01 septiembre 2012

AMERICAN HEART JOURNAL. Use of alternative methodologies for evaluation of composite end points in trials of therapies for critical limb ischemia

Sumeet Subherwal, MD, MBA, Kevin J. Anstrom, PhD, William S. Jones, MD, Michael G. Felker, MD, Sanjay Misra, MD, Michael S. Conte, MD, William R. Hiatt, MD, Manesh R. Patel, MD

Critical limb ischemia (CLI) represents advanced atherosclerosis of the lower extremities; results in severe hemodynamic compromise at rest; and manifests with lower extremity ischemic rest pain, ulceration, or gangrene. Patients with CLI have strikingly high morbidity and mortality rates, with 1-year mortality rates ranging from roughly 10% to 25% and 1-year amputation rates ranging from 10% to 20%.1, 2, 3, 4 Given the high morbidity and mortality associated with this CLI, goals of therapy include (1) reduction in overall mortality, (2) limb preservation with wound healing (in patients with wounds), and (3) improvement in quality of life with greater mobility and less pain. Attempts at medical therapies for CLI have included use of intravenous prostanoids, strict control of diabetes, smoking cessation, and wound care. Increasingly, the use of biologic therapies to induce angiogenesis (ie, protein therapy, gene therapy, and cell therapy) is being investigated for treatment of advanced peripheral arterydisease.2, 5, 6, 7, 8, 9 Furthermore, advances in technologies (ie, drug-coated balloons, atherectomy devices, and improvements in stent technology) for revascularization are increasingly being examined to improve outcomes in CLI.10, 11, 12 As these therapies evolve, a reappraisal of study designs and end points to evaluate newer biologics and device therapies will be needed. Ideally, study designs with end points that capture the major clinical goals of CLI therapy with sufficient sensitivity to detect meaningful differences should be sought. American Heart Journal Volume 164, Issue 3 , Pages 277-284, September 2012. Copyright © 2012 Mosby, Inc. All rights reserved.

01 octubre 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Open Versus Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms A Meta-Analysis of Randomized Trials

Objectives This study sought to evaluate the short-, intermediate-, and longer-term outcomes after endovascular versus open repair of abdominal aortic aneurysms (AAA), including both AAA-related and all-cause mortality. J Am Coll Cardiol Intv. 2012;5(10):1071-1080. doi:10.1016/j.jcin.2012.06.015. Copyright © 2012 by the American College of Cardiology Foundation

01 agosto 2012

JOURNAL OF ENDOVASCULAR THERAPY. Endovascular Brachytherapy Using Liquid Beta-Emitting Rhenium-188 for the Treatment of Long-Segment Femoropopliteal In-Stent Stenosis

Martin Werner, MD; Dierk Scheinert, MD; Marcela Henn; Susanne Scheinert, MD; Sven Bräunlich, MD; Yvonne Bausback, MD; Josef Friedenberger, MD; Johannes Schuster, MD; Klaus Hertting, MD; Michael Piorkowski, MD; Christian Rosner, DI; Andrej Schmidt, MD; Matthias Ulrich, MD; and Matthias Gutberlet, MD

Purpose: To evaluate the efficacy and safety of endovascular brachytherapy with liquid beta-emitting rhenium-188 (Re-188) in patients with long-segment in-stent stenosis in the femoropopliteal segment. J ENDOVASC THER 2012;19:467–475. Copyright © 2012 by the INTERNATIONAL SOCIETY OF ENDOVASCULAR SPECIALISTS

01 junio 2012

JOURNAL OF ENDOVASCULAR THERAPY. Safety and Feasibility of Intravascular Optical Coherence Tomography Using a Nonocclusive Technique to Evaluate Carotid Plaques Before and After Stent Deployment

Carlo Setacci, MD; Gianmarco de Donato, MD; Francesco Setacci, MD; Giuseppe Galzerano, MD; Pasqualino Sirignano, MD; Alessandro Cappelli, MD; and Giancarlo Palasciano, MD

Purpose: To evaluate the safety and feasibility of optical coherence tomography (OCT) in patients with carotid stenosis undergoing carotid artery stenting (CAS). J ENDOVASC THER 2012;19:303–311. Copyright © 2012 by the INTERNATIONAL SOCIETY OF ENDOVASCULAR SPECIALISTS

13 septiembre 2012

CVIR. Infectious or Noninfectious? Ruptured, Thrombosed Inflammatory Aortic Aneurysm with Spondylolysis

Ludomir Stefańczyk, Marcin Elgalal, Andrzej Papiewski, Wojciech Szubert and Piotr Szopiński

Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR. CardioVascular and Interventional Radiology 2012, DOI: 10.1007/s00270-012-0464-3. Copyright © The Author(s) 2012. This article is published with open access at Springerlink.com

