Overview of Volume 9, Issue 11 of Vascular Disease Management

Editor’s Corner »

Gene Responsible for Heritable Abdominal Aortic Aneurysm Uncovered

By: Frank J. Criado, MD, FACS, FSVM Editor-in-Chief Endovascular Specialist MedStar Union Memorial Hospital Baltimore, Maryland

The discovery of a single gene – seemingly specific – for development of familial (heritable) abdominal aortic aneurysm (AAA) was announced to the world in November 2011. And yet I have the impression that for some reason such momentous achievement has not had much of an impact on the vascular community at large. I trust the “silence” will soon end as physicians come to comprehend the enormous significance of this breakthrough. Read the full story »

Case Files by Dr. George »

Rare Case of Bilateral Common Iliac Vein Compression by Arterial Stents and Calcification

By: Eric Rosen, DO, Luke Groben, DO, Jon C. George, MD From the Division of Interventional Cardiology & Endovascular Medicine Deborah Heart and Lung Center, Browns Mills, New Jersey.

ABSTRACT: May–Thurner syndrome is a rare condition involving compression of the left iliac vein by the right common iliac artery. Rarely, iliac vein compression syndromes are found to be right-sided and even more rarely bilateral. We present a rare case of bilateral iliac vein compression treated percutaneously with excellent results. Read the full story »

Case Report and Brief Review »

Preservation of Infected Aortic Grafts with Intra-Abdominal Abscesses by Percutaneous Drainage and Specific Antibiotic Therapy

By: Izaäk F. Kodde, MD, Michiel L.P. van Zeeland, MD, Lyckle van der Laan, MD, PhD From the Department of General Surgery, Amphia Hospital, Breda, Netherlands.

ABSTRACT: Aortic graft infection is a rare but lethal complication of aortic surgery. Standard treatment consists of sepsis control by graft excision, antibiotics, and securing flow to distal circulation. We describe 2 patients with a proven infection of a central vascular prosthesis who were unable to tolerate surgical intervention. Conservative therapy comprised drainage of abscesses and specific intravenous antibiotics directed at the cultured microorganisms. Both patients were discharged home with oral antibiotics after 6 weeks of hospitalization. As long as oral antibiotics were continued, no infectious complications occurred. Conservative treatment with antibiotics and drainage of intra-abdominal abscesses after ruptured abdominal aneurysm repair may lead to midterm survival in selected cases. Read the full story »

Original Research »

Carotid Endarterectomy Under Local Anesthesia: An Alternative Treatment for Carotid Stenosis

By: Elias Kfoury, MD, Shitel Patel, MD, Dipankar Mukherjee, MD From the Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia.

ABSTRACT: Purpose. Carotid artery stenosis accounts for approximately 10% of all ischemic strokes, causing significant morbidity and mortality. Historically the standard of care for surgical candidates for carotid stenosis was carotid endarterectomy, traditionally done under general anesthesia. As carotid stenting becomes an established less invasive modality of treatment, we investigated carotid endarterectomy under local anesthesia as an alternative option. Methods.We conducted a retrospective review of medical charts for patients undergoing carotid endarterectomy at a large community hospital from July 2007 to June 2010. 30-day postoperative myocardial infarctions and strokes were evaluated for patients undergoing carotid endarterectomy under local anesthesia, compared to carotid endarterectomy under general anesthesia. Carotid artery shunting and preoperative stroke were also evaluated as risk factors for postoperative myocardial infarction and stroke. Fisher exact tests were calculated to compare postoperative outcomes between patient groups. Results. A total of 407 carotid endarterectomies under local anesthesia and 256 carotid endarterectomies under general anesthesia were included in the analysis. Age, sex, and occurrence of preoperative stroke were similar between study groups. General anesthesia patients were more likely to receive a shunt (82% vs 11%, P<.001).  General anesthesia patients had higher rates of postoperative myocardial infarction (1.2% vs 0%, P=.057) and stroke (2.3% vs 0.7%, P=.095), but these differences were not statistically significant. Patients with a shunt also had non-significantly higher rate of postoperative stroke (2.3% vs 0.7%, P=.096). Conclusions. Our evidence suggests that carotid endarterectomy under local anesthesia can be an effective alternative for carotid stenosis with a possibly better safety profile than carotid endarterectomy under general anesthesia. Larger randomized studies are needed to further evaluate these complications. Read the full story »

Case Report »

Endovascular Repair of Iatrogenic Inferior Vena Cava Stenosis in a Live Kidney Donor

By: Suraj Mammen, MBBS, MD1, Shyamkumar Nigudala Keshava, DNB, FRCR, FRANZCR1, Munawwar Ahmed, MD1, Edwin Stephen, MS1, Indrani Sen, MS2, Antony Devasia, MS, MCh, FRCS(Urol)3From the 1Department of Radiology, 2Department of Vascular Surgery, and 3Department of Urology, Christian Medical College Vellore, Tamil Nadu, India.

ABSTRACT: We report the endovascular treatment of a rare complication of iatrogenic inferior vena cava stenosis following a right live donor nephrectomy. This report highlights the clinical presentation, imaging, and management of such a case. Read the full story »

Case Report and Review »

Periaortic Ligature Technique to Treat Type 1A Endoleak During Emergent Endovascular Repair of a Ruptured Aortic Aneurysm

By: Roger L. Flekser, BSc, MBBS, Ramon L. Varcoe MBBS, MS, FRACS From the Prince of Wales Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia; The Vascular Institute, Sydney, Australia.

ABSTRACT: An 84-year-old female presented with a ruptured abdominal aortic aneurysm. Multiple comorbidities deemed her unsuitable for open surgical repair. Emergency endovascular aortic aneurysm repair was undertaken with a standard infrarenal graft despite unfavorable proximal aortic neck anatomy. She predictably developed a brisk type IA endoleak. Through a limited midline laparotomy incision two nylon bands were tied and tightened around the proximal aneurysm neck to provide a seal and exclude blood flow from the leaking sac. In this single operative case, aortic banding was achieved safely and effectively, facilitating endovascular aortic repair in the emergency setting. Read the full story »

Interview »

Dr. Frank R. Arko Describes the FDA Early Feasibility Trial for Stent Graft

Interview by Amanda Wright

The Food and Drug Administration has selected the Valiant Mona LSA stent graft as part of an early feasibility trial in humans in the United States. In this interview, Dr. Frank R. Arko discusses plans for the trial.

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