Journal of vascular surgery
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Multicenter Study Clinical Trial
Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis.
A decade after the first report of descending thoracic aortic aneurysm (DTA) repair with endografts, a commercial device is yet to be approved in the United States. The GORE TAG endoprosthesis, an investigational nitinol-supported expanded polytetrafluoroethylene tube graft with diameters of 26 to 40 mm, is the first DTA device to enter phase II trials in the United States and has been used worldwide for a host of thoracic pathologies. ⋯ The GORE TAG thoracic endoprosthesis provides a safe alternative for the treatment of DTAs, with low mortality, relatively low morbidity, and excellent 2-year freedom from aneurysm-related death. Longitudinal spine fractures have so far been associated with rare clinical events.
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Patients undergoing infrainguinal arterial reconstruction frequently have increased cardiac risk factors. Diabetic patients are often asymptomatic despite advanced cardiac disease. This study investigates whether preoperative cardiac testing improves the outcome in diabetic patients at risk for cardiac disease. ⋯ Preoperative cardiac evaluation, as defined by the ACC/AHA algorithm, does not predict or improve postoperative morbidity, mortality, or 36-month survival in asymptomatic, diabetic patients undergoing elective lower-extremity arterial reconstruction. These data do not support the current ACC/AHA recommendations as a standard of care for diabetic patients with an intermediate clinical predictor who undergo peripheral arterial reconstruction, a high-risk surgical procedure.
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Chronic inferior vena cava (IVC) occlusion is often associated with debilitating symptoms. Supportive therapy is the treatment offered to most patients, often with poor symptom control. ⋯ We present 2 case reports of long-standing long-segment IVC occlusion successfully treated with endovascular procedures that incorporated progressive balloon dilation and stenting. The remarkably rapid relief of pain and swelling and overall improvement in quality of life warrants attempts to correct the condition in other patients with IVC occlusion.