Vascular (Vascular)

Publications in this journal

• Article: Is Rickettsia the key to solving the puzzle of Buerger's disease?

  Bahare Fazeli
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  ABSTRACT: Buerger’s disease (BD) is an inflammatory and occlusive peripheral vascular condition with unknown aetiology that is typically found among young male smokers of low socioeconomic status. Rickettsia was suggested as one etiology of BD. However, this suggestion was never ruled out or proved. Recently, we could find evidence of Rickettsia by PCR in 3 of the 25 biopsy samples from the amputated limb of a young man diagnosed with BD. Now, the question is: Can a better understanding of Rickettsia infection help us to answer key questions about the aetiology of BD including: Why does BD usually affect men? Why are the progression and symptoms of BD closely related to smoking? Why are BD patients usually from low socioeconomic backgrounds? Can Rickettsia infection explain the pain characteristics, angiographic patterns and the pathological characteristics of BD? Why do BD patients usually have a good response to prostaglandin I2 analogues but not to immunosuppressive treatments?
  Vascular 05/2013;
• Article: Contained rupture of a celiac artery aneurysm treated with aortic endograft deployment and assisting percutaneous coil and thrombin infusion.

  John C Papakostas, Emmanouil Theodoropoulos, George Karydas, Petros K Chatzigakis
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  ABSTRACT: In this report we present a case of a ruptured celiac artery aneurysm (CAA) with a thrombosed distal neck, which was treated as an emergently with a deployment of a tube thoracic endograft to the descending thoracic and upper abdominal aorta. The initial treatment was assisted with a second stage percutaneous, transhepatic, ultrasound guided needle infusion of coil and thrombin to the aneurysmal sac due to type Ib endoleak, with immediate thrombosis of the aneurysm. This technique, although not standard, could also be considered as a useful choice for the treatment of CAAs with wide proximal and patent distal neck.
  Vascular 04/2013;
• Article: Preclinical evaluation of the InCraft(R) aortic endograft in a sheep model.

  Corey Teigen, James Rl Stanley, Paul Johnson, Christina Gross
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  ABSTRACT: Animal models remain the gold standard for the preclinical evaluation of tissue response, sealing and integrity of aortic endografts. Preclinical testing of the InCraft(®) device was performed to evaluate these attributes. Through the femoral arteries of eight male crossbred sheep, 22 mm diameter InCraft(®) Aortic Bifurcate devices were deployed in the abdominal aortas, and shortened 13 mm diameter iliac limbs were deployed in the right iliac arteries. Vessels were excised for radiographic and histopathologic assessment at six months. There were no instances of graft thrombosis, type I endoleak or endograft migration. No fractures of the stents or fixation barbs were observed. There were minimal inflammatory changes on histology, characterized by histiocytes and multinucleated giant cells located along the fabric. The InCraft(®) device has favorable tissue compatibility and functions well in a sheep model, maintaining patency and sealing without migration, stent fracture or abnormal histologic changes.
  Vascular 04/2013;
• Article: Prevalence of and risk factors for peripheral arterial disease in older adults in an Australian emergency department.

  E L Ng, T J Weiland, G A Jelinek, E Hadgkiss, A Wilson
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  ABSTRACT: The aim of the paper is to estimate the prevalence of symptomatic and asymptomatic peripheral arterial disease (PAD) in emergency department (ED) patients aged 50 years or more and to identify associated clinical and demographic factors. A prospective cross-sectional study was conducted at a single ED. The main outcome was estimated prevalence of PAD (ankle brachial index <0.9 in either leg). Demographic and clinical history data were collected. The San Diego Claudication Questionnaire (SDCQ), the Intermittent Claudication Questionnaire (ICQ) and the Kessler Psychological Distress Scale (K10) were also administered. Participants with a positive diagnosis of PAD were referred for further management and followed up by telephone. A total of 329 ED patients aged ≥50 years were screened. PAD prevalence was 10.3% (95% CI 7.5-14.1%). The prevalence of symptomatic and asymptomatic PAD was 6.4% (95% CI 4.2-9.6%) and 3.9% (95% CI 2.3-6.7%), respectively. PAD prevalence increased significantly with age rising to 25.7% (95% CI 17.0-36.7) among those ≥80 years. Multivariate analyses revealed that being aged ≥80 years (odds ratio [OR] 5.97, 95% CI 2.74-13.02), having a history of angina (OR 3.034, 95% CI 1.35-6.80) and being a former smoker (2.77, 95% CI 1.23-6.22) were the strongest predictors of PAD. In conclusion, targeted screening for PAD among the older ED population identifies ED patients with PAD.
  Vascular 04/2013;
• Article: Immediate surgery for acute internal carotid artery dissection and thrombosis during filter deployment prior to stenting: a case report.

