Journal of vascular surgery
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Comparative Study
A new imaging method for assessment of aortic dissection using four-dimensional phase contrast magnetic resonance imaging.
Medical management of type B aortic dissection can result in progressive dilation of the false lumen and poor long-term outcome. Recent studies using models of aortic dissection have suggested flow characteristics, such as stroke volume, velocity, and helicity, are related to aortic expansion. The aim of this study was to assess whether four-dimensional phase-contrast magnetic resonance imaging (4D PC-MRI) can accurately visualize and quantify flow characteristics in patients with aortic dissection and whether these features are related to the rate of aortic expansion. ⋯ 4D PC-MRI can be accurately applied to visualize and quantify flow characteristics in patients with aortic dissection. Stroke volume, velocity, distal dominant entry tears, and helical flow are related to the rate of aortic expansion. This study demonstrates the potential of this new imaging method. A larger prospective study is now required to measure flow characteristics and determine their predictive value for risk stratification of patients with aortic dissection.
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The lack of readily available branched and fenestrated endovascular aneurysm repair (EVAR) options has created an opportunity for creative deployment of endograft components to treat juxtarenal aneurysms. We present our early experience with "snorkel" or "chimney" techniques in the endovascular management of complex aortic aneurysms. ⋯ Early success with the snorkel technique for juxtarenal aneurysms has made it our procedure of choice for complex short-neck to no-neck EVAR. Although long-term follow-up is needed, the flexibility of the snorkel technique and lack of requirement for custom-built devices may make this approach more attractive than branched or fenestrated stent grafts.
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Venous thromboembolism is a significant cause of morbidity and death in pregnant women. Retrievable vena cava filters were placed right before labor as prophylaxis for peripartum pulmonary embolism. We reviewed the experience of caval filter placement and retrieval in term pregnancy in this study. ⋯ OptEase retrievable vena cava filter placement and retrieval in term pregnant patients with extensive DVT of the lower extremities is safe, effective, and feasible. The results in our study may justify prophylactic filter placement use right before labor.
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Multicenter Study Clinical Trial
Prospective multicenter clinical trial (STABLE) on the endovascular treatment of complicated type B aortic dissection using a composite device design.
This study evaluates the safety and effectiveness of a unique composite thoracic endovascular aneurysm repair (TEVAR) construct (proximal stent graft and distal bare metal stent) for the treatment of patients with complicated type B aortic dissection (cTBAD). ⋯ Initial data with a composite TEVAR construct have demonstrated favorable clinical and anatomic results. Continued enrollment and long-term data are needed to assess the overall effectiveness of this treatment strategy.
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Comparative Study
Surgical bypass vs endovascular treatment for patients with supra-aortic arterial occlusive disease due to Takayasu arteritis.
This study compared treatment outcomes of patients with supra-aortic arterial (SAA) occlusive disease due to Takayasu arteritis (TA) treated with bypass surgery or endovascular treatment. ⋯ Surgical or endovascular interventions were required in one of 10 TA patients with SAA occlusive lesions. Arteries reconstructed after surgical bypass had superior patency to those reconstructed by endovascular treatment. However, bypass surgery was more likely than endovascular treatment to be accompanied by serious early postoperative complications.