Dr. Craig Walker’s Video Series on Vascular Disease Management

Since the January 2014 issue of Vascular Disease Management when Dr. Craig Walker joined the journal as clinical editor, he has provided video commentary to accompany the monthly Editor’s Corner.  Access a selection of the videos below.

Dr. Walker introduces the April issue of Vascular Disease Management with a discussion of May-Thurner syndrome and other venocompressive disoders.

Dr. Walker presents the March issue of Vascular Disease Management with a discussion of recent clinical results and FDA approvals of drug-eluting balloons.

Although popliteal venous aneurysm is very rare, Dr. Walker notes that interventionalists should understand its etiology in the context of pulmonary embolism and deep venous thrombosis.

Although the future of inferior vena cava filters may bring nonthrombogenic or biodegradable filters that make removal simpler or unnecessary, clinicians today must remain vigilant about appropriate utilization and removal.

Treatment of critical limb ischemia has changed dramatically over the years. Dr. Walker presents an overview of its evolution and what direction therapy could be headed in the future.

The November 2014 issue of Vascular Disease Management presents a point-conterpoint argument in which the authors argue for and against the use of vascular closure devices. Dr. Walker discusses this article and the use of vascular closure devices in this video.


Coming Up in April: Vascular Disease Management Editor’s Update

In the editor’s update on Vascular Disease Management, we give you a sneak peek into the upcoming issue. In April, VDM will highlight covered stents in superficial femoral artery interventions. Clinical editor Craig Walker, MD, will also discuss “Covered Stents in the Treatment of SFA Disease” by Barry S. Weinstock, MD, in his monthly video message. See below for titles and abstracts for the April issue.


Editor’s Update*

April 2014, Vol. 11, No. 4

Covered Stents in the Treatment of SFA Disease
Barry S. Weinstock, MD
From Orlando Regional Medical Center, Orlando, Florida. 

Treatment of SFA disease remains challenging due to complex lesion morphologies, unique vessel characteristics, long lesion lengths and frequent chronic total occlusions.  Numerous studies have been performed using various renditions of balloon angioplasty, atherectomy and stenting. The Viabahn endoprosthesis is an attractive option for long, complex segments of SFA disease including chronic total occlusions.  Use of the Viabahn endograft to create an endoluminal bypass provides an angiographically optimal primary result while potential restenosis is limited to the proximal and distal edges of the endograft resulting in a length-independent restenosis rate, an advantage not offered by any other interventional procedure.  Recent enhancements to the Viabahn stent as well as better understanding of optimal device sizing and procedural technique have resulted in highly acceptable patency rates in even the most complex SFA lesions.   Strategies to optimize procedural success and to treat late complications such as restenosis and/or thrombosis are reviewed.

Isolated Tibiopedal Arterial Access for Minimally Invasive Retrograde Revascularization
Jon C. George, MD
From Division of Interventional Cardiology and Endovascular Medicine, Deborah Heart and Lung Center, Browns Mills, New Jersey.

A 71 year-old male with history of coronary artery disease, peripheral arterial disease (PAD), ulcerative colitis, and chronic thrombocytopenia presented with acute onset of severe right lower extremity claudication characterized by rest pain and a cold leg. The patient was treated using the tibiopedal arterial minimally invasive retrograde revascularization (TAMI) technique technique due to lack of alternative access with excellent outcomes. 

Type I Endoleak Management after Endovascular Aneurysm Repair of Infrarenal Abdominal Aortic Aneurysm: Utilization of N-butyl Cyanoacrylate Embolization in a Case of Failed Secondary Intervention
Derya Tureli, MD, and Feyyaz Baltacioglu, MD
From the Department of Radiology, Marmara University, Istanbul, Turkey.