28 diciembre 2011

DIR. Endovenous laser ablation for the treatment of varicose veins

Levent Oğuzkurt

Lower extremity venous insufficiency secondary to saphenous vein insufficiency is a common medical condition that decreases a patients quality of life. Traditionally treated with high ligation and stripping, minimally invasive procedures using endovenous thermal ablation techniques, such as endovenous laser ablation, have evolved. The use of detailed imaging and advances in the understanding of the anatomy of truncal vein insufficiency are important for performing the endovenous laser ablation procedure successfully. Endovenous laser ablation eliminates reflux with less morbidity, faster recovery, and improved cosmetic results with high patient satisfaction. As such, it has become the preferred treatment method for varicose veins since it was first introduced a decade ago. Diagn Interv Radiol 2012; 18:417–422. Copyright © Turkish Society of Radiology 2012

07 agosto 2012

JACC. Sirolimus-Eluting Stents for Treatment of Infrapopliteal Arteries Reduce Clinical Event Rate Compared to Bare-Metal Stents Long-Term Results From a Randomized Trial

Aljoscha Rastan, MD; Klaus Brechtel, MD; Hans Krankenberg, MD; Rainer Zahorsky, MD; Gunnar Tepe, MD; Elias Noory, MD; Uwe Schwarzwälder, MD; Roland Macharzina, MD; Thomas Schwarz, MD; Karlheinz Bürgelin, MD; Sebastian Sixt, MD; Thilo Tübler, MD; Franz-Josef Neumann, MD; Thomas Zeller, MD

Objectives The study investigated the long-term clinical impact of sirolimus-eluting stents (SES) in comparison with bare-metal stents (BMS) in treatment of focal infrapopliteal lesions. J Am Coll Cardiol. 2012;60(7):587-591. doi:10.1016/j.jacc.2012.04.035. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

01 marzo 2012

SEMINARS IN INTERVENTIONAL RADIOLOGY. Deep Vein Thrombosis: Thrombolysis in the Pediatric Population

Lindsey A. Greene, Neil A. Goldenberg

Improved medical treatment options have advanced pediatric care but often necessitate both invasive vascular procedures and venous access predisposing these patients to venous thrombotic events. Although pediatric deep vein thrombosis (DVT) is an increasingly recognized phenomenon, high-quality evidence for its antithrombotic treatment in general remains limited, and even more so with respect to thrombolytic therapy. Correspondingly, current American College of Chest Physicians guidelines discourage the routine use of thrombolytic therapy for pediatric DVT; by contrast, American Heart Association guidelines suggest consideration for such therapy in young patients in whom the balance of benefit to risk may be most favorable. The developing hemostatic system and relative rarity of thrombotic events have historically posed impediments to the design and conduction of prospective clinical trials of thrombolysis in children. This narrative review summarizes available information regarding thrombolytic therapy for pediatric DVT. Semin intervent Radiol 2012; 29(01): 036-043 DOI: 10.1055/s-0032-1302450. Copyright © 2012 by Thieme Medical Publishers, Inc.

01 marzo 2012

SEMINARS IN INTERVENTIONAL RADIOLOGY. Comprehensive Management of Subclavian Vein Effort Thrombosis

Robert W. Thompson

Subclavian vein (SCV) effort thrombosis, also known as the Paget-Schroetter syndrome, is a relatively uncommon condition that affects young, active, otherwise healthy individuals. It is considered a form of thoracic outlet syndrome, arising as a consequence of compression and repetitive injury of the SCV between the first rib and the overlying clavicle, as well as the anterior scalene muscle, subclavius muscle, and costoclavicular ligament. Effort thrombosis is distinct from other forms of deep vein thrombosis with respect to pathophysiology, clinical presentation, and functional consequences, and it requires treatment considerations unique to effective management of thoracic outlet compression as well as the obstructed SCV. In this review the comprehensive management of SCV effort thrombosis is addressed, with an emphasis on current interventional radiology techniques used in conjunction with definitive surgical treatment, based on early catheter-based venography, thrombolytic therapy, and prompt paraclavicular thoracic outlet decompression with direct SCV reconstruction. Semin intervent Radiol 2012; 29(01): 044-051 DOI: 10.1055/s-0032-1302451. Copyright © 2012 by Thieme Medical Publishers, Inc.

01 marzo 2012

SEMINARS IN INTERVENTIONAL RADIOLOGY. Aggressive Management of Pulmonary Embolism

Nael Saad

Pulmonary embolism (PE) and deep vein thrombosis are two elements of the same pathophysiological process referred to as venous thromboembolism. PE occurs when a thrombus migrates from a deep vein to the pulmonary arteries. Although the true incidence of PE is not known, it is estimated that 530,000 cases of PE occur annually in the United States. Clinical presentation varies from asymptomatic (incidentally diagnosed) to fatal. Development of symptoms depends on the embolic burden and the severity of any underlying cardiopulmonary disease. Several treatment options are available for patients diagnosed with PE. The mainstay of treatment is anticoagulation, but given the high mortality associated with some presentations of symptomatic PE, some advocate more aggressive therapy. In this article we discuss such therapies and their potential and appropriate use. Semin intervent Radiol 2012; 29(01): 052-056 DOI: 10.1055/s-0032-1302452. Copyright © 2012 by Thieme Medical Publishers, Inc.

