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Ann Vasc surg 2012; 26(8) Originals

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

Reliability and repeatability of toe pressures measured with laser Doppler and portable and stationary photoplethysmography devices
Sabour S. Source Department of Clinical Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: s.sabour@sbmu.ac.ir. PMID: 23068429 [PubMed - in process] Related citations

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

Meta-analysis of observational studies to evaluate immediate outcomes after endarterectomy or stenting for carotid artery stenosis
Messori A, Fadda V, Maratea D, Trippoli S. Source Health Technology Assessment Unit, Ente dei Servizi Tecnici di Area Vasta Toscana Centro Regional Health Service, Firenze, Italy. Electronic address: andrea.messori.it@gmail.com. PMID: 23068428 [PubMed - in process] Related citations

3. Ann Vasc Surg. 2012 Nov;26(8):1160-5. doi: 10.1016/j.avsg.2012.06.008.

Tissue markers in human atherosclerotic carotid artery plaque.


Moller MJ, Qin Z, Toursarkissian B. Source Division of Vascular Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Abstract Carotid artery stenosis predisposes to thrombo-embolization and stroke. Established tissue markers such as osteopontin, nitric oxide synthases, myeloperoxidases, and matrix metalloproteinases have been examined within stenotic plaques and their impact upon plaque stability discussed. However, a new generation of tissue markers is being discovered, and their role in atherosclerotic development and plaque stability is being debated. Prostaglandin synthase, 15-lipoxygenase-2, myeloid-related proteins 8 and 14, and protease nexin-1 have recently been shown to correlate with carotid artery atherosclerosis. These proteins highlight new areas of interest in the role of macrophages in atherosclerotic development, plaque formation, and rupture. Additionally, these new molecules raise the possibility of new screening and treatment techniques. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 23068427 [PubMed - in process] Related citations

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

Internal jugular vein hemangioma


Al-Natour M, Kenmuir C, Khuder S, Kazan V, Abbas J, Nazzal M. Source Division of Vascular and Endovascular Surgery, University of Toledo Medical Center, Toledo, OH. Abstract Primary tumors of the major body veins arising intraluminally are rare clinical entities. As such, few cases have been reported in the literature. As a primary tumor, hemangiomas arising in the internal jugular vein are extremely rare, while those arising

in the external jugular vein are only slightly more common. We present a case of an internal jugular vein hemangioma that was incidentally discovered during an ultrasound examination performed for the evaluation of the internal carotid arteries. We believe that this is the second case of internal jugular vein hemangioma reported in the English literature. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22951066 [PubMed - in process] Related citations

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

Isokinetic strength and endurance in proximal and distal muscles in patients with peripheral artery disease
Cmara LC, Ritti-Dias RM, Menses AL, D'Andra Greve JM, Filho WJ, Santarm JM, Forjaz CL, Puech-Leo P, Wolosker N. Source Hospital das Clnicas of the School of Medicine of the University of So Paulo, University of So Paulo, So Paulo, Brazil. Abstract BACKGROUND: The objective of this study was to analyze the muscle strength and endurance of the proximal and distal lower-extremity muscles in peripheral artery disease (PAD) patients. METHODS: Twenty patients with bilateral PAD with symptoms of intermittent claudication and nine control subjects without PAD were included in the study, comprising 40 and 18 legs, respectively. All subjects performed an isokinetic muscle test to evaluate the muscle strength and endurance of the proximal (knee extension and knee flexion movements) and distal (plantar flexion and dorsiflexion movements) muscle groups in the lower extremity. RESULTS: Compared with the control group, the PAD group presented lower muscle strength in knee flexion (-14.0%), dorsiflexion (-26.0%), and plantar flexion (-21.2%) movements

(P < 0.05) but similar strength in knee extension movements (P > 0.05). The PAD patients presented a 13.5% lower knee flexion/extension strength ratio compared with the control subjects (P < 0.05), as well as lower muscle endurance in dorsiflexion (28.1%) and plantar flexion (-17.0%) movements (P < 0.05). The muscle endurance in knee flexion and knee extension movements was similar between PAD patients and the control subjects (P > 0.05). CONCLUSION: PAD patients present lower proximal and distal muscle strength and lower distal muscle endurance than control patients. Therefore, interventions to improve muscle strength and endurance should be prescribed for PAD patients. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22951062 [PubMed - in process] Related citations

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

A randomized prospective multicenter trial of a novel vascular sealant


Stone WM, Cull DL, Money SR. Source Division of Vascular Surgery, Mayo Clinic, Scottsdale, AZ. Electronic address: Stone.william@mayo.edu. Abstract BACKGROUND: Increasing use of anticoagulant medications, particularly antiplatelet therapies, can increase the difficulty in obtaining adequate suture line hemostasis. Multiple vascular sealants have been used as adjuncts to surgical procedures, but none of them have been universally successful. The aim of this study was to evaluate the safety and effectiveness of a new prophylactic vascular sealant in arterial surgery. METHODS: A randomized prospective multi-institutional trial was undertaken comparing ArterX Vascular Sealant (AVS) with Gelfoam Plus during open arterial reconstruction.

