Seminars in Vascular Surgery (SEMIN VASC SURG )

Description

Each issue of Seminars in Vascular Surgery examines the latest thinking on a particular clinical problem and features new diagnostic and operative techniques. The journal allows practitioners to expand their capabilities and to keep pace with the most rapidly evolving areas of surgery.

  • Impact factor
    1.02
  • 5-year impact
    1.28
  • Cited half-life
    6.90
  • Immediacy index
    0.05
  • Eigenfactor
    0.00
  • Article influence
    0.53
  • Website
    Seminars in Vascular Surgery website
  • Other titles
    Seminars in vascular surgery (Online), Seminars in vascular surgery
  • ISSN
    1558-4518
  • OCLC
    60626665
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publications in this journal

  • Seminars in Vascular Surgery 01/2014; 26(2-3):57-8.
  • Seminars in Vascular Surgery 03/2013; 26(1):1.
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    ABSTRACT: Nutcracker syndrome is one of the abdominal venous entrapments, caused by compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. Occasionally a retro-aortic left renal vein is compressed between the aorta and the vertebral body (posterior nutcracker syndrome). The renal vein distal to the compression is dilated and renal venous flow can be diverted toward the pelvis through an incompetent, refluxing, left ovarian or spermatic vein, in addition to drainage through retroperitoneal venous collaterals. In this article, we describe the different surgical and endovascular techniques that are used to treat this syndrome.
    Seminars in Vascular Surgery 03/2013; 26(1):35-42.
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    ABSTRACT: Pulmonary embolism (PE) after venous procedures is fortunately rare. Our goal was to analyze the data of patients who developed PE after endovenous thermal ablation and phlebectomy for varicose veins and to review the literature on this subject. We report on three patients who developed PE after radiofrequency ablation of the great saphenous vein and mini phlebectomy for symptomatic primary lower-extremity varicose veins. Early postoperative duplex scans confirmed successful closure of the great saphenous vein in all. One patient presented with chest pain and dyspnea, one with blood-tinged sputum, and the third with symptoms of saphenous thrombophlebitis. Two patients had PE from the saphenous vein thrombus and the third had gastrocnemius vein thrombosis extending into the popliteal vein. One had previous deep vein thrombosis. Computed tomography of the chest confirmed PE in all. Two patients were treated with anticoagulation, but the third patient with small PE declined such treatment. One patient underwent temporary inferior vena cava filter placement because of recurrent PE. In conclusion, PE is very rare but it can occur after endovenous thermal ablation of lower-extremity varicose veins. Selective thrombosis prophylaxis and preoperative counseling of the patients about signs and symptoms of deep vein thrombosis and PE are warranted for early recognition and rapid treatment.
    Seminars in Vascular Surgery 03/2013; 26(1):14-22.
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    ABSTRACT: With the introduction of retrievable inferior vena cava filters, the number being placed for protection from pulmonary embolism is steadily increasing. Despite this increased usage, the true incidence of complications associated with inferior vena cava filters is unknown. This article reviews the known complications associated with these filters and suggests recommendations and techniques for inferior vena cava filter removal.
    Seminars in Vascular Surgery 03/2013; 26(1):23-8.
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    ABSTRACT: Stent migration and dislodgment is a potential complication after endovenous stenting of the left renal vein (LRV) for nutcracker syndrome. Our purpose is to describe the technique for endovenous removal of such a dislodged stent that was used in a 36-year-old woman with nutcracker syndrome initially treated with renal vein transposition. Recurrent renal vein compression and symptoms developed and a 14 × 20-mm self-expanding stent was placed in the LRV and was noted to be dislodged into the inferior vena cava on the first post-procedure day. Through right internal jugular access, the stent was stabilized by cannulating a cell of the stent using a guide wire and an angled angiographic catheter. A 20Fr sheath was then placed via right femoral vein access into the inferior vena cava. The stent lumen was cannulated from femoral approach and the stent straightened with a stiff wire. An 18-mm angioplasty balloon was then used to capture the stent. The stent was then compressed with two 25-mm loop snares while simultaneously deflating the balloon as it was pulled into the 20Fr sheath and removed. The LRV was restented with an 18 × 40-mm self-expanding stent. Stenting of LRV for nutcracker syndrome can result in stent migration. Endovenous removal of such a dislodged self-expanding stent is feasible. Our technique emphasizes stent stabilization with cell cannulation and capture over a larger diameter balloon.
    Seminars in Vascular Surgery 03/2013; 26(1):43-7.
