Vascular
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The successful management of patients with arterial or venous vascular disease is increasingly dependent on the effective use of pharmacotherapeutic agents. Anticoagulation therapies for thromboembolic disease are continually improving, and platelet inhibition remains a cornerstone treatment for all patients with atherosclerotic disease. Early ischemic complications can be avoided by proper preoperative prescription, intraoperative management, and postoperative pharmacotherapy. ⋯ Unfractionated or low-molecular-weight heparin, warfarin, and long-term platelet inhibition can improve survival, reduce the risk of other vascular bed ischemic events, and improve the long-term success of the target revascularization procedure. An overview of evidence-based antithrombotic strategies will include a discussion of patients who undergo the two most common open vascular reconstructive procedures, carotid endarterectomy and infrainguinal bypass. The appropriate use of antithrombotic therapy for vascular reconstructive surgery patients has important implications for both short- and long-term patient outcomes.
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Aortitis is an inflammatory condition that can be due to numerous causes. It is a diagnostic quandary because it commonly shows similar clinical, pathologic, and aortographic features independently of the etiology. ⋯ It required débridement and replacement of the infrarenal aorta with a cadaveric cryopreserved allograft. This case emphasizes the need for early diagnosis and aggressive therapy to avoid life-threatening sequelae.
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Recent advances in catheter-based endovenous interventions have broadened our understanding in the pathophysiology and therapeutic strategies of chronic venous insufficiency, a condition that can be caused by abnormality of various lower extremity venous structures, including superficial or deep vein reflux or incompetent perforating veins. This article reviews the history and therapeutic principles of percutaneous ablation of perforators (PAPs). Discussions related to treatment strategies and procedural techniques of PAPs using radiofrequency ablation, laser energy, and sclerosant injection are provided. Current clinical results of PAPs with radiofrequency and laser energy ablation as a treatment modality of chronic venous insufficiency are also discussed.
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We report the successful endovascular repair of a ruptured abdominal aortic aneurysm (AAA) in a multimorbid patient 8 months after endovascular abdominal aortic aneurysm repair (EVAR). A 74-year-old man with a history of EVAR 8 months earlier presented with hypotension, severe back pain, and tenderness on abdominal palpation. A contrast-enhanced computed tomographic scan showed a large retroperitoneal hematoma and confirmed the diagnosis of secondary abdominal aortic rupture. ⋯ An additional self-expanding stent was deployed in the solitary right renal artery to open its origin, which was partially overlapped by the proximal cuff. The patient was discharged on the tenth postoperative day and is alive and well 1 year postoperatively. This case indicates that endovascular repair is feasible not only in cases of primarily ruptured AAAs but also in secondarily ruptured AAAs after failure of EVAR.
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Case Reports
Endovascular therapy of spontaneous aortocaval fistulae associated with abdominal aortic aneurysms.
We report a case of an abdominal aortic aneurysm (AAA) associated with an aortocaval fistula managed with endovascular techniques. The patient had a known AAA, and on the latest computed follow-up tomographic scan, evidence of fistulization between the aorta and the vena cava was suggested, which was later corroborated by standard contrast angiography. ⋯ Successful exclusion of the AAA was performed, with no evidence of endoleaks or persistence of the fistula. The endovascular approach provides an efficacious alternative to traditional methods for repair of an aortocaval fistula, which is especially important in elderly patients with several comorbidities.