01 junio 2011

JACC CARDIOVASCULAR INTERVENTIONS. Safety of Contemporary Percutaneous Peripheral Arterial Interventions in the Elderly. Insights From the BMC2 PVI (Blue Cross Blue Shield of Michigan Cardiovascular Consortium Peripheral Vascular Intervention) Registry

Benjamin R. Plaisance, MD, Khan Munir, PhD, David A. Share, MD, MPH, M. Ashraf Mansour, MD, James M. Fox, MD, Paul G. Bove, MD, Arthur L. Riba, MD, Stanley J. Chetcuti, MD, Hitinder S. Gurm, MD and P. Michael Grossman, MD

Objectives: This study sought to evaluate the effect of age on procedure type, periprocedural management, and in-hospital outcomes of patients undergoing lower-extremity (LE) peripheral vascular intervention (PVI). Background: Surgical therapy of peripheral arterial disease is associated with significant morbidity and mortality in the elderly. There are limited data related to the influence of advanced age on the outcome of patients undergoing percutaneous LE PVI. JACC: CARDIOVASCULAR INTERVENTIONS VOL. 4, NO. 6, 2011. Copyright © 2011 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/$36.00. PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2011.03.012.

01 enero 2012

JOURNAL OF VASCULAR SURGERY. Age differential between outcomes of carotid angioplasty and stent placement and carotid endarterectomy in general practice

Rakesh Khatri, MD , Saqib A. Chaudhry, MD , Gabriela Vazquez, PhD , Gustavo J. Rodriguez, MD , Ameer E. Hassan, DO , M. Fareed K. Suri, MD , Adnan I. Qureshi, MD

Data derived from prospective randomized clinical trials suggest differential comparative benefit between carotid angioplasty and stent (CAS) placement and carotid endarterectomy (CEA) in various age strata. We sought to investigate the impact of age on outcomes of CAS and CEA in general practice. Journal of Vascular Surgery Volume 55, Issue 1 , Pages 72-78, January 2012. Copyright © 2012 by the Society for Vascular Surgery.

01 junio 2011

VASCULAR MEDICINE. Upper extremity deep venous thrombosis

Michael Czihal and Ulrich Hoffmann

Upper extremity deep venous thrombosis is a serious disease entity which, based on the pathogenesis and in view of the individual patient’s prognosis, must be divided into a primary and a secondary form. Primary upper extremity deep venous thrombosis is, when related to effort, a rather benign disease with excellent prognosis quoad vitam, carrying only a minor potential of developing disabling post-thrombotic syndrome. If primary upper extremity deep venous thrombosis occurs without any obvious cause, screening for underlying malignancy is recommended. Secondary upper extremity deep venous thrombosis typically occurs in older patients with severe comorbidities, mainly related to indwelling central venous catheters and cancer. As a consequence of the underlying diseases, prognosis of secondary upper extremity deep venous thrombosis is poor. Despite a lack of high-quality validation data, ultrasonography is regarded the first-line imaging technique, since it is a non-invasive method without exposure to radiation. In case of a non-diagnostic result of ultrasonography, other imaging modalities such as magnetic resonance imaging and computed tomography may be applied. Regardless of the etiology, the cornerstone of therapy is anticoagulant treatment with low molecular weight heparin or unfractionated heparin and vitamin K antagonists in order to prevent thrombus progression and pulmonary embolism. Owing to a lack of evidence, the optimal duration of anticoagulant treatment remains unclear. The additional benefit of compression therapy as well as of more aggressive therapeutic approaches such as thrombolysis, angioplasty and surgical decompression of the thoracic outlet needs to be investigated in randomized trials. Published online before print February 22, 2011, doi: 10.1177/1358863X10395657 Vascular Medicine June 2011 vol. 16 no. 3 191-202. Copiryght © The Author(s) 2011

01 junio 2011

CIRCULATION. Predictors of Abdominal Aortic Aneurysm Sac Enlargement After Endovascular Repair

Andres Schanzer, MD; Roy K. Greenberg, MD; Nathanael Hevelone, MPH; William P. Robinson, MD; Mohammad H. Eslami, MD; Robert J. Goldberg, PhD; Louis Messina, MD

