Journal of vascular surgery
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Case Reports
Modified use of the Hemodialysis Reliable Outflow (HeRO) graft for salvage of threatened dialysis access.
The Hemodialysis Reliable Outflow (HeRO) graft (Hemosphere Inc, Eden Prairie, Minn) offers a new option to provide upper extremity arteriovenous (AV) dialysis access in patients with central venous occlusive disease. Creative use of this device can allow for salvage of failing or threatened AV fistulas and grafts. We present two patients who underwent a modified implantation of the HeRO device for immediate salvage of a malfunctioning AV access. Ipsilateral central venous occlusions were successfully overcome by anastomosing a HeRO device to the existing AV access and tunneled across the chest to the contralateral internal jugular vein.
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This study determined the effect of pulmonary disease on outcomes after endovascular abdominal (EVAR) and endovascular thoracoabdominal aortic aneurysm (eTAAA) repair. ⋯ The perioperative risk of death between COPD patients and non-COPD patients is eliminated when endovascular techniques are used. Long-term survival in COPD patients is most strongly related to the severity of their disease, and forced expiratory volume in 1 second and forced expiratory flow in the middle 50% are reasonable indicators of poor long-term outcomes. Morphologic changes after EVAR and eTAAA repair are more favorable in COPD patients, with a lower endoleak rate and faster sac shrinkage.
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Several published studies have reported differing results of renal duplex ultrasound (RDU) imaging in detecting significant renal artery stenosis (RAS) using different Doppler parameters. This study is the largest to date to compare RDU imaging vs angiography and assess various published Doppler criteria. ⋯ A PSV of 285 cm/s or an RAR of 3.7 alone can be used in detecting ≥ 60% RAS. Previously published data must be validated in individual vascular laboratories.
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Percutaneous vertebroplasty is a widely used treatment for vertebral compression fracture. It is relatively safe, but it can be complicated by pulmonary or cerebral embolism caused by the cement injected during the procedure. ⋯ He was treated successfully by catheter-directed thrombolysis, angioplasty, and stenting. To the best of our knowledge, this is the first report of the successful treatment of delayed thrombosis caused by migrated cement inside the inferior vena cava.
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Computed tomography (CT) scans are routinely used for graft surveillance in patients who have had endovascular repair (EVAR) of an abdominal aortic aneurysm. There is a growing concern for cancers associated with inadvertent use of CT scans. We report the estimated risk of radiation associated solid organ malignancy caused by routine surveillance CT after EVAR using the Biological Effects of Ionizing Radiation (BEIR VII) model created by U.S. National Institute of Science and National Research Council. ⋯ Patients undergoing routine CT scans for postoperative surveillance after EVAR are at risk for acquiring new solid organ malignancy due to radiation exposure. The risk is higher in young patients, women, and those exposed to multiple contrast-enhanced CT scans. Our analysis questions the need for routine surveillance CT scans after EVAR in the absence of endoleaks or a change in aneurysm morphology, based on an increased malignancy risk.