Journal of vascular surgery
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Malposition, embolization, fracture, and migration of endovascular devices are unfortunate consequences of endovascular intervention and will be encountered at some point by nearly every practitioner. The existing literature on foreign body retrieval consists of large single-institution series and case reports. We provide an overview of this recent literature, clarifying what devices are being lost, what symptoms occur as a result, and how retrieval is being performed. We have identified all case series and case reports since the year 2000, summarized the results, and made some general observations and recommendations that may be useful to the practitioner faced with the prospect of retrieving a fractured medical device, malpositioned coil, or migrated inferior vena cava filter.
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Multicenter Study
Left subclavian artery coverage during thoracic endovascular aortic aneurysm repair does not mandate revascularization.
This study assessed the risk of left subclavian artery (LSA) coverage and the role of revascularization in a large population of patients undergoing thoracic endovascular aortic aneurysm repair. ⋯ LSA coverage does not appear to result in an increased incidence of SCI or CVA event when a strategy of selective revascularization is adopted. Selective LSA revascularization results in similar outcomes among the three cohorts studied. Revascularization in women carries an increased risk of a CVA event and should be reserved for select cases.
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Comparative Study
An outcome analysis of endovascular versus open repair of blunt traumatic aortic injuries.
Aortic injury is the second most common cause of death after blunt trauma. Thoracic endovascular aortic repair (TEVAR) has been rapidly adopted as an alternative to the traditional open repair (OR) for treatment of traumatic aortic injury (TAI). This paradigm shift has improved the outcomes in these patients. This study evaluated the outcomes of TEVAR compared with OR for patients with TAI. ⋯ Compared with TEVAR, patients who underwent OR had three times higher odds to face a complication or in-hospital death. The mean total cost of TEVAR was not significantly different than OR. The findings support the use of TEVAR over OR for patients with TAI.
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Lower extremity peripheral artery disease occurs mostly in the elderly and is associated with high mortality. Limited data are available regarding long-term mortality in patients with premature lower extremity atherosclerosis (PLEA). Our objective was to determine the all-cause mortality and its predictors in younger PLEA patients. ⋯ Patients with PLEA demonstrate high all-cause mortality. No traditional cardiovascular risk factors predicted mortality. Aspirin therapy at the time of first evaluation was a significant and independent predictor of improved survival in patients with PLEA.
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Repair of saccular aortic aneurysms (SAAs) is frequently recommended based on a perceived predisposition to rupture, despite little evidence that these aneurysms have a more malignant natural history than fusiform aortic aneurysms. ⋯ While SAA were not found to have a higher growth rate than their fusiform counterparts, both clinical and radiologic follow-up is necessary, as a significant number ultimately require surgical intervention. Further clinical research is necessary to determine the optimal management of SAA.