Journal of vascular surgery
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We present a hybrid endovascular approach to a 6.5-cm aneurysm of the right-sided aortic arch with an aberrant left subclavian artery arising from a Kommerell diverticulum, connected to the left pulmonary artery through the ligamentum arteriosum. The two-step procedure consisted of a bilateral carotid-subclavian bypass, followed by an ascending aorta-bicarotid bypass and completed by an endovascular exclusion of the aneurysms by covering the whole aortic arch and its branches. The patient had no complications and is asymptomatic 21 months after surgery. Hybrid procedures may be helpful in complex aortic arch pathologies, reducing complications of challenging open surgery.
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Comparative Study
The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients.
Initially, patients with a short angulated aortic neck were considered unfit for endovascular aneurysm repair (EVAR). Recently, however, more liberal use of EVAR has been advocated. This study analyzes the correlation of aortic neck length to early and late outcomes. ⋯ EVAR can be used for patients with a short aortic neck; however, it was associated with a significantly higher rate of early and late type I endoleaks, resulting in an increased use of proximal aortic cuffs for sealing the endoleaks.
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Randomized Controlled Trial Comparative Study
Randomized controlled trial of aspirin and clopidogrel versus aspirin and placebo on markers of smooth muscle proliferation before and after peripheral angioplasty.
In peripheral arterial disease (PAD) patients, a limiting factor in the success of percutaneous transluminal angioplasty (PTA) is the development of restenosis secondary to vascular smooth muscle cell (SMC) proliferation. Following endothelial damage and platelet activation, there is release of factors and adhesion molecules which affect SMC proliferation. The aim of this study was to determine the effect of combination antiplatelet therapy (clopidogrel and aspirin compared with aspirin and placebo) on the ability of plasma from PAD patients undergoing PTA to stimulate SMCs in vitro. We further aimed to investigate the effect of combination treatment on the levels of circulating adhesion molecules and factors, which are known to mediate SMC proliferation in experimental models. ⋯ High rates of restenosis remain the major limitation of peripheral arterial angioplasty and stenting.The restenotic lesion occurs secondary to platelet activation, released circulating factors, and subsequent smooth musclecell proliferation and migration into the intima. Methods to limit the restenotic lesion are poorly understood. This paperinvestigates the effect of PTA on smooth muscle cell activation and the release of factors in plasma which mediate SMCproliferation. It also examines the effect of combination antiplatelet therapy as a potential therapeutic strategy.
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Comparative Study
Perioperative outcomes and amputation-free survival after lower extremity bypass surgery in California hospitals, 1996-1999, with follow-up through 2004.
There are very few population-based studies of long-term outcomes after lower extremity (LE) bypass graft surgery. This study analyzes perioperative and long-term limb salvage and amputation-free survival outcomes for patients undergoing initial aortoiliac or femoropopliteal bypass graft surgery in California hospitals from 1996 to 1999. ⋯ Long-term outcomes of LE bypass surgery were superior for high-volume hospital patients. Graft surveillance and risk factor follow-up care provide a major opportunity for quality improvement efforts. The contrast between traditional limb salvage and amputation-free survival outcomes raises questions about the value of surgical treatment, particularly for patients with limited life expectancy and without coding of tissue loss or critical limb ischemia.
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Comparative Study
Carotid angioplasty and stenting: treatment of postcarotid endarterectomy restenosis is at least as safe as primary stenosis treatment.
This study compared transcranial Doppler (TCD) imaging and outcomes of carotid angioplasty and stenting (CAS) in stenosis after carotid endarterectomy (CEA) vs primary atherosclerotic stenoses. ⋯ CAS for restenosis after CEA has a complication rate lower than primary CAS. The time interval between CEA and CAS did not influence micro embolic load.