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    ABSTRACT: Recent sequencing of the human genome has opened up new areas of investigation for genetic aberrations responsible for the pathogenesis of many human diseases. To date, there have been no studies that have investigated the entire human genome for the genetic underpinnings of chronic venous insufficiency (CVI). Utilizing Gene Chip Arrays we analyzed the relative expression levels of more than 47,000 transcripts and variants and approximately 38,500 well-characterized genes from each of 20 patients (N (CVI)=10; N (Control Group)=10). Relative gene expression profiles significantly differed between patients with CVI and patients unaffected by CVI. Regulatory genes of mediators of the inflammatory reaction and collagen production were up-regulated and down-regulated, respectively in CVI patients. DNA microarray analysis also showed that relative gene expression of multiple genes which function remains to be elucidated was significantly different in CVI patients. Fundamental advancements in our knowledge of the human genome and understanding of the genetic basis of CVI represents an opportunity to develop new diagnostic, prognostic, preventive and therapeutic modalities in the management of CVI.
    Seminars in Vascular Surgery 03/2013; 26(1):2-13.
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    ABSTRACT: Vascular malformations result from an arrest of development of a normal vascular structure or from abnormal growth of a vascular structure. Treatment continues to be a challenge. We sought to study the outcomes of sclerotherapy and embolization for vascular malformations. We reviewed clinical data of all patients treated with sclerotherapy or embolization for arteriovenous or venous malformations between 2006 and 2010 at Mayo Clinic. Follow-up information was obtained from clinical charts and a questionnaire sent to all patients. Overall, 60 patients (24 male and 36 female; mean age 31.7 years; range, 5.6 to 72.4 years) had 163 unique sclerotherapy or embolization procedures for lesions involving the lower extremity (55%), upper extremity (18.3%), pelvis (11.7%), abdomen (5%), chest (5%), back (3.3%), and multiple locations (1.7%). Thirty-one patients had low-flow venous malformations and 29 patients had high-flow arteriovenous malformations. Twenty-four patients required more than three sessions. The most common indication for intervention was pain (57 of 60 [95%]). Sixteen patients (27%) had documented or patient-reported complications. There was no significant difference in complication rates or lesion size between patients with low-flow or high-flow lesions. There were no procedural deaths. Mean available follow-up was 2.0 ± 1.3 years (range, 0.5 to 5.0 years). Median pain scores at most recent follow-up decreased significantly (P<.001). Eighty-three percent of the responders (24 of 29) would recommend treatment to others. With appropriate patient selection, sclerotherapy and embolization can decrease the pain of patients with arteriovenous and venous malformations. Multiple interventions might be necessary. Practitioners should be aware of the potential complications and counsel their patients about these risks.
    Seminars in Vascular Surgery 03/2013; 26(1):48-54.
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    ABSTRACT: Chronic occlusion of the Inferior Vena Cava (IVC) can go unnoticed because of the remarkable compensatory mechanism of the human body. On the other hand, IVC occlusion can have a significant and debilitating effect on an individual's ability to live a normal lifestyle and be an active and productive member of society. With the introduction of endovascular technology, new treatment options have opened for patients with this condition. This article describes the technical aspects of IVC recanalization and briefly discusses follow-up care and limited reports on outcomes from the procedure.
    Seminars in Vascular Surgery 03/2013; 26(1):29-34.
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    ABSTRACT: Duplex ultrasound testing has evolved to be a clinically useful modality for the evaluation of chronic mesenteric ischemia (CMI) due to visceral artery origin atherosclerosis. Patients with known or suspected CMI can be scanned to identify stenosis or occlusion of the celiac, superior mesenteric, and inferior mesenteric arteries. Testing requires expertise in abdominal ultrasound imaging and arterial duplex scan interpretation, as well as a fundamental understanding of visceral artery hemodynamics and collateral pathways created as a result of occlusive lesions. Duplex testing can also be utilized to evaluate functional patency following visceral artery bypass grafting procedures or endovascular stent angioplasty, Repair site stenosis can be reliably identified which assists in decision-making regarding the need for re-intervention to treat or prevent recurrent gut ischemia. Visceral duplex testing of a bypass graft or stent angioplasty site that shows peak systolic velocity (PSV) >300 cm/s with end-diastolic velocities >50 to 70 cm/s, or a damped velocity spectra within a bypass graft and low (<40 cm/s) PSV should be considered for interrogation by visceral angiography to confirm or exclude severe (>70%) stenosis. Visceral duplex testing should be considered a screening diagnostic modality that compliments clinical assessment of CMI both prior to and following open surgical or endovascular visceral artery interventions.