Background—The majority of infrarenal abdominal aortic aneurysm (AAA) repairs in the United States are performed with endovascular methods. Baseline aortoiliac arterial anatomic characteristics are fundamental criteria for appropriate patient selection for endovascular aortic repair (EVAR) and key determinants of long-term success. We evaluated compliance with anatomic guidelines for EVAR and the relationship between baseline aortoiliac arterial anatomy and post-EVAR AAA sac enlargement. Circulation. 2011; 123: 2848-2855 Published online before print April 10, 2011, doi: 10.1161. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

01 marzo 2011

SEMINARS IN VASCULAR SURGERY. Choosing the Appropriate Intervention for Symptomatic and Asymptomatic Carotid Disease in the Era of Multiple Therapies: Integration of Risk Profile and Technical Data

Gautam V. Shrikhande, MD, and James F. McKinsey, MD

With rapid evolution of endovascular techniques, carotid artery stenting has emerged as an alternative to carotid endarterectomy. Several investigations have been performed that examine the roles of carotid endarterectomy and carotid artery stenting and some trials have sought to compare the two treatment modalities. There have also been advances in the understanding of optimal medical management of carotid artery stenosis. The obvious question that arises is what is the most appropriate treatment option for patients with symptomatic and asymptomatic carotid artery stenosis? The answer is not straightforward and requires an understanding of differential outcomes in select subgroups. A review of the major studies, including some of the most recent trials, will help to elucidate the optimal therapy. Seminars in Vascular Surgery Volume 24, Issue 1 , Pages 53-59, March 2011. Copiryght © 2011 Elsevier Inc. All rights reserved.

01 enero 2012

JOURNAL OF VASCULAR SURGERY. Neurological complications of sclerotherapy for varicose veins

Tharsi Sarvananthan, MBBS, Amanda Claire Shepherd, MBBS, Torsten Willenberg, MD, and Alun Huw Davies, DM, FRCS, London, United Kingdom

Sclerotherapy has been shown to be an effective and increasingly popular therapeutic strategy for the treatment of varicose veins. However, recent reports of serious side effects, including cerebrovascular accidents (CVA) and transient ischemic attacks (TIA), as well as speech and visual disturbances, have caused serious concern regarding its use. This review evaluated the reported incidences of neurological side effects associated with the use of sclerotherapy. Journal of Vascular Surgery Volume 55, Issue 1 , Pages 243-251, January 2012. Copyright © 2012 by the Society for Vascular Surgery.

01 junio 2011

CIRCULATION. Myocardial Infarction After Carotid Stenting and Endarterectomy. Results From the Carotid Revascularization Endarterectomy Versus Stenting Trial

Joseph L. Blackshear, MD; Donald E. Cutlip, MD; Gary S. Roubin, MD; Michael D. Hill, MD; Pierre P. Leimgruber, MD; Richard J. Begg, MD; David J. Cohen, MD; John F. Eidt, MD; Craig R. Narins, MD; Ronald J. Prineas, MD; Stephen P. Glasser, MD; Jenifer H. Voeks, PhD; Thomas G. Brott, MD; for the CREST Investigators

Background—The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) found a higher risk of stroke after carotid artery stenting and a higher risk of myocardial infarction (MI) after carotid endarterectomy. Circulation. 2011; 123: 2571-2578 Published online before print May 23, 2011, doi: 10.1161.

01 marzo 2011

SEMINARS IN VASCULAR SURGERY. Endovascular Management of Patients with Takayasu Arteritis: Stents versus Stent Grafts

Moqueet A. Qureshi, MD , Zenia Martin, MD and Roy K. Greenberg, MD

Our objective was to report the experience of endovascular therapy to treat patients with Takayasu arteritis (TA) and evaluate outcomes. A review was undertaken of TA patients treated with endovascular means during a 9-year (2004 to 2011) period. Patients were diagnosed using the American College of Rheumatology criteria and classified, based on angiographic criteria, using the Numano s Classification. The primary assessment of our analysis included patency of stent and stentgrafts. Seminars in Vascular Surgery Volume 24, Issue 1 , Pages 44-52, March 2011. Copiryght © 2011 Elsevier Inc. All rights reserved.

