Journal of vascular surgery
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Celiac artery compression syndrome (CACS) remains a controversial diagnosis, despite several reported series documenting therapeutic efficacy of CA decompression. Traditional therapy consists of open surgical decompression, but since 2000, five isolated case reports have been published in which CACS has been successfully treated with laparoscopic techniques. This approach was adopted as the sole initial therapy for CACS at the Johns Hopkins Hospital in 2002. This article reports the results of a unique surgical series that triples the reported worldwide experience with this therapy. ⋯ Laparoscopic decompression of the CA may be a useful therapy for CACS, but there is potential for vascular injury, and adjunctive CA intervention is often required. Surgeons should consider laparoscopic CA decompression as a therapeutic alternative for CACS and should participate in the care of patients with this diagnosis.
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Thoracic aortic anomalies are rare and may be associated with pathologic vascular conditions necessitating intervention. We present a case of a patient with a left aortic arch, right descending thoracic aorta, and a Kommerell's diverticulum giving rise to an aberrant right subclavian artery. The Kommerell's diverticulum was successfully managed with a right carotid to subclavian artery bypass and thoracic endograft exclusion.
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The role of endovascular graft oversizing on risk of distal graft migration following endovascular aneurysm repair for abdominal aortic aneurysm is poorly understood. A controlled in vitro investigation of the role of oversizing in graft-aorta attachment strength for endovascular grafts (EVGs) with barbs was performed. ⋯ Greater than 30% graft oversizing affects both barb penetration and graft apposition adversely resulting in a low pullout force in this in vitro model. Barbed stent grafts with excessive oversizing are likely to result in poor fixation and increased risk of migration.
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Although patient preference and outcome data support continued development and use of minimally invasive endovascular therapies, only a few studies have documented radiation exposure to the patient. This report summarizes patient radiation exposure by endovascular procedure at Cleveland Clinic. ⋯ The increasing complexity of endovascular interventions has resulted in increased radiation exposure to all involved, with the highest doses occurring in aneurysm repairs. Future innovations should concentrate on reducing the risk of radiation exposure to all personnel and developing newer imaging techniques.
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Review Meta Analysis
Neurological complications after left subclavian artery coverage during thoracic endovascular aortic repair: a systematic review and meta-analysis.
Recent studies suggest an increased risk of neurologic complications after coverage of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR). The preventative role of preoperative revascularization of the LSA using carotid-subclavian bypass or transposition remains controversial. We assessed this increased risk and the role of revascularization by undertaking a systematic review and meta-analysis of the literature. ⋯ The risk of neurologic complications is increased after coverage of the LSA during TEVAR. Preemptive revascularization offers no protection against CVA, perhaps indicating a heterogeneous etiology. Revascularization may reduce the risk of SCI, although limited data tempers this conclusion. Improved or perhaps compulsory reporting to registries of a minimum data set may help further assess the exact etiology of these complications and identify a higher-risk subset of patients in whom revascularization might prove protective.