Journal of vascular surgery
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The safety and feasibility of fenestrated/branched endovascular repair of acute visceral aortic disease in high-risk patients is unknown. The purpose of this report is to describe our experience with surgeon-modified endovascular aneurysm repair (sm-EVAR) for the urgent or emergent treatment of pathology involving the branched segment of the aorta in patients deemed to have prohibitively high medical and/or anatomic risk for open repair. ⋯ Urgent or emergent treatment of acute pathology involving the visceral aortic segment with fenestrated/branched endograft repair is feasible and safe in selected high-risk patients; however, the durability of these repairs is yet to be determined.
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Lifelong surveillance is recommended for both endovascular aneurysm repair and acute, uncomplicated type B thoracic aortic dissection, though compliance remains a significant challenge. We sought to determine factors associated with failure to obtain recommended surveillance. ⋯ Despite a significant rate of reintervention following EVAR, TEVAR, and type B dissection, long-term compliance with surveillance is limited. In addition, predicting who is at risk of being lost to follow-up remains difficult. If current recommendations for lifelong surveillance are to be followed, coordinated protocols are required to capture EVAR, TEVAR, and type B dissection patients to ensure optimal follow-up for these patients. However, the lack of survival benefit in those with complete follow-up suggests that further study is needed with regard to ideal duration of long-term follow-up.
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Antegrade ipsilateral subintimal angioplasty for recanalization of the superficial femoral arteries (SFAs) has a failure rate of 10%-20%. We report our initial experiences performing recanalization of the SFA or popliteal artery (PA) in cases of failed antegrade angioplasty using a medial infracondylar retrograde popliteal approach with the patient supine. ⋯ The medial infracondylar retrograde popliteal approach with the patient in the supine position can be considered safe and efficient for recanalization of the SFA or proximal PA after failure of an antegrade approach.