A 52-year-old male patient with infrarenal abdominal aortic aneurysm underwent an endovascular aneurysm repair procedure. At the end of the procedure, a type 1A endoleak was detected. Because there was no margin for placement of an aortic extender cuff, balloon dilatation was performed with an expectation for total resolution. A control angiogram performed 2 days later showed that the endoleak persisted and balloon dilatation was performed at the attachment site one more time. A control CT scan performed 2 days after the secondary procedure revealed that the type IA endoleak persisted and had grown larger. Open surgical repair was rejected by the patient. The patient underwent a single session of N-butyl cyanoacrylate embolization of the type IA endoleak using a transarterial approach. Coil utilization was not required. Technical success was achieved in the patient with complete resolution of the endoleak confirmed by follow-up CT studies. There were no procedure related complications.

Is ‘Substantially Equivalent’ Good Enough for Lower-Limb Therapy Patients: Contributions to the Meaningful Data Collection Discussion
Ragotham R. Patlola, MD
From Cardiovascular institute of the South, Lafayette, Louisiana.

Data on the Acuseal Graft for Hemodialysis: An Interview With Marc Glickman, MD
From Sentara Healthcare, Norfolk, Virginia.


* Articles are subject to change at the editor’s discretion.

Vascular Disease Management Editor’s Update: Coming in March

Coming in March, Vascular Disease Management will feature manuscripts by authors from a range of specialties. Carlos Bechara, MD,  a vascular surgeon from Baylor College of Medicine, presents research studying lower-extremity bypass grafts. Jason Salsamendi, MD, an interventional radiologist from the University of Miami Miller School of Medicine, describes a case with his colleagues in which they used a technique that could aid interventions in various high-flow situations. And cardiologist Barry Weinstock, MD, from Orlando Regional Medical Center provides an update on contrast-induced nephropathy.

Editor’s Update
March 2014, Vol. 11, No. 3

Comparing Short and Midterm Infrainguinal Bypass Patency Rates Between Two ePTFE Prosthetic Grafts: Spiral Laminar Flow and Propaten
Carlos F. Bechara, MD
From Baylor College of Medicine, Houston, Texas.

Abstract: Objective: The ideal prosthetic graft to use for lower extremity bypass in patients with no vein conduit is yet to become available. Spiral laminar flow graft (SLFG) was designed to reduce turbulent flow at the distal anastomosis, hence reducing neointimal hyperplasia to improve graft patency. We examined our data for this type of graft and compared it to the Propaten graft by W.L. Gore (PG), which is another polytetrafluoroethylene (ePTFE) graft. Method: Single-center data were retrospectively reviewed for patients undergoing infrainguinal bypass using prosthetic grafts between January 2010 and January 2012. Kaplan-Meier analyses were performed to estimate primary and secondary patency rates for patients undergoing femoral to popliteal artery bypass (above and below the knee) as well as femoral to tibial artery bypass. The same was done for patients undergoing infrainguinal bypass using PG during the same time period. Results: 20 infrainguinal bypasses were performed using SLFG and 39 using PG were identified. A majority of the SLFG cases (14, 70%) were femoral to popliteal bypass (above and below the knee) and 6 cases (30%) were femoral to tibial artery bypass. Similar percentages were seen in the PG group. Statistically, the 6-, 12-, 18-, and 24-month primary and secondary patency rates for both grafts were the same regardless of the distal target artery. The primary patency for the popliteal artery (above and below knee) target group were 94%, 61 %, 61%, and 54% for the PG group, and 79%, 50%, 50%, and 50% for the SLFG group, respectively. The secondary patency rates were 94%, 66%, 66%, and 66% for the PG group and 86%, 57%, 57%, and 57% for the SLFG group, respectively. The 6-, 12-, and 18-month primary patency rates for the tibial artery bypass groups were 51%, 36%, and 37% for the PG group and 50%, 33%, and 17% for the SLFG group, respectively. The secondary patency rates were 54%, 34%, and 34% for the PG group and 60%, 40%, and 20% for the SLFG group, respectively. Conclusion: The design of the SLFG to mimic physiologic flow at the distal anastomosis is an interesting concept, but it has not translated into clinical benefit in comparison to another ePTFE graft in our series. Further research and modifications are needed to achieve the ideal graft for infrainguinal arterial bypass.

