endovascular aneurysm repair.


Vakhitov D, Suominen V, Pimenoff G, Uurto I, Saarinen J, Salenius JP. Source Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland. damir@fimnet.fi Abstract BACKGROUND: To report a case of multiple additional procedures after successful endovascular treatment of abdominal aortic aneurysm. METHODS: An endovascular abdominal aortic aneurysm repair with a bifurcated aortic Vanguard endograft successfully performed in 1999 resulted in multiple complications, including endoleaks and a row separation, treated endovascularly. Subsequently, tuberculosis sepsis and prosthesis infection resulted in long-term antibiotic treatment. Additional graft leaks, aneurysm sack growth, and sack ruptures were also treated endovascularly because the patient consistently denied open repair. Endovascular procedures, however, did not solve the problem, turning to be increasingly challenging. The patient finally approved open graft removal and aortobifemoral reconstruction that were successfully performed 11 years after the initial endograft implantation. RESULTS: The patient has recovered from surgery well and is asymptomatic. No evidence of bacterial colonization was found according to the specimen taken during the laparotomy. CONCLUSION: Vanguard and other first-generation aortic endografts are associated with high incidence of complications and reinterventions. Open surgery is a method of choice in similar cases.

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22321484 [PubMed - indexed for MEDLINE] Related citations

11. Ann Vasc Surg. 2012 May;26(4):573.e1-4. doi: 10.1016/j.avsg.2011.10.017. Epub 2012 Feb 8.

Percutaneous mechanical thrombectomy for extensive acute lower-extremity deep venous thrombosis in a patient after double-lung transplantation.
Telich-Tarriba JE, Anaya-Ayala JE, Davies MG, El-Sayed HF. Source Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, The Methodist Hospital Research Institute, Houston, TX 77030, USA. Abstract Venous thromboembolism, which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), has been estimated to affect 25% of patients after major surgery; however, the literature on venous thromboembolism after thoracic transplantation and optimal approach remains limited. We report the status of a 67year-old female who developed massive right lower-extremity DVT after double-lung transplantation. Because her surgery had taken place a week before this event, it was decided that pharmaco-thrombolysis was contraindicated due to the high risk of bleeding complications in a fresh double-lung transplant recipient. The patient was taken emergently to the operating room for percutaneous mechanical thrombectomy, which provided grade III (complete lysis) and restored venous patency in the affected extremity. This report highlights the successful use of purely percutaneous mechanical thrombectomy for acute DVT in a double-lung recipient, and also advocates inferior vena cava filter placement to prevent embolic events during the mechanical thrombectomy. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22321479 [PubMed - indexed for MEDLINE] Related citations

12. Ann Vasc Surg. 2012 May;26(4):572.e11-3. doi: 10.1016/j.avsg.2011.11.024. Epub 2012 Feb 8.

Distalization of the anastomosis: an effective treatment for dialysis access-associated steal syndrome.
Corfield L, Muller J, Ryan J, Bond R. Source Department of Vascular Surgery, Fremantle Hospital, Perth, Western Australia. lcorfield@doctors.org.uk Abstract Steal syndrome after arteriovenous fistula formation for dialysis access can cause ischemic pain and tissue loss. This is an indication for surgical revision, usually either banding (or ligation) or the distal revascularisation and interval ligation procedure. However, banding is inexact, and distal revascularisation and interval ligation can further compromise the arterial supply to the arm. We report three cases in which an alternative approach of moving the arteriovenous anastomosis distally was used, thereby protecting arterial inflow to the hand. In all three cases, the steal resolved and the fistula remained patent. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22321475 [PubMed - indexed for MEDLINE] Related citations

13. Ann Vasc Surg. 2012 May;26(4):572.e5-9. doi: 10.1016/j.avsg.2011.11.023. Epub 2012 Feb 8.

Popliteal artery entrapment syndrome in a young girl: case report of a rare finding.
Molinaro V, Pagliasso E, Varetto G, Castagno C, Gibello L, Zandrino F, Suita R, Rispoli P. Source Division of Vascular Surgery, Department of Medical and Surgical Disciplines, Molinette Hospital, University of Turin, Turin, Italy. Abstract