    Seminars in Vascular Surgery 01/2013;
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    ABSTRACT: Vascular laboratory testing of patients with arterial and venous disease requires a thorough understanding of the diagnostic instrumentation, anatomy, and blood flow hemodynamics. Diagnostic testing typically uses both Doppler ultrasound, especially duplex ultrasonography, alone or in combination with air plethysmography, to identify and classify vascular disease. In patients with symptomatic peripheral vascular disease, clinical evaluation is enhanced by noninvasive testing, and for many patients can provide sufficient information to proceed with medical treatment or intervention without additional confirmatory imaging studies. The diagnostic accuracy of vascular testing depends on the precision and reproducibility of the measurement (eg, pressure, pulse contour, blood flow velocity, or volume flow rate). For example, the measurement of ankle systolic blood pressure cannot always be assumed to be accurate because the test result can be affected by a number of factors, including biological variability, cuff size and placement, examiner skill, or the presence of tibial artery calcification preventing cuff occlusion. Interpretation of all vascular diagnostic testing requires an appreciation of the limitations, pitfalls, and artifacts of the testing modality. Interpretation errors can result in an incorrect diagnosis and subsequent decision making.
    Seminars in Vascular Surgery 01/2013; 26(2-3):67-71.
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    ABSTRACT: Intraoperative assessment of arterial repairs can be performed using angiography or ultrasound techniques. Duplex ultrasound is an accurate technique to image and assess the hemodynamics of repaired arteries using color and pulsed Doppler velocity spectra recordings. Procedure-specific interpretation criteria should be used to determine the technical adequacy of carotid artery endarterectomy, renal/visceral arterial repairs, and infrainguinal limb arterial bypass. The interpretation pathway for intraoperative assessment is detailed, focusing on transducer selection, imaging technique, and velocity spectra criteria for residual stenosis.
    Seminars in Vascular Surgery 01/2013; 26(2-3):105-110.
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    ABSTRACT: Conditions producing dialysis access dysfunction include failure of access maturation, cannulation injury to the conduit wall, thrombosis, low volume flow, and aneurysmal degeneration. Duplex ultrasound is an accurate diagnostic technique to assess dialysis access anatomy and function, including the obligatory criteria for maturation, e.g. volume flow >800 ml/min, conduit depth 0.6 cm from skin surface, and adequate (>5 mm) conduit diameter for cannulation. Measurement of access volume flow from the brachial artery or access conduit is prognostic for effective dialysis and conduit patency; including the determination if access maturation has occurred or when to intervene for a duplex-identified access stenosis. The application of duplex surveillance after autogenous vein or prosthetic bridge dialysis access construction has the potential to improve patency and function in the patient whose life is dependent on effective hemodialysis.
    Seminars in Vascular Surgery 01/2013;
  • Seminars in Vascular Surgery 01/2013;
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    ABSTRACT: Open repair of thoracoabdominal aortic aneurysms (TAAAs) is associated with significant morbidity and mortality. While open repair has remained the mainstay for treatment, this major surgical reconstruction is associated with a variety of complications due to the cardiopulmonary stress of this large-scale operation. Some of these complications include respiratory failure, heart failure, and acute renal failure, as well as spinal cord ischemia. With the progression of endovascular stent-graft technology, the development of a staged hybrid technique was first reported in the literature in 2004. The tenet of the hybrid approach is based on the reduced physiologic stress of operating through one visceral cavity rather than two (abdomen and thorax), which reduces complications and improves the ultimate outcome. This hybrid approach effectively "shifts" the proximal endovascular aortic repair landing zone away from a diseased paravisceral aorta to healthier proximal descending thoracic aorta by means of preceding open retrograde visceral bypass grafts. When thoracic endovascular aneurysm repair became available in 2005, there was much enthusiasm for this hybrid technique to extend the application for these patients with aneurysmal aorta in the paravisceral segment. However, subsequent reports have raised caution about the ultimate outcomes for this hybrid approach due to the major complications that still occur for these commonly infirmed patients. Instead, consideration of preoperative comorbidities, such as renal insufficiency, can influence outcomes. Review of the existing body of evidence identifies multiple small series describing these patients, but there is limited data of controlled trials or reasonable comparisons. We review some of the existing reports and provide our own experience with the hybrid technique of visceral debranching in preparation of a hybrid approach for thoracic endovascular aneurysm repair. We retrospectively evaluated our own experience evaluating hybrid repairs for TAAAs over a 5-year period. Between 2006 and 2010, 18 hybrid TAAA repairs were performed. Thirty-day mortality was 11.1%, with a 30-day visceral graft patency of 94.4%. One patient ruptured between visceral debranching and endovascular TAAA exclusion and is included as one of the two mortalities. Overall spinal cord ischemia occurred in 11.1% of hybrid TAAA repair patients. While fenestrated stent-graft technology continues to develop, the hybrid approach to TAAAs may reduce mortality as well as morbidity, particularly spinal cord ischemia, as supported by the current body of literature. The timing of each component of the staged approach remains to be standardized and long-term graft patency has not been established.