RESULTS: Three hundred thirty-one anastomotic sites in 217 patients were randomized. One hundred one of 167 (60.5%) anastomotic sites in the AVS group achieved immediate hemostasis compared with 65 of 164 (39.6%) in the control group (P = 0.001). In anastomoses with polytetrafluoroethylene grafts, 105 of 167 (62.5%) in the AVS group achieved immediate hemostasis compared with 56 of 164 (34.0%) in the control group (P < 0.001). No significant differences were noted in morbidity or mortality. Operative time was significantly less in the AVS group compared with the control group (3.2 vs. 3.8 hours, P < 0.01). CONCLUSION: Use of AVS results in superior hemostatic effectiveness compared with Gelfoam Plus, with no difference in safety. Although no cost analysis was performed, cost savings likely resulted from significantly decreased operative time. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22939276 [PubMed - in process] Related citations

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

Thoracic aortobifemoral bypass in treatment of juxtarenal leriche syndrome (midterm results)


Koksal C, Kocamaz O, Aksoy E, Cakalagaoglu C, Kara I, Yanartas M, Ay Y. Source Department of Cardiovascular Surgery, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey. Electronic address: ckoksal@hotmail.com. Abstract BACKGROUND: The standard surgical treatment of infrarenal aortoiliac obstructive disease is abdominal aortobifemoral bypass (AABFB). However, alternative surgical procedures may be considered in cases of juxtarenal Leriche syndrome and previous aortofemoral graft obstruction. We present midterm results of 20 consecutive patients who underwent thoracic aortobifemoral bypass (TABFB) either as primary or secondary procedure.

METHOD: Between 1999 and 2010, 20 patients who were diagnosed to have juxtarenal Leriche syndrome (n = 17) and failure of previous AABFB graft (n = 3) were enrolled. The patients were classified according to the Rutherford classification. Mean follow-up period was 60.9 38.3 months. Mean preoperative ankle-brachial index on the left lower extremity was 0.18 and on the right lower extremity was 0.20. RESULTS: Seventeen patients with the diagnosis of juxtarenal Lercihe syndrome were primarily and three patients were secondarily (for treatment of failed previous AABFB graft) treated using TABFB procedure. The mean ankle-brachial index at last follow-up was 0.75 on the left lower extremity and 0.76 on the right. One-year patency rate was 100%, and 5-year patency rate was 94%. CONCLUSION: TABFB precludes the risk of renal artery embolization in cases of juxtarenal obstruction, without adding any risk of morbidity and mortality. Its long-term patency is similar or even superior to conventional surgical bypass techniques. We propose its use as an initial treatment in juxtarenal Leriche syndrome as well as a remedial procedure in cases with previous AABFB graft occlusion. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22938827 [PubMed - in process] Related citations

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

Identifying the incidence of and risk factors for reamputation among patients who underwent foot amputation
Kono Y, Muder RR. Source Division of Infectious Diseases, University of Pittsburgh, VA Pittsburgh Healthcare System, Pittsburgh, PA. Abstract BACKGROUND:

Many patients who have lower-extremity amputations secondary to peripheral vascular disease or diabetes require reamputation eventually. This study was designed to identify the incidence of and risk factors for ipsilateral reamputation after forefoot amputation, to evaluate whether postoperative infection increases the risk of reamputation, and to evaluate whether the risk of reamputation was reduced by the duration of antimicrobial therapy after amputation. METHODS: A retrospective analysis of patients who underwent foot amputation for nontraumatic reason from January 2002 to December 2004 at the Veterans Affairs Pittsburgh Healthcare System was performed. RESULTS: Among 116 patients, 57 (49.1%) had ipsilateral reamputation within 3 years after their first surgeries; 78.9% received reamputation in the first 6 months; 53 (45.7%) died within 3 years; and 16 (13.8%) developed postoperative infections. Upper level of amputation, long duration of hospitalization, insulin-dependent diabetes, and gangrene on physical examination on admission were risk factors for reamputation in univariate analysis. Gangrene (odds ratio: 3.81, 95% confidence interval: 1.60-9.12, P = 0.003) and insulin-dependent diabetes (odds ratio: 2.93, 95% confidence interval: 1.26-6.78, P = 0.012) were risk factors in multivariate analysis. Postoperative infection did not increase the risk of reamputation. Longer than 2-week course of antibiotic use after amputation did not prevent reamputation. CONCLUSIONS: Approximately one-half of patients required ipsilateral reamputation and died in 3 years. Gangrene on admission and history of insulin-dependent diabetes were significant risk factors (P = 0.003, P = 0.028). Long duration of antibiotic use after amputation and postoperative infection did not change the risk of reamputation. Published by Elsevier Inc. PMID: 22840342 [PubMed - in process] Related citations

9. Ann Vasc Surg. 2012 Nov;26(8):1071-6. doi: 10.1016/j.avsg.2012.01.019. Epub 2012 Jul 25.

Role of ultrasound arterial mapping in planning therapeutic options for critical ischemia of lower limbs in diabetic patients
Mart X, Romera A, Vila R, Cairols MA.