The popliteal artery (PA) entrapment syndrome, a rare cause of arterial thrombosis, is most often encountered in young male athletes. Here, we report a very unusual case of PA entrapment syndrome in a 14-year-old girl who presented with a 1-month history of calf claudication to our observation facility. Diagnostic work-up revealed obesity, sedentary lifestyle, and an aberrant accessory slip of the medial head of gastrocnemius around the PA. Arterial echo color Doppler ultrasonography and computed tomographic angiography studies were performed. Surgical treatment involved revascularization with resection of the medial head of gastrocnemius, the cause of the arterial entrapment, and enlargement angioplasty using an autologous saphenous vein patch, in combination with antiplatelet therapy, resulting in restitution ad integrum of the affected limb and, finally, an improved quality of life of the patient. This case underscores the importance of clinical suspicion, diagnosis, and treatment of lowerlimb claudication in very young patients presenting with unusual symptoms. If missed, the condition may evolve dramatically. Prompt diagnosis and surgical treatment are key to complete recovery and the prevention of irreversible complications that may result in limb loss. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22321474 [PubMed - indexed for MEDLINE] Related citations

14. Ann Vasc Surg. 2012 May;26(4):572.e15-7. doi: 10.1016/j.avsg.2011.08.020. Epub 2012 Feb 3.

Unusual positional compression of the internal carotid artery causes carotid thrombosis and cerebral ischemia.
Keshelava G, Nachkepia M, Arabidze G, Janashia G, Beselia K. Source Department of Cardiovascular Surgery, West Georgian National Interventional Medicine, Kutaisi, Georgia. gaga_keshelava@yahoo.com Abstract This article reports an unusual case of positional compression of internal carotid artery resulting in carotid thrombosis and stroke in a 37-year-old man. A patient was operated urgently for a free-floating thrombotic mass in the internal carotid artery. Open thrombectomy was performed in acute phase of stroke for prevention of the recapitulative cerebral thromboembolism. Hemiplegia completely disappeared within 7 months. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. Centre of

PMID: 22305474 [PubMed - indexed for MEDLINE] Related citations

15. Ann Vasc Surg. 2012 May;26(4):573.e5-7. doi: 10.1016/j.avsg.2011.10.016. Epub 2012 Feb 3.

Endovascular repair of aortic isthmus coarctation with a selfexpanding covered stent.


Oberhuber A, Muehling BM, Orend KH, Schelzig H. Source Department of Thoracic and Vascular Surgery, University of Ulm, Ulm, Germany. alexander.oberhuber@uniklinik-ulm.de Abstract BACKGROUND: Coarctation is one of the most often seen congenital aortal defects. In the majority, diagnosis will be made in newborns. Endovascular repair is critical in children owing to their growth, but in adult patients, it is an interesting alternative. METHODS: A 31-year-old man presenting with hypertension of upper extremities and pulseless lower extremities was admitted to our hospital. Systolic blood pressure was 190 mm Hg, although a triple antihypertensive medication was administered. Computed tomographic angiography showed a nearly total occlusion of the aortic isthmus. Coarctation was treated by an endovascular approach with a self-expanding covered stent-graft (Medtronic Talent; Medtronic World Medical, Sunrise, FL) after predilatation with a Reliant balloon (Medtronic World Medical, Sunrise, FL). RESULTS: After a follow-up of 40 months, the patient is normotensive and antihypertensive medication could be reduced. Lower extremities showed normal pulses and normal ankle-brachial index. Computed tomographic scans showed unchanged stent-graft position, with constant slight waist. DISCUSSION: Endovascular repair of atresia or coarctation of the thoracic aorta is a minimal invasive debatable option. Not only reduction of blood pressure but also reduction of left ventricular mass and prolongation of life expectancy can be achieved by endovascular treatment.

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22305473 [PubMed - indexed for MEDLINE] Related citations