  V Tolva, G B Bertoni, P G Bianchi, G C Keller, R Casana
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  ABSTRACT: Carotid artery stenting (CAS) is a validated option in the treatment of selected extracranial carotid artery stenosis. Carotid artery dissection during CAS is a rare but potentially devastating complication. We report a case of acute dissection and thrombosis of the left internal carotid artery during filter tip wire engaging maneuvers, complicated by intraoperative complete blindness of the left eye. Immediate conversion to carotid endarterectomy was performed under general anesthesia with electroencephalographic monitoring. The patient was discharged home symptomless and remains asymptomatic eight months after the operation, with normal left internal carotid patency and fully recovered eyesight. In conclusion, the management of acute carotid occlusion during CAS requires emergent evaluation and definitive endovascular or open surgical repair to minimize neurologic morbidity. We advocate that all endovascular procedures are carried out in a well-established surgical environment.
  Vascular 04/2013;
• Article: Investigation of the expression of mediators of neovascularization from mononuclear leukocytes in thromboangiitis obliterans.

  Bahare Fazeli, Houshang Rafatpanah, Hassan Ravari, Reza Farid Hosseini, S A Rahim Rezaee
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  ABSTRACT: The aim of this study was to investigate the expression of the cytokines, chemokines and effective molecules of peripheral blood mononuclear cells (PBMCs) that play a role in neovascularization in thromboangiitis obliterans (TAO). Lymphocytes from TAO patients (n = 20) and control subjects (healthy smokers [n = 16] and non-smokers [n = 17]) were evaluated using realtime polymerase chain reaction in order to examine the mRNA expression of CXCL1 and interleukin 8 (IL-8; inducers of collateral development by recruitment of circulating progenitor cells [CPCs]), endothelial cell growth factor A (VEGF-A) and inducible nitric oxide synthase (iNOS; inducers of angiogenesis) and interferon gamma (IFN-γ) and vascular endothelial growth factor receptor 1 (VEGFR-1; inhibitors of angiogenesis). CXCL1 expression was significantly higher in the TAO patients than control subjects. The expressions of IL-8, VEGFR-1 and IFN-γ were significantly higher in the TAO patients and smokers than in non-smokers. However, no differences in iNOS and VEGF-A expression were noted. In conclusion, PBMCs from TAO patients expressed cytokines that potentially recruit CPCs and promote arteriogenesis. However, TAO patients typically have low CPC levels, perhaps due to high oxidative stress. Further studies are recommended in order to investigate the efficacy of antioxidant therapy on the outcome of TAO before administration of angiogenic factors.
  Vascular 04/2013;
• Article: Influence of the chronic abdominal aortic occlusion on the femoral artery disease pattern.

  Nikola S Ilic, Igor Koncar, Marko Dragas, Milka Golubovic, Vesna Bozic, Cinara Ilijas, Maksimovic Zivan, Lazar Davidovic
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  ABSTRACT: We design a study to evaluate whether patients with chronic aortic occlusion have a different pattern of femoral artery atherosclerosis than patients with other forms of aortoiliac disease as well as to discuss potential causal mechanisms. From January 2008 to January 2010, 467 patients with aortoiliac occlusive disease were enrolled at Clinic of Vascular and Endovascular Surgery in Belgrade, Serbia. Among them 60 patients were divided into two groups, patients with chronic aortic occlusion (COA) and diffuse aortoiliac occlusive disease (AIOD, Leriche type II). Each group consisted of 30 patients. Those two groups were compared according to symptomatology, ABI values, femoral artery pressure gradient, atherosclerosis level in the femoral region and predictors of atherosclerosis.Patients with AIOD had severe atherosclerosis unlike patients with COA. Also, high elevation of postoperative ABIs in patients with an early atherosclerosis (0, I, II and III) was noted suggesting patent distal arterial tree. FAP gradient was significantly higher in COA group comparing with AIOD group (left: t = - 10.963, P < 0.01;right: t = - 8.962, P < 0.01). In conclusion, our data demonstrate that older patients have had more time to develop multilevel disease (AOID) and those with CAO have more isolated aortic disease chronic aortic occlusion.
  Vascular 04/2013;
• Article: Vascular graft thrombosis secondary to activated protein C resistance: a case report and literature review.