01 enero 2012

JVIR. Pathogenesis of Varicose Veins

Rahmi Oklu, MD, PhD, Roy Habito, MD, Manuel Mayr, MD, PhD, Amy R. Deipolyi, MD, PhD, Hassan Albadawi, MD, Robin Hesketh, PhD, T. Gregory Walker, MD, Katy R. Linskey, MD, Chandler A. Long, MD, Stephan Wicky, MD, Julianne Stoughton, MD, and Michael T. Watkins, MD

Despite the high prevalence of varicose veins and the recent surge in research on the condition, the precise mechanisms underlying their development remain uncertain. In the past decade, there has been a shift from initial theories based on purely mechanical factors to hypotheses pointing to complex molecular changes causing histologic alterations in the vessel wall and extracellular matrix. Despite progress in understanding the molecular aspects of venous insufficiency, therapies for symptomatic varicose veins are directed toward anatomic and physical interventions. The present report reviews current evidence identifying the underlying biochemical alterations in the pathogenesis of varicose veins. Journal of Vascular and Interventional Radiology Volume 23, Issue 1 , Pages 33-39, January 2012. Copyright © SIR, 2012

05 junio 2012

CIRCULATION. Early Results of Fenestrated Endovascular Repair of Juxtarenal Aortic Aneurysms in the United Kingdom

On behalf of the British Society for Endovascular Therapy and the Global Collaborators on Advanced Stent-Graft Techniques for Aneurysm Repair (GLOBALSTAR) Registry

Background—Fenestrated endovascular repair of abdominal aortic aneurysms has been proposed as an alternative to open surgery for juxtarenal and pararenal abdominal aortic aneurysms. At present, the evidence base for this procedure is predominantly limited to single-center or single-operator series. The aim of this study was to present nationwide early results of fenestrated endovascular repair in the United Kingdom. Circulation. 2012; 125: 2707-2715 doi: 10.1161/​CIRCULATIONAHA.111.070334. Copyright © 2012 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

01 enero 2012

ANNALS OF VASCULAR SURGERY. Endovascular Management of Acute Limb Ischemia

Brian G. Hynes, Kenneth Rosenfield, Ronan J. Margey and Michael R. Jaff, Nicholas Ruggiero II, 1 2 Thomas J. Kiernan, Boston, Massachusetts; Philadelphia, Pennsylvania; and Cork, Ireland

Despite major advances in pharmacologic and endovascular therapies, acute limb ischemia (ALI) continues to result in significant morbidity and mortality. The incidence of ALI may be as high as 13-17 cases per 100,000 people per year, with mortality rates approaching 18% in some series.1, 2 This review will address the contemporary endovascular management of ALI encompassing pharmacologic and percutaneous interventional treatment strategies. Annals of Vascular Surgery Volume 26, Issue 1 , Pages 110-124, January 2012.
Copiryght © Annals of Vascular Surgery Inc. Published online: September 15, 2011.

01 enero 2012

JOURNAL OF VASCULAR SURGERY. Common femoral endovenectomy with iliocaval endoluminal recanalization improves symptoms and quality of life in patients with postthrombotic iliofemoral obstruction

David Vogel, MD , Anthony J. Comerota, MD, Mustafa Al-Jabouri, MD , Zakaria I. Assi, MD

The postthrombotic syndrome is a debilitating condition occurring in 30% to 50% of patients with lower extremity deep vein thrombosis (DVT). Following iliofemoral DVT, however, postthrombotic morbidity is especially severe, due to occlusion of the common femoral vein (CFV) and iliac veins. While endoluminal recanalization appears effective in restoring patency to the iliac venous system, infrainguinal obstruction of the CFV remains a problem. The purpose of this study is to report preliminary observations of common femoral endovenectomy and intraoperative endoluminal recanalization of the iliac veins in patients with incapacitating postthrombotic iliofemoral obstruction. Journal of Vascular Surgery Volume 55, Issue 1 , Pages 129-135, January 2012. Copyright © 2012 by the Society for Vascular Surgery.

01 enero 2012

ANNALS OF VASCULAR SURGERY. Endovascular Repair of Bilateral Iliac Artery Aneurysms in a Patient With Loeys–Dietz Syndrome

Kevin Casey, Mohamed Zayed, Joshua I. Greenberg, Ronald L. Dalman, and Jason T. Lee, Stanford, California

Background: Loeys–Dietz syndrome (LDS) is a rare congenital connective tissue disorder (CTD) caused by mutations in the gene encoding for transforming growth factor-β receptors I and II. This recently described syndrome is characterized by aortic aneurysms and dissections, arterial tortuosity, and spontaneous organ perforation. The technical feasibility of endovascular interventions, particularly endovascular aneurysm repair (EVAR), in CTDs is relatively unknown. Annals of Vascular Surgery Volume 26, Issue 1 , Pages 107.e5-107.e10, January 2012.
Copiryght © Annals of Vascular Surgery Inc. Published online: August 11, 2011.