Flow-Arrest Interventional Repair of Renal Allograft Arteriovenous Fistula and Pseudoaneurysms
Jason Salsamendi, MD, Ami Vakharia, MD, and Adam N. Checkver, MD
From Jackson Memorial Hospital, Miami, Florida.

Abstract: As core biopsies of transplanted kidneys remain the “gold standard” for diagnosis of rejection, the risk of iatrogenic complications such as arteriovenous fistulas (AVF) and pseudoaneurysms remain quite real. This case report describes a case of a 59-year-old female with a suspected occult post-biopsy AVF and pseudoaneurysm which over 6 years became enlarged and multilobulated, discovered on routine follow-up imaging. As the patient because symptomatic with flash pulmonary edema, intervention was planned. Angiography demonstrated a complex network of pseudoaneurysms with high flow drainage to the renal venous system. As initial attempts at coil embolization failed due to high flow velocities, a proximal and distal balloon occlusion technique was implemented along with a combination of coils (Axium; Covidien) and glue (Trufil; DePuy) to obtain lasting resolution of the patient’s pathology with minimal risk of embolization material flowing distally. The authors theorize that this technique will facilitate similar results in various high-flow situations, as with transplant AV fistulas. 

Contrast Induced Nephropathy: How to Avoid a Life of CIN
Barry S. Weinstock, MD
From Orlando Regional Medical Center, Orlando, Florida. 

Abstract: Contrast-induced nephropathy, defined as a worsening or cessation of renal function following contrast administration remains an important issue with both clinical and economic impact.   Contrast nephropathy occurs more frequently in “high risk” patients including those with pre-existing renal insufficiency, high volumes of contrast administration, advanced age, hypotension, congestive heart failure, diabetes and anemia.  Multiple strategies have been studied to decrease the risk of contrast nephropathy.  Current practice patterns often utilize approaches with little or no supporting data.  These approaches are reviewed as well as newer strategies such as “targeted renal therapy” and expanded use of CO2 angiography.

First in Human Study for the Valiant Mona LSA Graft: An Interview With Frank R. Arko, MD
Frank R. Arko, MD
From the Sanger Heart and Vascular Institute at Carolinas Medical Center in Charlotte, N.C.

* Articles are subject to change at the editor’s discretion.


Vascular Disease Management: Coming in February

In February, Vascular Disease Management will share a clinical review on orbital atherectomy, discussion of a new technique for distal embolic protection, clinical images on fibromuscular dysplasia, an interview on the PEARL registry on mechanical thrombectomy, and a letter to the editor on collecting patient data in which Dr. George Adams and colleagues respond to a VDM blog post by Dr. Lawrence Garcia, “Collecting More Data for Vascular Patients.” See below for the full listing of articles scheduled for the February issue.

Editor’s Update
February 2014, Vol. 11, No. 2

Next Steps to Collecting More Data for Peripheral Vascular Patients: A Continued Discussion Regarding Rigorous Scientific Data
George Adams, MD, MHS, Jihad Mustapha, MD, Gary Ansel, MD, and William Gray, MD

Procedural Outcomes of Orbital Atherectomy Treatment of Peripheral Arterial Disease in an Outpatient Office-Based vs Hospital Setting
Guy Mayeda, MD, Geroge Pliagas, MD, Christopher LeSar, MD, William Julien, MD, David Lew, MD, Sandeep Bajaj, MD

A Technique for Enhanced Distal Embolic Protection in the Endovascular Treatment of Iliofemoral Thrombosis with the Trellis Device
Saadi A. Siddiqi, DO, Tokir Mujtaba, MD, Immad Sadiq, MD