Source Vascular Surgery Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain. Electronic address: xamame@hotmail.com. Abstract BACKGROUND: To assess the role of ultrasound arterial mapping in planning therapeutic options for critical limb ischemia (CLI) in diabetic patients. METHODS: This observational and comparative study included 244 patients with CLI. All participants (64% were diabetic) underwent ultrasound arterial mapping before planning surgical treatment. We established two groups: diabetic (n = 156) and nondiabetic (n = 88). Arterial mapping was divided into segments. We studied 2,021 individual segments and used arteriography when ultrasound arterial mapping was not conclusive. We compared the degree of pathology between the groups, agreement between the treatment decision made after ultrasound mapping and the final surgical decision in both groups, and agreement between ultrasound mapping and arteriography in patients who underwent both procedures. RESULTS: Diabetic patients had a significantly higher degree of pathology in all segments, except the common iliac artery. Decisions made after ultrasound mapping matched the final surgical decision 90% and 94% of the time in diabetic patients and nondiabetic patients, respectively. Decisions made on the basis of ultrasound arterial mapping matched decisions made on the basis of arteriography in 86.3%. CONCLUSIONS: Ultrasound arterial mapping allowed for good therapeutic planning for CLI in diabetic patients, even though these patients had more severe arterial pathology. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22835567 [PubMed - in process] Related citations

10. Ann Vasc Surg. 2012 Nov;26(8):1106-13. doi: 10.1016/j.avsg.2012.02.007. Epub 2012 Jul 25.

Maximal venous outflow velocity: an index for iliac vein obstruction


Jones TM, Cassada DC, Heidel RE, Grandas OG, Stevens SL, Freeman MB, Edmondson JD, Goldman MH. Source Division of Vascular Surgery, Department of Surgery, University of Tennessee Medical Center, Knoxville, TN. Electronic address: tmjones1@utmck.edu. Abstract Leg swelling is a common cause for vascular surgical evaluation, and iliocaval obstruction due to May-Thurner syndrome (MTS) can be difficult to diagnose. Physical examination and planar radiographic imaging give anatomic information but may miss the fundamental pathophysiology of MTS. Similarly, duplex ultrasonographic examination of the legs gives little information about central impedance of venous return above the inguinal ligament. We have modified the technique of duplex ultrasonography to evaluate the flow characteristics of the leg after tourniquet-induced venous engorgement, with the objective of revealing iliocaval obstruction characteristic of MTS. Twelve patients with signs and symptoms of MTS were compared with healthy control subjects for duplex-derived maximal venous outflow velocity (MVOV) after tourniquet-induced venous engorgement of the leg. The data for healthy control subjects were obtained from a previous study of asymptomatic volunteers using the same MVOV maneuvers. The tourniquet-induced venous engorgement mimics that caused during vigorous exercise. A right-to-left ratio of MVOV was generated for patient comparisons. Patients with clinical evidence of MTS had a mean right-to-left MVOV ratio of 2.0, asymptomatic control subjects had a mean ratio of 1.3, and MTS patients who had undergone endovascular treatment had a poststent mean ratio of 1.2 (P = 0.011). Interestingly, computed tomography and magnetic resonance imaging results, when available, were interpreted as positive in only 53% of the patients with MTS according to both our MVOV criteria and confirmatory venography. After intervention, the right-to-left MVOV ratio in the MTS patients was found to be reduced similar to asymptomatic control subjects, indicating a relief of central venous obstruction by stenting the compressive MTS anatomy. Duplex-derived MVOV measurements are helpful for detection of iliocaval venous obstruction, such as MTS. Right-to-left MVOV ratios and postengorgement spectral analysis are helpful adjuncts to duplex imaging for leg swelling. The MVOV maneuvers are well tolerated by patients and yields physiological data regarding central venous obstruction that computed tomography and magnetic resonance imaging fail to detect. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22835564 [PubMed - in process] Related citations

