The treatment of chronic venous insufficiency of the lower extremity secondary to saphenofemoral junctional valve incompetency has undergone significant changes with the advent of endovascular techniques. Through effective management and correction of valvular dysfunction via endothelial disruption or ablation in a minimally invasive fashion, both thermal and nonthermal platforms have evolved from a better understanding of disease mechanisms and evolution of early treatment technologies.
A pioneer in vascular surgery and medical education reflects on changes in the open-endovascular tide and what makes a great meeting, as well as a preview of VEITHsymposium 2015.
Daniel G. Clair, MD, discusses the risk factors leading to limb failure and device elements that can help diminish this complication.
Iliac limb occlusion after endovascular aneurysm repair (EVAR) can result in acute ischemic symptoms and subsequent major morbidity or mortality. In contemporary investigational device exemption (IDE) trials, the incidence of limb occlusion at 12 months has ranged from approximately 1% to 8%. Despite the fact that these rates far and away surpassed that of type I endoleaks in these same trials, the importance of improving limb patency has received comparatively little focus.
During the last decade, endovascular aneurysm repair (EVAR) has gained wide acceptance as the preferred method of treating suitable patients with abdominal aortic aneurysms. EVAR is associated with lower 30-day mortality and morbidity rates, faster discharge, and fewer complications than with surgery, but seems to be associated with higher secondary intervention rates. Graft limb stenosis or thrombosis are important causes of secondary interventions after EVAR.
An expert panel discusses the current role, data, and techniques for the use of drug-coated balloons in tackling PAD.
Understanding the advantages and disadvantages that can result from different balloon technologies on the market.
From a financial standpoint, DCBs have become the most attractive endovascular option for treating atherosclerosis in the superficial femoral artery.
Few endovascular technologies have been as anticipated as drug-coated balloons (DCBs). For at least 5 years, the endovascular community has been discussing the role of paclitaxel in the peripheral arterial system and its potential value, first on stents and now on angioplasty balloons. Do we finally have a solution for restenosis and intimal hyperplasia? Can we potentially eliminate the need to leave stents in patients? How will the long-term patency and, more importantly, the clinical efficacy of these technologies change our practice? These are all questions that we are just beginning to answer.
Dr. Koen Deloose talks to Dr. Martin Werner about available options, cost-effectiveness considerations, and what the future holds for complex SFA disease.
OBJECTIVE: The objective of our study was to compare the effectiveness of radiofrequency ablation (RFA) for viable hepatocellular carcinoma (HCC) including areas of retained oil after transarterial chemoembolization (TACE) versus RFA treatment of viable HCC alone for ablation coverage.
PURPOSE: We aimed to describe the frequency of adverse events after computed tomography (CT) fluoroscopy-guided irreversible electroporation (IRE) of malignant hepatic tumors and their risk factors.
PURPOSE: We aimed to evaluate the safety and efficacy of fluoroscopically placed jejunal extension tubes (J-arm) in patients with existing gastrostomy tubes.
Iatrogenic hepatic arterial injuries (IHAIs) include pseudoaneurysm, extravasation, arteriovenous fistula, arteriobiliary fistula, and dissection. IHAIs are usually demonstrated following percutaneous transhepatic biliary drainage, percutaneous liver biopsy, liver surgery, chemoembolization, radioembolization, and endoscopic retrograde cholangiopancreatography. The latency period between the intervention and diagnosis varies. The most common symptom is hemorrhage, and the most common lesion is pseudoaneurysm. Computed tomography angiography (CTA) is mostly performed prior to angiography, and IHAIs are demonstrated on CTA in most of the patients. Patients with IHAI are mostly treated by coils, but some patients may be treated by liquid embolic materials or stent-grafts. CTA can also be used in the follow-up period. Endovascular treatment is a safe and minimally invasive treatment option with high success rates.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel 2-stage technique intended to induce rapid growth of the future liver remnant (FLR). Initial reports of a 12% mortality rate have sparked debate regarding the safety of the procedure. A 64 years old male was planned for a right-sided hemi-hepatectomy due to colorectal cancer liver metastases. Intra-operatively it was decided to convert to an ALPPS due to unexpectedly small segments 2-4. Post-operative serum laboratory tests indicated an acute liver failure and radiological imaging showed no sign of arterial blood flow to the right hemi-liver. A computed tomography examination on post-operative day 3 revealed that the FLR had increased from 290 to 690 mL in 3 d (138% growth). In the following days serum values gradually improved and stage 2 was carried out on post-operative day 7. The rest of the hospital stay was uneventful and the patient made a full recovery. ALPPS is a fascinating advancement in liver surgery. Despite severe post-operative complications, in properly selected cases it provides successful outcomes that other modalities of treatment cannot offer.
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