01 junio 2011

JACC. The Importance of Functional Status in the Management of Peripheral Arterial Disease

Mehdi H. Shishehbor, DO, MPH

An estimated 8 to 12 million Americans carry the diagnosis of peripheral arterial disease (PAD) (1,2). Their prognosis is extremely poor and is similar to that associated with many malignancies. Within 10 years of diagnosis, more than 50% of afflicted patients will have succumbed to this disorder and nearly 20% will have had a limb amputated (3,4). Importantly, the presence of PAD is frequently indicative of cerebral and coronary artery disease. Indeed, the majority of patients with PAD die from coronary heart disease (3). Lack of physical fitness, a powerful predictor of cardiovascular and all-cause mortality, may explain why individuals with PAD have such poor outcomes (5–7). In a series of important reports, McDermott et al. (5,6,8) have shown greater functional decline to be associated with patients with PAD than those without PAD. Furthermore, individuals with PAD who are typically considered "asymptomatic" are less fit than those with classic intermittent claudication, as measured by the 6-min walk test, and have less calf muscle mass and increased calf fat density (9). Journal of the American College of Cardiology Vol. 57, No. 23, 2011. Copyright © 2011 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00. Published by Elsevier Inc. doi:10.1016/j.jacc.2010.12.037.

01 marzo 2011

SEMINARS IN VASCULAR SURGERY. Role of Carotid Stenting in Management of Carotid Bifurcation Disease: Was the Revolution Overstated?

William A. Gray, MD

At its advent, carotid artery stenting (CAS) was widely touted by some as a revolution in the revascularization of severe carotid artery disease, destined to replace carotid endarterectomy (CEA). However, 15 years after the early phases of CAS, it still has only a limited role in carotid therapy in the US. This article will explore the reasons why, which are related to expert operator availability, early trials (largely EU based) that did not support the safety of CAS but which were confounded by a variety of factors which severely limited a true assessment of CAS outcomes, mandatory time-lines involved with regulatory approval, technique and patient selection, and Medicare non-coverage for the multiple FDA-approved devices except for a very select population of patients. The recent publication of the CREST study, and the subsequent FDA Devices Panel presentation of additional analyses, demonstrates equivalent safety and long-term stroke prevention efficacy. This, combined with the adjunct morbidity associated with CEA including cranial nerve injury and excess incisional site complications, suggests that, assuming FDA and CMS approvals, that CAS is poised to have a greater place in the management of the carotid patient. Seminars in Vascular Surgery Volume 24, Issue 1 , Pages 21-23, March 2011. Copiryght © 2011 Elsevier Inc. All rights reserved.

01 junio 2011

CIRCULATION. Total Arch Repair for Acute Type A Aortic Dissection With 2 Modified Techniques: Open Single-Branched Stent Graft Placement and Reinforcement of the Dissected Arch Vessel Stump With Stent Graft

Liang-Wan Chen, MD; Xi-Jie Wu, MD; Lin Lu, MD; Gui-Can Zhang, MD; Guo-Feng Yang, MD; Zhao-Wei Yang, MD; Yi Dong, MD; Hua Cao, MD; Qiang Chen, MD

Background—In total arch replacement for patients with acute type A aortic dissection, anastomoses of the graft to the left subclavian artery and descending aorta are often difficult, and the arch vessel anastomosis is frequently performed at the site of dissection. To make this procedure easier and safer, we developed 2 modified techniques: open single-branched stent graft placement into the left subclavian artery and the descending aorta and reinforcement of the dissected arch vessel stump with a stent graft neointima. The feasibility and initial clinical results of these 2 new techniques are reported. Circulation. 2011; 123: 2536-2541 Published online before print May 16, 2011, doi: 10.1161. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539.