11. Ann Vasc Surg. 2012 Nov;26(8):1145-53. doi: 10.1016/j.avsg.2012.02.006. Epub 2012 Jul 25.

The ongoing battle between infrapopliteal angioplasty and bypass surgery for critical limb ischemia
Schamp KB, Meerwaldt R, Reijnen MM, Geelkerken RH, Zeebregts CJ. Source Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands. Abstract BACKGROUND: Critical limb ischemia (CLI) represents the extreme of the peripheral arterial occlusive disease spectrum and is associated with high mortality. Limb salvage often requires infrapopliteal revascularization by either angioplasty or bypass surgery. The past decade has witnessed a paradigm shift in CLI management toward endovascular treatment. This narrative review describes the clinical outcome, treatment strategy, and limitations of both modalities. METHOD: A literature search was performed of the PubMed and Cochrane databases. All articles, published until September 2011, describing treatment by infrapopliteal arterial revascularization were included. RESULTS: Angioplasty and bypass surgery are both related to a limb salvage rate of approximately 80% at 3-year follow-up. Patency rates appear to be higher after surgery. A reliable comparison of the two modalities, however, is complicated by various confounders, including patient selection, lesion characteristics, and complication rates. Additionally, most studies did not describe the standard use of best medical treatment or outcome for relief of ischemic pain, wound healing, or functional improvement. CONCLUSION: Infrapopliteal angioplasty and bypass surgery both provide an acceptable limb salvage rate, but patency appears to be better after bypass surgery. Both modalities are likely to be complementary. Additional randomized trials are indicated to provide a treatment algorithm for patients with CLI and infrapopliteal arterial occlusive disease. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22835563

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12. Ann Vasc Surg. 2012 Nov;26(8):1154-9. doi: 10.1016/j.avsg.2012.03.005. Epub 2012 Jul 21.

Vascular surgeons in france: an endangered species?


Berger L, Mace JM. Source Vascular Surgery Department, University Hospital of Caen, Caen, France. Electronic address: berger-l@chu-caen.fr. Abstract BACKGROUND: In France, in the next 10 years, a large number of vascular surgeons will retire, and the risk of them not being replaced has raised the question of our capability to predict future activity in this discipline. Otherwise, the French population is expanding and aging. It will increase by 2.7% in 2020, and the number of individuals aged >65 years is expected to increase by 3.3 million, which represents a 33% rise between 2005 and 2020. As the number of vascular surgery procedures is closely associated with aging population, we can expect a significant increase in vascular surgery workload. We present a model to predict changes in vascular surgery activity according to population aging, including other parameters that could affect workload evolution. METHODS: To meet vascular surgeons' needs in the coming years, we initially performed an overview of the demographics of practitioners and estimated the retirements. The second part of our work consisted in studying three groups of arterial surgical and endovascular procedures used in the treatment of infrarenal abdominal aortic aneurysm, peripheral arterial occlusive disease (PAOD), and carotid artery occlusive disease. Data were selected and extracted from the national Medical Information System Program database. Our predictive model is based on the OMPHALE method developed by the National Institute for Statistics and Economic Studies, and we applied it from the year 2000 to 2030. To integrate other parameters affecting workload, we established, from year 2000 data, a prediction based on aging population for the year 2008. Based on this model, we defined a weighted index for each group by comparing expected and observed workloads. This index has been applied to validate our weighted predictive model for year 2009. RESULTS:

Among the 611 vascular surgeons in activity in 2011, nearly two-thirds will retire in the next 15 years. Compared with the number of surgeons in formation, there will be a lack of four surgeons per year in the same period. Our predictive model reported an increase by 61% for the three groups for the period 2000 to 2030. Between 2009 and 2030, nearly 22,700 additional acts are expected, representing a 38% increase. According to the model, between 2000 and 2008 only, vascular procedures increased in total by 52.2%, with an increase of 89% in the PAOD group. Between 2000 and 2009, the global increase was 58.0%, with 3.9% for abdominal aortic aneurysm, 101.7% for PAOD, and +13.2% for carotid artery occlusive disease. Our weighted model based on aging population and corrected by a weighted factor predicted this increase. If the activity for each surgeon remained constant, 183 additional surgeons would be needed according to our refined model. CONCLUSION: In addition to the replacement of numerous retired surgeons, aging population and other factors could result in a significant increase in the demand for vascular surgical services. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22819526 [PubMed - in process] Related citations

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

Increased expression of hypoxia-inducible factor-1alpha and bcl-2 in varicocele and varicose veins
Lee JD, Yang WK, Lee TH. Source Department of Surgery, Taichung Armed Forces General Hospital, Taiwan, Republic of China; Central Taiwan University of Science and Technology, Taiwan, Republic of China. Electronic address: jane.dar@yahoo.com.tw. Abstract BACKGROUND: Primary vein wall abnormalities leading to secondary blood stasis and increased venous pressure that cause tissue hypoxia are observed in varicocele and varicose veins. Both types of diseased vessels are characterized by dilated thickened vein walls.