    Seminars in Vascular Surgery 12/2012; 25(4):203-7.
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    ABSTRACT: When one compares the potential advantages of endovascular aortic repair with respect to traditional open repair, it would seem logical that extension into the paravisceral aorta would be easily justified, given the complexity of open aortic repair and its associated complications. Eight years have transpired between trial initiation and Food and Drug Administration approval of the first fenestrated device in the United States for the treatment of juxtarenal aneurysms. While there are only a few centers in the United States with substantial experience performing fenestrated and branched endovascular aortic repair, there is a diverse experience outside the United States that has been gained over the past decade. It is through the experience of these centers that the technical and procedural complexities of complex endovascular aortic repair has been solved and provide the foundation that has allowed aortic specialists to move endovascular therapy into the paravisceral aorta with fenestrated and branched endovascular aortic repairs.
    Seminars in Vascular Surgery 12/2012; 25(4):193-9.
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    ABSTRACT: Inflammatory abdominal aortic aneurysms (IAAA) are being treated more frequently by endovascular aneurysm repair (EVAR). Some authors caution against treating IAAA by EVAR because retroperitoneal inflammation may not subside post-operatively. A recent experience of 69 IAAA treated by open and endovascular methods is presented with results supporting the use of EVAR for IAAA. Several other studies evaluating EVAR in the treatment of IAAA are discussed.
    Seminars in Vascular Surgery 12/2012; 25(4):227-31.
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    ABSTRACT: A sufficient infrarenal aortic neck is one of the key elements for successful outcome after endovascular repair of infrarenal aortic aneurysms (EVAR). The so-called proximal neck must be evaluated thoroughly during pre-operative sizing and planning concerning length, angulation, shape, existence of thrombus and calcification. Dynamic imaging with center lumen line reconstructions are of great help and should be used especially in challenging proximal anatomy. In this manuscript literature has been reviewed concerning the influence of proximal neck morphology on long-term EVAR outcome. Moreover, associations between endograft characteristics and proximal neck sealing will be thoroughly discussed.
    Seminars in Vascular Surgery 12/2012; 25(4):182-6.
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    ABSTRACT: Endovascular abdominal aneurysm repair is now the preferred therapy for many patients with abdominal aortic aneurysms and has been associated with reduced immediate and short-term morbidity and mortality. Because perioperative complications so often compromise the open repair of ruptured aortic aneurysms, EVAR has been considered as an attractive option in these patients. A number of small, typically single-center studies have demonstrated excellent results. In the absence of compelling, objective clinical data, there are certainly many patients with ruptured aortic aneurysms who are well-suited for EVAR. The development of protocols and systems for the expeditious diagnosis and treatment of ruptured aneurysms should further improve therapy for this life-threatening condition.
    Seminars in Vascular Surgery 12/2012; 25(4):217-26.
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    ABSTRACT: Management of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) continues to be controversial, despite recent guidelines submitted by the Society for Vascular Surgery recommending routine revascularization of the LSA in most circumstances. Up to one third of patients require coverage of the LSA during TEVAR. The LSA provides extensive circulation to the upper extremity, spinal cord, and brain, consequently, sacrifice of this great vessel might not be physiologically tolerated. Studies supporting routine preoperative revascularization of the LSA note increased rates of spinal cord ischemia, strokes, and upper extremity ischemia when the LSA is sacrificed. Other studies supporting a selective revascularization strategy note no difference in neurologic outcomes and recommend expectant management of upper extremity ischemia. In addition, LSA revascularization has associated complications that are avoided by selective revascularization. The purpose of this article is to review and focus the available data in support of routine versus selective LSA revascularization.
    Seminars in Vascular Surgery 12/2012; 25(4):232-7.

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