  Sinisa Pejkic, Nebojsa Savic, Miroslav Paripovic, Milos Sladojevic, Predrag Doric, Nikola Ilic
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  ABSTRACT: Hypercoagulability is a well-documented and prominent risk factor for venous thromboembolism. The role of thrombophilia in arterial thrombotic events is less well defined. A 52-year-old male patient with multiple atherogenic risk factors was admitted for non-healing pedal ulcer and absent distal pulses. Based on the clinical presentation, Doppler ultrasound and angiography findings, the patient underwent elective in situ bypass arterial reconstruction. The saphenous vein graft was of satisfactory quality and the procedure went routinely. Acute graft thrombosis on postoperative day 0 was recognized immediately and prompted an emergent surgical revision. No technical errors or anatomical/mechanical causes for failed reconstruction were found and the graft was successfully thrombectomized using a Fogarty balloon-catheter. Graft rethrombosis, however, ensued after several hours. Considering the absence of threatening limb ischemia and the idiopathic recurrent thrombosis, raising suspicion of prothrombotic state, conservative treatment was pursued. Postoperative thrombophilia testing proved positive for activated protein C resistance, mandating introduction of chronic oral anticoagulation. Six months later, the operated extremity is viable. Inexplicable vascular graft thrombosis, particularly if early and recurrent, should raise suspicion of underlying thrombophilia. If confirmed by laboratory testing, long-term secondary antithrombotic prophylaxis may be required.
  Vascular 04/2013;
• Article: Need for changes in clinical criteria for diagnosing Buerger's disease.

  Bahare Fazeli
  Vascular 04/2013; 21(2):117-118.
• Article: Successful endovascular extraction of newer generation Angio-Seal collagen plug and anchor after acute embolization.

  Nidal Abi Rafeh, Faisal B Saiful, Georges Khoueiry, Mohammad Zgheib, Salman Arain
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  ABSTRACT: A 75-year-old woman with past medical history of coronary bypass, atrial fibrillation, mitral valve repair undergoes percutaneous coronary intervention of left circumflex artery with a drug eluting stent. An Angio-Seal vascular closure device was used post procedure to obtain hemostasis. Shortly after deployment, frank bleeding was observed necessitating manual compression at the arteriotomy site. After hemostasis was achieved, the right lower extremity was found to be pale, bluish with feeble pulses. Doppler ultrasound was emergently performed revealing decreased blood flow after mid superficial femoral artery (SFA) and an echo lucent object lodged luminally in the SFA. Patient was urgently taken to the vascular laboratory where an Angio-Seal device, including the collagen plug and anchor, was successfully removed endovascularly patient made full recovery and was discharged home the following day.
  Vascular 03/2013;
• Article: Aspirin usage is associated with improved prosthetic infrainguinal bypass graft patency.

  Aa Gassman, Bc Degner, O Al-Nouri, L Philippi, R Hershberger, P Halandras, B Aulivola, R Milner
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  ABSTRACT: The American Heart Association recommends that, unless contraindicated, all patients undergoing surgical revascularization for critical limb ischemia should be placed postoperatively on antiplatelet therapy and remain on it indefinitely. The goal of this study was to evaluate if preoperative use of aspirin was associated with improved bypass grafting patency rates and limb salvage. We performed a four-year, retrospective review of one center's experience with open infra-inguinal bypass. We examined the effect pre- and postoperative usage of antiatherosclerotic agents (i.e. aspirin, statin, etc.) have on graft outcomes such as two-year secondary patency, stenosis and limb salvage via univariate Kaplan-Meir survival curve analysis and multiple regression analysis. Our cohort included 165 bypasses in individuals with multiple co-morbidities. The most frequent indication was critical limb ischemia (79%) and most bypasses crossed the knee (63%). Pre- and postoperative aspirin usage was associated with increased two-year secondary prosthetic graft patency over control (preoperative: 78% versus 44%, P < 0.002 and postoperative: 72% versus 50%, P < 0.01). Preoperative aspirin usage was associated with an improvement in the rate of amputation (odds ratio [OR] = 0.44 [95% CI 0.198-0.997]) and stenosis (OR = 0.45 [95% CI 0.217-0.956]). Medications commonly prescribed for atherosclerosis such as aspirin are associated with a significant patency benefit when administered pre- and postoperatively. In a population undergoing infrainguinal bypass with prosthetic graft for predominantly critical limb ischemia, medical optimization should include both pre- and postoperative antiatherosclerotic drug regimens.
  Vascular 03/2013;
• Article: Internal carotid artery redundancy and dissection in a young cocaine abuser.