Hypoxia upregulates Bcl-2 (antiapoptosis protein) expression in different human cell types. We studied the expression of hypoxia-inducible factor-1alpha (HIF-1) and Bcl-2 in both venous diseases. METHODS: All vascular specimens, including the saphenous and internal spermatic veins, from patients with either varicocele or left inguinal herniorrhaphy (control group) were studied using immunoblotting, immunohistochemical staining, and double immunofluorescence staining. The data were analyzed using 1-way analysis of variance with Tukey comparison test. RESULTS: Protein analysis revealed that both venous diseases had a higher expression of HIF-1 and Bcl-2 compared with the control group (P < 0.05). Immunohistochemical staining and double immunofluorescence staining revealed that the greatest degree of HIF-1 and Bcl-2 colocalization occurred in the muscle layer of both diseased vessels. Moreover, under confocal microscopy, elevated Bcl-2 expression was found in the endothelium of both study groups compared with the control group. CONCLUSIONS: Our findings revealed increased expression of HIF-1 and Bcl-2 in varicocele and varicose veins and increased Bcl-2 expression especially in the endothelium under hypoxia. Thus, Bcl-2 overexpression may protect cells against apoptosis and contribute to the dilated thickened walls seen in both types of diseased vessels. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22749322 [PubMed - in process] Related citations

14. Ann Vasc Surg. 2012 Nov;26(8):1064-70. doi: 10.1016/j.avsg.2011.12.012. Epub 2012 Jun 26.

Does routine completion angiogram during embolectomy for acute upper-limb ischemia improve outcomes?
Zaraca F, Ponzoni A, Sbraga P, Stringari C, Ebner JA, Ebner H. Source Department of Vascular and Thoracic Surgery, Regional Hospital Bolzano, Bolzano, Italy. Electronic address: francesco.zaraca@asbz.it.

Abstract BACKGROUND: Since 1963, Fogarty balloon catheter thromboembolectomy is usually adopted as the gold standard treatment for acute limb ischemia. As the success of the procedure depends on complete removal of all thromboembolic material, intraoperative arteriography can be used after arterial thromboembolectomy as a guide for extension of the procedure. It is still a matter of debate whether intraoperative angiography should be routinely performed in all cases or only in selected cases, depending on intraoperative findings, when the surgeon suspects an incomplete disobstruction. Most published evidence derives from analysis of lower-limb thromboembolectomies. The aim of our retrospective study was to elucidate the value of routine completion angiogram in acute arterial embolism of the upper limb. METHODS: Clinical and demographic data of 100 patients with acute embolic upper-limb ischemia were prospectively recorded during an 18-year period in a central hospital vascular unit setting. The relevance of intraoperative angiography was retrospectively analyzed. The procedures were divided into two groups: group A, when intraoperative angiography was performed in selected cases (selective angiography); and group B, when angiography was performed as a routine procedure in all cases (routine angiography). All factors associated with reocclusion and mortality were investigated to produce meaningful information that could assist the surgeon to predict outcomes. RESULTS: Cumulative reocclusion and mortality rates at 24 months were 14.0% and 70.0%, respectively. After upper-limb arterial embolectomy, the rate of extension of the procedure was significantly higher in group B than in group A (26.0% vs. 4.0%, P = 0.002). At 24 months after embolectomy, group B resulted in a lower incidence of reocclusion compared with group A (12.0% vs. 2.0%, P = 0.05), whereas there was no statistical difference between the two groups in terms of mortality (P > 0.05). On univariate analysis, the factor associated with increased 2-year reocclusion rate was only the avoidance of completion angiography, although it lost some of its predictive value on multivariate analysis. Factors associated with increased 2-year mortality rate on univariate analysis included age >80 years, diabetes mellitus [DM], and antiplatelet drug use. Only DM was significantly associated on multivariate analysis. CONCLUSION: Routine use of intraoperative angiography influences outcome after embolectomy for upper-limb acute arterial occlusion. Routine use of intraoperative angiography, compared with selective use, results in a higher rate of extension of the procedure for residual lesion and in a lower rate of reocclusion at 24 months. In prevention of reocclusion, completion angiogram has a hazard ratio of 5.44 on multivariate analysis. Postoperative late mortality is mainly affected by old age and DM. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22743219

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15. Ann Vasc Surg. 2012 Nov;26(8):1093-9. doi: 10.1016/j.avsg.2012.02.001. Epub 2012 Jun 8.

Spiral laminar flow prosthetic bypass graft: medium-term results from a first-in-man structured registry study
Stonebridge PA, Vermassen F, Dick J, Belch JJ, Houston G. Source Division of Cardiovascular Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland; and Division of Vascular and Thoracic Surgery, University of Ghent, Ghent, Belgium. Electronic address: p.a.stonebridge@dundee.ac.uk. Abstract BACKGROUND: A number of surgical strategies and graft enhancements have been trialled to improve the performance of prosthetic grafts. Neointimal hyperplasia may, in part, be a normal cellular response to an abnormal (turbulent) flow environment. This first-in-many study assesses the safety and medium-term patency performance of a new graft designed to induce stable laminar flow through the distal anastomosis. METHOD: Forty patients who required an infrainguinal bypass graft were recruited/registered from a number of centers in Belgium and The Netherlands. Thirty-nine received a Spiral Laminar Flow graft as part of a standard treatment protocol (23 above-the-knee and 16 below-the-knee bypasses). Kaplan-Meier analyses were used to calculate primary and secondary patency rates. RESULTS: The 12-, 24-, and 30-month primary patency rates were 86%, 81%, and 81% for abovethe-knee bypasses and 73%, 57%, and 57% for below-the-knee bypasses, respectively. In the case of secondary patency rates, numbers were unchanged for above-the-knee bypasses and were 86%, 64%, and 64%, respectively, for below-theknee bypasses. There were no amputations in the study population. CONCLUSION:

