Journal of vascular surgery
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Ultrasound-guided foam sclerotherapy is a generally safe, cost-effective, and practical technique for the treatment of certain venous malformations; however, not all vascular malformation lesions are amenable to the ultrasound-guided method. Venous outflow of the sclerosing agent and extravasation are difficult to check when only ultrasound guidance is used. This study describes a new fluoroscopy-guided technique that uses standardized sclerosing foam for peripheral venous malformations. The short-term efficacy and safety of fluoroscopy-guided foam sclerotherapy for peripheral venous malformations was evaluated. ⋯ Fluoroscopic guidance could have great promise in foam sclerotherapy of peripheral venous malformations, although larger studies are necessary to determine the advantages of this technique over other sclerotherapeutic methods.
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Multicenter Study Comparative Study
Predicting 1-year mortality after elective abdominal aortic aneurysm repair.
Benefit of prophylactic abdominal aortic aneurysm (AAA) repair requires sufficient survival to overcome operative risk. Since death within 1 year of elective open or endovascular (EVAR) infrarenal AAA repair likely indicates ineffective treatment, we developed a prediction model for 1-year mortality to aid clinical decision-making. ⋯ Predictors of 1-year mortality can identify patients less likely to benefit from elective AAA repair. These factors differ for open repair vs EVAR and should be considered in individual patient decision-making. Our EVAR model had less impact on 1-year survival, even if CHF and large AAA diameter were present. However, a combination of age, COPD, renal insufficiency, and need for suprarenal clamping have significant impact on 1-year mortality after open AAA repair. Consideration of these variables should assist decision-making for elective AAA repair, especially in borderline cases.
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Cerebral hyperperfusion syndrome is a rare, serious complication of carotid revascularization either after carotid endarterectomy or carotid stent placement. Impaired cerebral autoregulation and post-revascularization changes in cerebral hemodynamics are the main mechanisms involved in the development of the syndrome. ⋯ This article reviews the literature, intending to make a synthesis of all new data concerning the clinical manifestations of hyperperfusion syndrome, the pathophysiologic pathways involved in its development, the prediction, and the appropriate management. Also, a review of the most recent series of hyperperfusion syndrome following carotid revascularization, both with classic open endarterectomy and carotid artery stenting has been performed.
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Blunt thoracic aortic injury (BAI) remains a leading cause of trauma deaths, and off-label use of endovascular devices has been increasingly utilized in an effort to reduce the morbidity and mortality in this population. Utilizing a nationwide database, we determined the incidence of BAI, and analyzed both functional and survival outcomes at discharge compared with matched controls. ⋯ This manuscript is the first to define the incidence of BAI utilizing the NTDB. Remarkably, two-thirds of patients are unable to undergo attempts at aortic repair, which portends a poor prognosis. When controlling for associated injuries, blunt aortic injury independently impacts survival and results in poor function in those surviving to discharge.
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Rupture of infected anastomotic femoral artery pseudoaneurysms (AFAPs) represents a limb and life-threatening condition requiring emergency intervention. This study aimed to evaluate the feasibility, safety, and efficacy of a hybrid repair for ruptured infected AFAPs consisted of percutaneous stent-graft deployment and second-stage surgical debridement. ⋯ Emergency stent-graft deployment, followed by secondary surgical debridement and long-term antimicrobial therapy is a viable alternative for ruptured infected AFAPs. Especially for patients unfit for major surgery, it may be the most favorable treatment option.