  M Meghani, M N Siddique, T Bhat, M Samarneh, S Elsayegh
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  ABSTRACT: Carotid artery redundancies are common findings on routine imaging studies and are usually considered to be benign variants. We present a case of a 40-year-old man, with a history of cocaine abuse, who was diagnosed with dissection of the right internal carotid artery and looping of the bilateral internal carotid arteries. This report attempts to highlight the possible association between carotid artery redundancy and dissection, especially in the context of vascular injury such as cocaine abuse, as in our case.
  Vascular 03/2013;
• Article: A vascular laboratory protocol for improving and managing after-hours suspected acute deep venous thrombosis.

  Angela H Martin, George Eckert, Gary W Lemmon, Alan Sawchuk, Michael C Dalsing
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  ABSTRACT: This study reviews the clinical and workforce impact of a suggested protocol designed for the management of suspected acute deep venous thrombosis (DVT) in patients seen after standard vascular laboratory business hours. The protocol included the use of Wells score, D-dimer and a single dose of therapeutic anticoagulant to defer venous duplex ultrasound (VDU) testing until routine business hours unless contraindicated. Information was collected on medical history, physical exam and the timing of any diagnostic studies and treatment provided. Over 15% of studies done after-hours were deemed unnecessary by our protocol and in every individual the results were negative for an acute DVT. There were no adverse events from a one-time dose of anticoagulant. Limiting emergency VDU coverage to evaluate for acute DVT based on a management protocol can eliminate unnecessary after-hours VDU testing without having a negative impact on patient care.
  Vascular 03/2013;
• Article: Endovascular repair with chimney technique of abdominal aortic aneurysm with hostile aortic neck.

  Jang Yong Kim, Jae Young Park, Soon Gu Cho, Chan Ik Jin, W Anthony Lee, Yong Sun Jeon, Kee Chun Hong
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  ABSTRACT: Abdominal aortic aneurysm (AAA) with hostile aortic neck is not a good candidate for conventional endovascular aneurysm repair (EVAR), and a recent paper showed that EVAR with chimney technique (Ch-EVAR) yielded reasonable outcome. We report here a case of successful Ch-EVAR treatment of AAA with hostile neck. An 81-year-old man presented with a 71-mm AAA during evaluation of a gastric ulcer. Aortic neck was 30 mm in diameter, 10-15 mm in length and angulated by 100°. EVAR was performed with chimney stenting to both renal arteries, and the patient recovered after transient hematuria. At one-year follow-up, AAA had increased by 7 mm with delayed type I endoleak control without renal insufficiency. The patient needed close follow-up.
  Vascular 03/2013;
• Article: Successful treatment of a spontaneous rupture of the left external iliac vein in a man.

  Nirvana Sadaghianloo, Elixène Jean-Baptiste, Pierre Haudebourg, Serge Declemy, Aurélien Mousnier, Réda Hassen-Khodja
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  ABSTRACT: Spontaneous rupture of the external iliac vein associated with a May-Thurner syndrome is infrequent, particularly in men. We report a case of previously healthy 73-year-old man with a left iliac vein thrombosis, who presented a large lower left abdominal hematoma of sudden-unset. Emergent laparotomy revealed a 3-cm longitudinal tear in the left external iliac vein, which was repaired primarily. Patient's recovery was uneventful. Possible etiological factors have been identified as venous hypertension due to iliac vein thrombosis associated with Cockett syndrome, as well as inflammatory venous wall. Some other estrogenic factors could explain female preponderance of the event.
  Vascular 03/2013;
• Article: Cell death pattern of a varicose vein organ culture model.