This first-in-man series shows potential for the idea of spiral flow-enhanced prosthetic grafts. As always, randomized studies are required to explore the role of different enhanced prosthetic grafts. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22682930 [PubMed - in process] Related citations

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

Role of the Renin-Angiotensin system in the pathogenesis of intimal hyperplasia: therapeutic potential for prevention of vein graft failure?
Osgood MJ, Harrison DG, Sexton KW, Hocking KM, Voskresensky IV, Komalavilas P, Cheung-Flynn J, Guzman RJ, Brophy CM. Source Department of Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: michael.j.osgood@vanderbilt.edu. Abstract The saphenous vein remains the most widely used conduit for peripheral and coronary revascularization despite a high rate of vein graft failure. The most common cause of vein graft failure is intimal hyperplasia. No agents have been proven to be successful for the prevention of intimal hyperplasia in human subjects. The renin-angiotensin system is essential in the regulation of vascular tone and blood pressure in physiologic conditions. However, this system mediates cardiovascular remodeling in pathophysiologic states. Angiotensin II is becoming increasingly recognized as a potential mediator of intimal hyperplasia. Drugs modulating the renin-angiotensin system include angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. These drugs are powerful inhibitors of atherosclerosis and cardiovascular remodeling, and they are first-line agents for management of several medical conditions based on class I evidence that they delay progression of cardiovascular disease and improve survival. Several experimental models have demonstrated that these agents are capable of inhibiting intimal hyperplasia. However, there are no data supporting their role in prevention of intimal hyperplasia in patients with vein grafts. This review summarizes the physiology of the renin-angiotensin system, the role of angiotensin II in the pathogenesis of cardiovascular remodeling, the medical indications for these agents, and the experimental data supporting an important role of the reninangiotensin system in the pathogenesis of intimal hyperplasia.

Copyright 2012 Annals of Vascular Surgery Inc. All rights reserved. PMID: 22445245 [PubMed - in process] Related citations

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

Long-Term Follow-Up of Endovascular Treatment for TransAtlantic Inter-Society Consensus II Type B Iliac Lesions in Patients Aged <50 Years
Radak D, Babic S, Sagic D, Antonic Z, Kovacevic V, Stevanovic P, Tanaskovic S, Sotirovic V, Otasevic P. Source Department of Vascular Surgery, Institute for Cardiovascular Disease "Dedinje", Belgrade, Republic of Serbia; Faculty of Medicine, University of Belgrade, Serbia. Abstract BACKGROUND: To study the initial and long-term results of endovascular treatment in patients aged <50 years with Trans-Atlantic Inter-Society Consensus-II type B unilateral iliac lesions and chronic limb ischemia. METHODS: From January 2000 to February 2010, 60 consecutive endovascular interventions were performed on 23 women and 37 men aged 50 years. After successful treatment, all patients were followed up at 1, 3, 6, and 12 months after the procedure and every 6 months thereafter. RESULTS: Successful percutaneous revascularization of the iliac artery was achieved in 56 patients (93.3%). The early vascular-related complication rate was 6.7%. The primary patency rates at 1, 3, and 5 years were 88%, 59%, and 49%, respectively. Cox univariate analysis revealed that an age range of 45 to 50 years (hazard ratio [HR]: 0.290; 95% confidence interval [CI]: 0.152-0.553; P = 0.0001), lower preprocedural ankle-brachial index (HR: 2.438; 95% CI: 1.04-5.715; P = 0.047), lesion length >5 cm (HR: 0.838; 95% CI: 0.746-0.943; P = 0.003), and diabetes (HR: 2.005; 95% CI: 1.0103.980; P = 0.047) had significant influence on decreasing primary patency. CONCLUSIONS:

Endovascular treatment of TASC-II type B iliac lesions in patients aged <50 years is a safe procedure with low procedural risk. Primary patency rates at 1, 3, and 5 years were 88%, 59%, and 49%, respectively. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22410143 [PubMed - in process] Related citations

