Background—The direct thrombin inhibitor, bivalirudin, is associated with similar efficacy and superior safety in patients undergoing percutaneous coronary intervention. However, the role of direct thrombin inhibitors in carotid artery stenting is not well defined. The objective of this study was to compare the safety and effectiveness of bivalirudin and unfractionated heparin (UFH) for carotid artery stenting. We hypothesized that bivalirudin would be associated with less in-hospital postprocedure bleeding than UFH but similar rates of in-hospital and 30-day ischemic outcomes.
Objective: Vasodilators are used with caution in patients with chronic obstructive pulmonary disease (COPD). We have developed a device for percutaneous arteriovenous shunt creation in the iliac region to increase cardiac output and oxygen delivery for patients with COPD. Although this device does not cause significant blood pressure changes in normotensive patients with COPD, we hypothesized that arteriovenous shunt creation might cause vasodilator effects in hypertensive patients because of a reduction in vascular resistance.
Beginning with the first radial artery (RA) access I performed in 2000, I realized that the transradial approach is the true minimally invasive, safer, patient-friendly approach for coronary and endovascular intervention. This belief eventually evolved into a “radial always, unless contraindicated” approach. Because of the safety associated with radial access, the European Society of Cardiology consensus statement has recommended that radial access should be the default approach for cardiac catheterization.1
Since the early 2000s, percutaneous transcatheter aortic valve replacement (TAVR) has rapidly developed. Currently, there is sufficient evidence that it can be considered as a valid alternative to conventional cardiac surgery for patients with severe aortic stenosis who are at high surgical risk. The patients we currently treat are generally frail and elderly and are more likely to have vascular access issues.
Aortic dissections are classified by site (Stanford type A, ascending aorta; type B, descending aorta) and chronicity (acute if onset of symptoms < 2 weeks, chronic if > 2 weeks). The acute group can further be subdivided into complicated and noncomplicated subgroups. Complications, and therefore indications for intervention, include rupture, expanding aneurysms, visceral and lower limb malperfusion, refractory pain, hypertension, and false aneurysm formation.
Carotid artery stenting (CAS) has been shown to be an effective treatment modality in patients with carotid artery occlusive disease. However, patients with complex aortic arch anatomy and octogenarians may be considered high risk, with increased stroke risk during CAS. Schneider et al identified severe aortoiliac disease, unfavorable aortic arch configuration (type II or III), bovine arch anatomy, and supra-aortic vessel take-off as conditions rendering CAS more difficult.9
In terms of devices that treat chronic total occlusions (CTOs), the TruePath™ CTO Device (Boston Scientific Corporation, Natick, MA; see sidebar) offers the most versatility in managing a variety of lesion types and anatomical locations. For example, an intraluminal device such as the Frontrunner (Cordis Corporation, Bridgewater, NJ) serves its purpose, but when the interventionist is faced with a very hard, smooth proximal cap, it will not be easily traversed unless specific techniques are employed to make a “dent” in the cap. The TruePath device, however, is designed to “drill” through the proximal cap or occlusion regardless of composition, be it soft tissue, ulcerated plaque, mixed fibrocalcific, or extremely calcific. In addition, because of its 0.017-inch profile, it may traverse multiple levels over the length of a given CTO, including the distal cap.
Endovascular treatment of chronic total occlusions of the peripheral arteries was initially accomplished using subintimal angioplasty. After the seminal description of the technique by Bolia et al,1 the use of subintimal angioplasty was questioned as a useful technique for recanalization of totally occluded arteries. The patency of a subintimal tract was thought to be poor, and the technique raised the risk for propagation of the dissection into normal arteries beyond the occlusion. With improved wires and catheters, as well as the development of stents to address the acute technical and angiographic failure of subintimal angioplasty of total occlusions, the use of subintimal angioplasty increased.
The number of patients living with peripheral vascular disease (PVD) in the United States will continue to increase and will exceed 20 million by the year 2030. But this epidemic is not isolated to Western countries. A recent analysis evaluating the prevalence of PVD in third-world countries shows an increase of 27%. The overall incidence of critical limb ischemia (CLI) and lower extremity arterial ulcers has been estimated at 1% to 2%.
Objectives This study sought to evaluate whether a strategy with a 600-mg clopidogrel load and a short-term, high-dose atorvastatin reload would improve outcomes in clopidogrel-naïve, statin-treated patients undergoing protected carotid stenting.
Background: Dabigatran and warfarin have been compared for the treatment of acute venous thromboembolism (VTE) in a previous trial. We undertook this study to extend those findings.
Background: Factors explaining the association between impaired kidney function and venous thrombosis have not been identified so far. The aim of our study was to determine whether the association between impaired kidney function and venous thrombosis can be explained by the concurrent presence of genetic or acquired venous thrombosis risk factors.
Objectives: Because of the increasing number of interventional endovascular procedures with fluoroscopy and the corresponding high annual dose for interventionalists, additional dose-protecting measures are desirable. The purpose of this study was to evaluate the effect of disposable radiation-absorbing surgical drapes in reducing scatter radiation exposure for interventionalists and supporting staff during an endovascular aneurysm repair (EVAR) procedure.
It has been a singular honor and a privilege to serve as the 67th president of this distinguished society. A true American dream, when someone born behind the Iron Curtain, raised in communist Hungary, immigrates to this great nation, joins the staff of Mayo Clinic, and completes his term as president of the most prestigious vascular surgical society in the world. It is humbling to look around the room and see hundreds of colleagues I admire, including past presidents, giants of our profession who guided us during the past decades so that today we have a society that is stronger, larger, and more vibrant than any time before. I am thankful to them for their vision and hard work. I am equally thankful to the current leadership of the Society for Vascular Surgery (SVS), to a dedicated staff and hundreds of volunteers, many here today, who helped me build a better society and strengthen our profession during this past year.
Purpose: To test the ability of a drug-eluting balloon (DEB) to reduce recurrent in-stent restenosis (ISR) in diabetic patients with femoropopliteal stents.
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