Background: Benefits of 2-dimensional (2D) angiosome-oriented infrapopliteal revascularization remain controversial. The aim of this retrospective study was to clarify the effect of single tibial artery revascularization on the dorsal and plantar microcirculation of critically ischemic limbs based on skin perfusion pressure (SPP).
Context: Endovascular procedures, requiring X-ray guidance, are commonly performed in vascular surgery. X-ray exposure is associated with biological risks for both patients and physicians. Medical X-ray use must follow “as low as reasonably achievable” (ALARA) principles, which aim at using the lowest radiation exposure to achieve a procedure safely. This is underlined by European and international recommendations that also suggest that adequate theoretical and practical training is mandatory during the initial education of physicians. However, the content of this education and professional practices vary widely from one country to another.
Objective: To compare 30 day outcomes and costs of fenestrated and branched stent grafts (f/b EVAR) and open surgery (OSR) for the treatment of complex abdominal aortic aneurysms (AAA) and thoraco-abdominal aortic aneurysms (TAAA).
Objectives/Background: ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus) is a prospective multicentre randomized controlled trial including consecutive patients with ruptured aorto-iliac aneurysms (rAIA) eligible for treatment by either endovascular (EVAR) or open surgical repair (OSR). Inclusion criteria were hemodynamic stability and computed tomography scan demonstrating aorto-iliac rupture.
Objective: In this study the first results are presented of a new endovascular technique using covered stents to reconstruct the aortic bifurcation in patients with aortoiliac occlusive disease. With the “Covered Endovascular Reconstruction of the Aortic Bifurcation” (CERAB) technique, the anatomy and physiology of the aortic bifurcation is mimicked.
Objectives: To analyze the early and long-term survival and re-intervention rate in patients undergoing TEVAR for blunt traumatic thoracic aortic injury.
I know what you are thinking: “What does oncology have to do with Endovascular Today?” The topics within these pages usually pertain to vascular diseases and the many issues surrounding them. Even the name of the publication indicates a vascular orientation. So why this foray into cancer?
Patients with colorectal liver metastases (CRLM) represent an underserved population who may benefit from liver-directed therapy. Although the classic paradigm of liver-directed therapies is to apply treatments with curative intent, the body of evidence has matured, suggesting that noncurative intent may be beneficial. Liver-directed therapies in the palliative setting may also improve patient quality of life as well as survival. This article provides insight and perspective on the role of ablation and embolization strategies in the context of contemporary management of CRLM.
Globally, primary liver cancer is the sixth most common cancer and is the second highest cause of cancer mortality.1 Hepatoma, or hepatocellular carcinoma (HCC), accounts for approximately 80% of primary liver tumors. Major risk factors for the development of HCC include hepatitis B infection, hepatitis C infection, cirrhosis, heavy alcohol consumption, and nonalcoholic steatohepatitis.2
Neuroendocrine tumors (NETs) arise from neural and endocrine organs throughout the body, most commonly the gastrointestinal system and pancreas. The World Health Organization classifies well-differentiated gastroenteropancreatic NETs into low grade and intermediate grade, and most poorly differentiated tumors are considered high grade, based on mitotic count/Ki-67 proliferative index.1 Indolent and well-differentiated tumors of the digestive system are traditionally called carcinoid and pancreatic neuroendocrine (islet cell) tumors. Well-differentiated tumors are often indolent, even in the setting of metastatic disease, and thus, are labeled “cancers in slow motion.”2
More than 65,000 patients will be diagnosed with renal cell carcinoma (RCC) in the United States this year.1 RCC is the most common malignant renal neoplasm and accounts for 2% to 3% of all malignancies in the United States.2 The proliferation of cross-sectional imaging techniques (CT and ultrasound) for abdominal disease and symptomatology has led to increased diagnosis and awareness of incidental RCC. Incidental RCCs tend to be smaller and lower stage with an advantageous survival profile when compared to patients with regional or distant metastases.3
According to the Surveillance, Epidemiology, and End Result program of the National Cancer Institute, 48,960 new cases of pancreatic cancer are expected in United States in 2015.1 Pancreatic cancer has a peak incidence in the sixth and seventh decade of a person’s life, affecting men more commonly than women. Even though it is only the twelfth most common cancer by incidence (accounting for only 3% of all new cancers diagnosed), it is one of the most lethal cancers, with a 7.2% expected 5-year survival and 40,560 attributed deaths in 2015.1 One of the contributing factors leading to high mortality is delayed diagnosis due to vague early symptoms.
Thrombosis is a major complication of both cancer and its treatment. In up to 10% to 20% of patients, this can be the presenting sign of cancer, especially in older patients or those with idiopathic thrombosis. Furthermore, up to 25% of patients with spontaneous thrombosis will develop cancer within 2 years. Certain presentations are more worrisome for underlying cancer as the cause (ie, warfarin-refractory thrombosis, idiopathic bilateral deep vein thrombosis [DVT], or both arterial and venous thrombosis), and the most frequently associated cancers are adenocarcinoma of the lung and gastrointestinal tract, especially pancreatic cancer. Primary brain tumors, as well as kidney, ovarian, and uterine cancers, are also associated with a higher risk of thrombosis,1 but the risk does not appear to be as high for breast and prostate cancer.2
An association between venous thrombosis and malignancy is well established, with the first description of this phenomenon occurring in 1823.1 Malignancy is associated with a significantly increased risk of venous thrombosis, with relative risk estimates ranging from 4 to 7.1 In a large study that examined more than 3,000 cancer patients, malignancy was seen to increase the risk of venous thrombosis sevenfold (odds ratio, 6.7).2 Venous thrombosis risk in this study was particularly high in patients with distant metastasis, factor V Leiden, or prothrombin 20210A mutation, as well as in the first few months after cancer diagnosis. Cancer stage significantly influences the likelihood of thrombosis, with an adjusted relative risk of 2.9 and 17.1 in stage 1 and 4 disease, respectively.3 The level of risk also relates to malignancy type, with the highest incidence of thrombosis seen in patients with brain, pancreatic, lung, and ovarian cancer.1
Caval occlusion of malignant etiology is an insidious pathologic entity, resulting in substantial morbidity and limiting quality of life in severely ill and/or terminal patients. Relief from this condition relies upon astute recognition of the pathology and skilled intervention. Patients with long-standing chronic occlusions of the inferior vena cava (IVC) secondary to malignancy may present a diagnostic challenge. Onset can be slow, and the cause may not be obvious (ie, acquired symptomatology vs congenital defect).1 Symptoms and presentation vary between affected individuals based on various factors, including clot distribution, level of occlusion, activity level, and collateralization. Occlusion may commonly present as a dull aching pain in the extremities, as well as symptoms of venous claudication, in which lower limb swelling and discomfort are precipitated by exercise and relieved by rest and elevation. Venous ulceration can be seen in long-standing cases.2
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