Ann Vasc surg 2012; 26(8) Case Reports

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

Strategies to tackle unrecognized bilateral renal occlusion after endovascular aneurysm repair.
Adu J, Cheshire NJ, Riga CV, Hamady M, Bicknell CD. Source

artery

Imperial Vascular Unit, St Mary's Campus, Imperial College Healthcare NHS Trust, London, UK. Abstract BACKGROUND: Unintentional renal artery occlusion after endovascular aortic aneurysm repair (EVAR) is an uncommon phenomenon. The sequelae from this specific complication are severe; consequently, the topic of renal artery coverage is a pertinent issue. We present a case series of patients undergoing EVAR with unintentional renal artery coverage, review the treatment options available, and suggest a treatment algorithm for this scenario based on the evidence. METHODS AND RESULTS: We report four patients who were found to have renal artery occlusion after EVAR detected up to 5 weeks postoperatively. Renal revascularization was achieved using endovascular renal artery stenting in two patients, and open hepato-spleno-renal bypass in the remaining two cases. Treatment strategies used led to symptom resolution and recovery of renal function in all cases. CONCLUSIONS: Both open and endovascular techniques may be used as procedures to treat this condition-the choice of procedure is primarily determined by accessibility of the renal orifice. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 23068430

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

Management of a challenging arteriovenous malformation of the scalp and orbit in a patient with polycystic kidney disease.
Bit N, Vidyasagaran T, Amalorpavanathan J, Balakrishnan TM, Sritharan N. Source Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India. nupur.bit@gmail.com Abstract Arteriovenous malformations are notorious for their propensity to bleed, sometimes with fatal consequences. We describe an unusual case of a patient with polycystic kidney disease and with a large arteriovenous malformation involving the orbit and scalp who presented with multiple episodes of profuse bleeding from the upper eyelid and loss of vision in the corresponding eye. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22981016 [PubMed - in process] Related citations

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

Endovascular repair of a left common carotid pseudoaneurysm associated with a jugular-carotid fistula after gunshot wound to the neck.
Faure E, Canaud L, Marty-An C, Alric P. Source

Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France. elsafaure@hotmail.com Abstract The management of traumatic injury of the common carotid artery has traditionally required a conventional surgical intervention, which is associated with a high mortality rate. Endovascular procedures might offer a less invasive alternative to treat these injuries, with a lower rate of mortality and morbidity. We report the case of a 30-yearold man who presented after penetrating injury due to a low-velocity gunshot wound to the neck. Angiography demonstrated a high-flow arteriovenous fistula and large false aneurysm of the common carotid artery. A self-expanding covered stent was placed across the injured portion of the artery, resulting in thrombosis of the aneurysm and preservation of the parent artery, without any significant complication. Covered stent placement is an alternative approach to treating carotid artery pseudoaneurysms associated with a jugular-carotid fistula. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22981012 [PubMed - in process] Related citations

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

Inferior vena cava clip migration: unusual cause of duodenal foreign body.
Antonoff MB, Beilman GJ. Source Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. antonoff@umn.edu Abstract Before the development of the inferior vena cava (IVC) filter, various techniques of IVC interruption were described for the management of patients at high risk for thromboembolic events, and for whom anticoagulation was either inadequate or contraindicated. In this report, we describe the enteric migration of a Miles IVC clip, occurring 27 years after IVC interruption. This previously undescribed complication and the patient's prolonged follow-up period render this case of significant interest. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

PMID: 22981011 [PubMed - in process] Related citations

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

Internal jugular vein hemangioma.


Al-Natour M, Kenmuir C, Khuder S, Kazan V, Abbas J, Nazzal M. Source Division of Vascular and Endovascular Surgery, University of Toledo Medical Center, Toledo, OH 43614, USA. Abstract Primary tumors of the major body veins arising intraluminally are rare clinical entities. As such, few cases have been reported in the literature. As a primary tumor, hemangiomas arising in the internal jugular vein are extremely rare, while those arising in the external jugular vein are only slightly more common. We present a case of an internal jugular vein hemangioma that was incidentally discovered during an ultrasound examination performed for the evaluation of the internal carotid arteries. We believe that this is the second case of internal jugular vein hemangioma reported in the English literature. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22951066 [PubMed - in process] Related citations

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

Aneurysm of a 32-year-old aortorenal saphenous vein bypass graft.


Bath J, Cho JS.

Source Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. Abstract We report the case of an incidentally discovered aneurysm of a previous saphenous vein bypass graft performed 32 years earlier for a renal artery aneurysm. The patient is a 52-year-old man who initially suffered from symptoms of hypertension and left-sided back pain. Saphenous vein bypass grafting was performed with aneurysm resection. Thirty-two years after surgery, the patient underwent a magnetic resonance imaging scan for back pain, hip pain, and anemia, discovering a 1.8-cm focal aneurysm at the site of the previous bypass. The patient underwent a repeat aortorenal bypass with an 8-mm flanged Dacron graft with excision of the existing aneurysmal saphenous vein graft. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22951065 [PubMed - in process] Related citations

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

Totally implanted venous access devices implanted in the saphenous vein. Relation between the reservoir site and comfort/discomfort of the patients.
Toro A, Mannino M, Cappello G, Celeste S, Cordio S, Di Carlo I. Source Department of Surgical Sciences, Organ Transplantation, and Advanced Technologies, Cannizzaro Hospital, University of Catania, Catania, Italy. Abstract BACKGROUND: When a totally implantable venous access device (TIVAD) is implanted in the femoral or saphenous vein, the port can be placed in the abdominal wall, thigh, or anteroinferior thoracic wall. This study analyzed the relationship between the position of the port and patient comfort.