01 enero 2012

ANNALS OF VASCULAR SURGERY. Preservation of Hypogastric Artery Blood Flow During Endovascular Aneurysm Repair of an Abdominal Aortic Aneurysm With Bilateral Common and Internal Iliac Artery Involvement: Utilization of Off-the-Shelf Stent-Graft Components

Paul J. Riesenman, Joseph J. Ricotta II, and Ravi K. Veeraswamy, Atlanta, Georgia

A 72-year-old male presented with a 7.4-cm abdominal aortic aneurysm with bilateral common and internal iliac involvement. To maintain pelvic perfusion, preservation of the patient’s left hypogastric artery (HA) was pursued. Two weeks after right HA embolization, endovascular repair of the patient’s aneurysms was performed using a branched endograft approach. A 22-mm main body bifurcated endograft was unsheathed and the proximal covered stent was removed. The contralateral gate was preloaded with a wire and catheter. The device was resheathed and placed in the left common iliac artery. The preloaded wire in the contralateral gate was snared from the right side, establishing through-and-through femoral access. A contralateral femoral sheath was advanced up and over the aortic bifurcation from the right side into the contralateral gate of the bifurcated endograft. The repair was bridged to the left HA using a balloon-expandable stent-graft, followed by standard endovascular abdominal aortic aneurysm repair. Completion angiography demonstrated exclusion of patient’s aneurysms, without evidence of endoleak, and maintenance of pelvic blood flow through the left HA. The patient recovered without complication and was discharged home on postoperative day 4. This technique illustrates the technical feasibility of using a preloaded commercially available endograft to preserve HA blood flow and maintain pelvic perfusion during endovascular aortic aneurysm repair. Annals of Vascular Surgery Volume 26, Issue 1 , Pages 109.e1-109.e5, January 2012. Copiryght © Annals of Vascular Surgery Inc.

01 enero 2012

ANNALS OF VASCULAR SURGERY. Increasing Complexity in the Open Surgical Repair of Abdominal Aortic Aneurysms

Neal R. Barshes, James McPhee, C. Keith Ozaki, Louis L. Nguyen, Matthew T. Menard, Edwin Gravereaux, and Michael Belkin, Boston, Massachusetts

Background: Patient selection and techniques for the operative management of abdominal aortic aneurysms (AAAs) continue to evolve. We sought to examine trends in open surgical repair (OSR) over a 15-year period in which endovascular aneurysm repair (EVAR) has become increasingly prevalent. Annals of Vascular Surgery Volume 26, Issue 1 , Pages 10-17, January 2012. Ann Vasc Surg 2012; 26: 10-17 DOI: 10.1016/j.avsg.2011.11.001.
Copiryght © Annals of Vascular Surgery Inc.

15 febrero 2012

CARDIOVASCULAR DISORDERS. Effect of calcification on the mechanical stability of plaque based on a three-dimensional carotid bifurcation model

Kelvin KL Wong, Pongpat Thavornpattanapong, Sherman CP Cheung, Zhonghua Sun and Jiyuan Tu

This study characterizes the distribution and components of plaque structure by presenting a three-dimensional blood-vessel modelling with the aim of determining mechanical properties due to the effect of lipid core and calcification within a plaque. Numerical simulation has been used to answer how cap thickness and calcium distribution in lipids influence the biomechanical stress on the plaque. BMC Cardiovascular Disorders Volume 12, Number 1 (2012), 7, DOI: 10.1186/1471-2261-12-7. Copyright © 2012 Wong et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License .

01 junio 2011

JACC. Greater Sedentary Hours and Slower Walking Speed Outside the Home Predict Faster Declines in Functioning and Adverse Calf Muscle Changes in Peripheral Arterial Disease

Mary M. McDermott, MD, Kiang Liu, PhD, Luigi Ferrucci, MD, PhD, Lu Tian, ScD, Jack M. Guralnik, MD, PhD, Yihua Liao, MS and Michael H. Criqui, MD, MPH

Objectives: In participants with peripheral arterial disease (PAD), we determined whether more sedentary behavior and slower outdoor walking speed were associated with faster functional decline and more adverse changes in calf muscle characteristics over time. Background: Modifiable behaviors associated with faster functional decline in lower-extremity PAD are understudied. Journal of the American College of Cardiology Vol. 57, No. 23, 2011. Copyright © 2011 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00. Published by Elsevier Inc. doi:10.1016/j.jacc.2010.12.038.