Recurrent Myocardial Infarctions in a Young Female With Fibromuscular Dysplasia
Rajesh V. Swaminathan, MD

Results of the PEARL Registry on Mechanical Thrombectomy of Hemodialysis Fistulas and Grafts: An Interview With Eugene J. Simoni, MD
Eugene J. Simoni, MD 

News About Chronic Cerebrospinal Venous Insufficiency Treatment in Multiple Sclerosis

Zivadinov_447x260The January 2014 issue of Vascular Disease Management includes an interview with Robert Zivadinov, MD, on the Prospective Randomized Endovascular Therapy in MS (PREMiSe) trial, which studied balloon angioplasty for the treatment of multiple sclerosis. In the interview, Dr. Zivadinov admits that he was surprised by the results, which he describes as follows:

“The primary endpoint of the study was safety at 24 hours and 1 month. There were really no serious adverse events—neither over the 6 month period nor now at the 12 month mark of the study. The other endpoint was the restoration of the blood flow, which was measured immediately postprocedure on catheter venography. One of the criteria was that blood flow should be restored at least by 50% after the procedure and that was achieved at 1 month, as measured by duplex; the restoration should have reached 75% of the flow improvement and there was no difference between the treated and not treated patients.”

Readers have shared conflicting opinions on this topic in the comments:

  • “These are very interesting results which I believe are totally consistent with my observations having followed over 200 MS patiently with CCSVI treated by venoplasty.”
  • “Venous obstruction itself does not cause the periventricular punching out of lesions seen in MS.”
  • “I totally disagree with Dr. Zivadinov, I think venous angioplasty is a highly effective treatment for CCSVI and MS.”
  • “In my opiniion premise study just didn’t had success with angioplasty and correcting the flow – that is the purpose of treatment.”

What are your thoughts? View reader comments and share your own at “Results of the PREMiSe Study on CCSVI in MS: An Interview With Robert Zivadinov, MD, PhD.”

And do you want more content on chronic venous insufficiency on Vascular Disease Management? Tell us by taking this one-question poll.

Vascular Disease Management to Welcome New Clinical Editor Craig Walker, MD

Dr Walker Headshot_CroppedOn January 1, 2014, Craig Walker, MD, founder, president, and medical director of the Cardiovascular Institute of the South, will begin as the clinical editor of Vascular Disease
Management. Dr. Walker, board certified in internal medicine, cardiovascular disease, and interventional cardiology, established the Cardiovascular Institute of the South, a world-renowned practice with locations in 13 cities across south Louisiana and Alabama. Dr. Walker also co-founded one of the largest cardiovascular conferences in the nation, New Cardiovascular Horizons, to educate and train medical professionals on the latest techniques to treat coronary and peripheral vascular disease. He has served as primary investigator for several cardiovascular and peripheral devices. Dr. Walker is author and co-author of more than 60 medical publications and has delivered hundreds of presentations and lectures to both lay and medical audiences.

“Great strides are being made in diagnosing and treating vascular disease. More than ever
before it is important to disseminate information about vascular disease and evolving therapies,” says Dr. Walker. “I am pleased to serve as the new editor of Vascular Disease Management and I am convinced that a web-based peer-reviewed journal will have capabilities that purely print journals cannot match.”

See more at the related press release.

VDM Sits Down With Michael Jaff, DO, at VIVA 2013

At VIVA 2013, Vascular Disease Management spoke about the meeting with steering committee member Michael R. Jaff, DO, chair of the Institute for Heart, Vascular, and Stroke Care and medical director of the Vascular Center, the Vascular Diagnostic Laboratory, and the Vascular Ultrasound Core Laboratory at Massachusetts General Hospital in Boston. He described the genesis of the VIVA meeting, where a group of colleagues envisioned a multidisciplinary vascular therapy meeting.

“There must be a better way to be collaborative and use technology that was emerging to teach better.”

See the video with Dr. Jaff here.