METHODS: All patients who underwent TIVAD implantation from 1995 to 2011 were included in the study. Sex, age, indication for TIVAD implantation, contraindication for implantation in a vein draining into the superior vena cava, surgical technique, length of procedure, complications, difficulties recorded by nurses, and patient comfort or discomfort were recorded. RESULTS: The TIVAD was implanted in the saphenous vein in 6 of 581 patients (1.3%) who received a TIVAD, consisting of four male subjects and two female subjects aged 35 to 56 years (mean age: 47.3 years), who all underwent TIVAD implantation for the treatment of a solid tumor. The port was positioned in the anteroinferior thoracic wall in one patient, the abdominal wall in one patient, the anterior thigh in three patients, and the lateral thigh in one patient. The mean procedure duration was 52 minutes (range: 20-135 minutes). No immediate or early complications were recorded. The nurses had difficulty in puncturing the port in the abdominal wall. Patient comfort levels were high when the port was placed in the anterior thigh. CONCLUSION: The anterior thigh may be the most useful and comfortable position for the port of a TIVAD implanted in the inferior vena cava. Larger studies should be undertaken to confirm this. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22951064 [PubMed - in process] Related citations

8. Ann Vasc Surg. 2012 Nov;26(8):1128.e11-4. doi: 10.1016/j.avsg.2012.02.022. Epub 2012 Aug 28.

Aortoiliac thrombi in inflammatory bowel disease.


Singh K, Marco SA, Wang ML, Milone L, Deitch JS. Source Division of Vascular and Endovascular Surgery, Staten Island University Hospital, Staten Island, NY 10305, USA. Kuldeep_Singh@siuh.edu Abstract

Isolated arterial thrombi complicating inflammatory bowel disease occurs rarely. We encountered a case of a 28-year-old man with Crohn disease who presented with abdominal pain and severe claudication and was found to have an isolated aortoiliac thrombus. Bilateral aortoiliac thromboembolectomies were performed with successful restoration of femoral blood flow. Long-term anticoagulation therapy was instituted after an extensive hypercoagulable workup, which failed to reveal an etiology for the patient's coagulopathy. We present our case and perform an extensive literature review on this topic. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22951060 [PubMed - in process] Related citations

9. Ann Vasc Surg. 2012 Nov;26(8):1128.e1-5. doi: 10.1016/j.avsg.2012.02.020. Epub 2012 Aug 28.

Recurrent acute lower-limb ischemia with multiple organ infarctions secondary to acute myeloid leukaemia M1.
Overton J, Nicklin A, Eleftheriou P, Frith D, Gravante G, Sapsford W. Source Department of Vascular Surgery, Barts and the London NHS Trust, London, UK. overtonjohn@hotmail.com Abstract BACKGROUND: Acute myeloid leukemia (AML) is usually associated with coagulopathy and disorders of hemostasis, but cases of ischemic events have been reported. We present a case of AML with recurrent acute limb ischemia and multiple organ infarctions. METHODS AND RESULTS: A 57-year-old woman diagnosed with AML subtype M1 developed recurrent bilateral acute lower-limb ischemia refractory to multiple thromboembolectomies and bypass grafting. Histopathology revealed that thrombi were composed of leukemic blasts, and computed tomography angiogram incidentally revealed multiple infarctions. She demonstrated a response to chemotherapy, but died of an overwhelming sepsis 22 days after her acute admission. CONCLUSIONS:

AML subtype M1 with acute lower-limb ischemia and multiple organ infarctions is associated with a poor prognosis. The role of emergency chemotherapy in reducing the tumour burden and possibly improving the results of vascular interventions needs to be defined. Limb-salvaging surgery should not be delayed but be administered immediately according to the degree of ischemia. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22951059 [PubMed - in process] Related citations

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

Pasteurella multocida-infected expanded polytetrafluoroethylene hemodialysis access graft.


Schneider JR, White GW, Dejesus EF. Source Vascular and Interventional Program of Cadence Healthcare, Winfield, IL 60190, USA. joe_schneider@cdh.org Abstract Infections are among the risks related to prosthetic hemodialysis access grafts. However, dialysis access graft infections caused by Pasteurella multocida have not been reported previously. We report a case of a P. multocida-infected nonfunctioning expanded polytetrafluoroethylene graft in the forearm after a cat bite. At surgery, the graft was completely unincorporated and was completely excised. Operative culture results were positive for P. multocida, a common oral flora found in cats and dogs. The patient was treated with intravenous ceftriaxone, and the wounds healed with local care. Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22835566 [PubMed - in process] Related citations