July VDM: EVAR Research and ClearWay RX

In the July 2013 issue of Vascular Disease Management, we present original research from Jordan et al on secondary procedures and long-term effects of endovascular vs open repair of AAA. The authors found that EVAR is associated with a higher risk of secondary vascular procedures, whereas open AAA repair is associated with a higher risk of late secondary nonvascular procedures. The authors recommend further prospective multicenter long-term studies to reproduce these associations and identify factors that may help reduce secondary procedures.

Also of note in this issue is a case report of combination thrombolytic therapy using the ClearWay RX and an embolic protection device in upper-extremity occlusion. Markiewicz et al describe the therapy as a potential endovascular alternative to traditional infusion catheter for patients who cannot be addressed by surgery in a timely way.

See below for details from the July issue.

Volume 10 – Issue 7 – July 2013

Editor’s Corner »

The Important CAS Technical Issue of Balloon Postdilatation Remains Unresolved

By: Frank J. Criado, MD, FACS, FSVM

The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) substudy investigators reported in May that the risk of restenosis was reduced by 64% with balloon angioplasty after stent deployment as opposed to angioplasty before stent implantation. Angioplasty after stenting might, however, increase the risk of stroke.

Case Files by Dr. George »

Arteria Lusoria and Truncus Bicaroticus: A Unique Aortic Arch Anatomic Variation

By: Jonathan Nachtigall, DO, Eric Rosen, DO, and Jon C. George, MD

Angiography for a 67-year-old female with history of prior cerebrovascular accidents and lower extremity claudication symptoms revealed a common ostium of bilateral common carotid arteries with a separate distal common origin of bilateral subclavian arteries.

Original Contribution »

Secondary Procedures and Long-Term Morbidity and Mortality Following Endovascular and Open Repair of Abdominal Aortic Aneurysm

By: Marjan Mujib, MD, MPH, Francisco Alcocer, MD, Marc Passman, MD, Thomas C. Matthews, MD, and William D. Jordan, MD From the University of Alabama at Birmingham.

A retrospective study was performed in 1,005 patients who underwent endovascular aneurysm repair and in 903 patients who underwent open aneurysm repair between 1985 and 2009. Results showed that endovascular aneurysm repair is associated with a higher risk of secondary vascular procedures whereas open abdominal aortic aneurysm repair is associated with higher risk of late secondary nonvascular procedures.

Case Report and Review »

ClearWay RX-Directed Combination Thrombolytic and Glycoprotein IIb/IIIa Therapy With Embolic Protection Device in an Acute Upper Extremity Occlusion

By: Richard J. Markiewicz, MD1, Rajesh Dave, MD, FACC, FSCAI2, Shawn Colby, RN1 From the1DeBakey Heart Institute, Hays Medical Center, Hays, Kansas; 2Capital Cardiovascular Associates, Holy Spirit Cardiovascular Institute, Camp Hill, Pennsylvania

A 75-year-old patient who presented with acute left upper limb ischemia with rest pain, pallor, and partial paralysis was successfully treated with with a combined approach consisting of an embolic protection device, intralesion delivery of tissue plasminogen activator and glycoprotei- nIIb/IIIa inhibitor via a specialized catheter, and rheolytic thrombectomy.This approach may provide a unique endovascular solution as an alternative to traditional infusion catheter.

Interview »

FDA Approval of Medtronic’s Endurant AUI Stent Graft System: An Interview With Michel Makaroun, MD

By: Interview by Jennifer Ford

Vascular Disease Management spoke with Michel Makaroun, MD, principal investigator for the Endurant Stent Graft System US Clinical Study, about the FDA approval of the Endurant II Aorto-Uni-Iliac (AUI) Stent Graft System.



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