  Chung S Lim, Serafim Kiriakidis, Ewa M Paleolog, Alun H Davies
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  ABSTRACT: The study aimed to investigate the viability of a varicose vein (VV) organ culture model by assessing cell death pattern. To assess pattern of cell death with time, VV organ cultures were incubated for up to 14 days with regular medium changed. To assess viability, cell death of VV organ cultures treated with sodium azide and their untreated counterparts was assayed. Increased cell death was measured in VV organ cultures from day 0 to 2. Cell death decreased gradually after day 2 and plateaued from day 8 to 14. VV organ cultures treated with sodium azide demonstrated significantly more cell death in tissue (P = 0.001). Cell death measured in cultures treated with sodium azide continued to increase until day 7. In conclusion, this study demonstrated the viability of a VV organ culture model with most cell death occurred within the first two days and then declined to a relatively low level.
  Vascular 03/2013;
• Article: Anomalous splenic artery aneurysm.

  Sydney S N Wong, T F Lindsay, G Roche-Nagle
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  ABSTRACT: Aneurysms of the splenic artery are the most common visceral aneurysm. A splenomesenteric trunk, which involves the splenic artery arising from the superior mesenteric artery (SMA), is rare and occurs in less than 1% of patients. Thus splenic artery aneurysms (SAAs) with an anomalous origin from the SMA are quite rare. We report our experience with the surgical management of a 2.6-cm aneurysm involving a splenic artery arising from the SMA in a 40-year-old woman. This was treated with surgical resection with preservation of the spleen. A discussion about SAAs and the management of aneurysms arising from a splenomesenteric trunk follows.
  Vascular 03/2013;
• Article: Effects of anesthesia versus regional nerve block on major leg amputation mortality rate.

  Roy Lin, Anil Hingorani, Natalie Marks, Enrico Ascher, Robert Jimenez, Thom McIntyre, Theresa Jacob
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  ABSTRACT: There are greater than 120,000 above-knee amputations (AKA) and below-knee amputations (BKA) performed in the USA each year. Traditionally, general anesthesia (GA) was the preferred modality of anesthesia. The use of regional nerve blocks has recently gained popularity, however, without the supporting evidence of any mortality benefits. Our objective was to evaluate whether regional nerve blocks yield significant mortality reduction in major lower-extremity amputations. Retrospective data of both AKA and BKA procedures at the Maimonides Medical Center from 2005 to 2009 were analyzed. Patients received either general sedation, spinal or ultrasound-guided regional nerve blocks as per decision of the attending anesthesiologist. Regional nerve blocks for major lower-extremity amputations consisted of femoral, sciatic, saphenous and popliteal nerve blocks. A retrospective inquiry of 30-day mortality was performed with reference to the Social Security Death Index and hospital records. One hundred and fifty-eight patients were included in the study (82 men and 86 women with mean age of 74.5 years ± 12.9 SD, range of 33-98 years) of which 46 patients had regional nerve blocks and 112 had GA or spinal blocks. Patients who received both regional blocks and GA/spinal blocks within 30 days were excluded. The overall 30-day mortality was 17.1% (27 patients) consisting of 15.2% for regional nerve analgesia versus 17.9% for GA/spinal blocks (P = 0.867). Age did not affect mortality outcome in either groups of anesthesia modality. Our analysis did not reveal any mortality benefit of utilizing regional nerve block over GA or spinal blocks.
  Vascular 03/2013;
• Article: Endovascular repair of a pseudoaneurysm of the popliteal artery following arthroscopic knee surgery: case report and review of literature.

  Zachary Aburahma, Stephen M Hass
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  ABSTRACT: We report a case of a pseudoaneurysm of the popliteal artery following arthroscopic knee surgery. Endovascular repair was successfully used as the treatment for this patient and studies have shown this to be a safe alternative to surgery.
  Vascular 03/2013;
• Article: Customized fenestrated endovascular graft repair of abdominal aortic aneurysm with concomitant horseshoe kidney.

  Kai Brown, David Robinson, Alan Bray
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  ABSTRACT: The occurrence of an abdominal aortic aneurysm (AAA) with horseshoe kidney (HSK) is an uncommon but complex surgical problem. This report outlines three such cases, the particular issues encountered and how customized endovascular grafts were successfully used to overcome them. Case one shows an accessory renal artery arising from the left common iliac artery, case two shows a right accessory renal artery from the AAA sac and case three has the right renal artery coming off the distal abdominal aorta within the sac. Across three patients, each graft had a single custom fenestration, which preserved a total of three major vessels with no change in renal function. Customized endografts are a viable tool to preserve aberrant vessels and thus renal mass in AAA and HSK. Customized endografts require an extensive work-up and are currently expensive to fabricate. However they are rapidly evolving as a mainstream tool in vascular surgery and provide a solution in cases of aberrant visceral vasculature.
  Vascular 03/2013;