Journal of vascular surgery
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Comparative Study Observational Study
Use of the Viabahn stent graft for the treatment of recurrent cephalic arch stenosis in hemodialysis accesses.
Cephalic arch stenosis (CAS) is a frequent and challenging failure mode of brachiocephalic fistulas. Natural tortuosity of the cephalic arch requires special consideration in selecting a treatment modality. Typical percutaneous angioplasty and bare-metal stent (BMS) treatments provide a short-term treatment solution for CAS without a durable effect. This study assessed Viabahn (W. L. Gore & Associates, Flagstaff, Ariz) stent grafts (SGs) as a first-line percutaneous option to provide a durable treatment for CAS. ⋯ In treatment of a CAS, the Viabahn SG study group demonstrated superior target lesion primary patency and required fewer subsequent interventions compared with historic cohorts treated with angioplasty or angioplasty followed by BMS placement. Given the significant improvement in target lesion primary patency, future studies should challenge Viabahn SGs as a primary percutaneous treatment modality vs durable surgical alternatives.
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Aortic coarctation (AC) is most commonly identified in pediatric patients; however, adults can present with late sequelae of untreated coarctation or complications of prior open repair. To date, there are limited data about the role of thoracic endovascular aortic repair (TEVAR) in this group of patients. The purpose of this analysis was to describe our experience with management of adult coarctation patients using TEVAR. ⋯ Adult AC patients can be treated safely with TEVAR, and the annular constriction of an AC can be successfully dilated by the stent graft. Given these findings, a greater number of patients with longer term follow-up is warranted to further define the role of TEVAR in the management of adult AC patients.
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Spinal cord ischemia (SCI) is a devastating complication after branched or fenestrated endovascular aortic repair (B/FEVAR) for thoracoabdominal aortic disease. The purpose of this analysis was to describe the impact of a bundled clinical care protocol designed to reduce the risk of SCI in this population of patients. ⋯ Implementation of a bundled multimodal protocol may significantly reduce risk of SCI after B/FEVAR, with the greatest risk reduction occurring in the most vulnerable patients. Interestingly, reduction in SCI risk was associated with improvement in 1-year survival.
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Observational Study
Incidence and risk factors of groin lymphocele formation after venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients.
Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) is a well-established therapy for refractory cardiopulmonary failure. Femoral cannulation offers a quick and effective means of providing circulatory support but is not without complication. Inflammation or lymphatic disruption at the site of cannulation can cause the formation of lymphoceles, leading to the patient's discomfort and possibly necessitating intervention. The purpose of this study was to evaluate the incidence of in-hospital lymphocele formation in VA-ECMO patients and to identify predictors for their development. ⋯ Lymphocele formation is relatively common after femoral VA-ECMO. There was a significantly higher incidence of lymphocele formation in diabetic patients requiring support for PGD after heart transplantation.
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In surgical aortic repair or cardiac surgery with aorta occlusion, the occurrence of mesenteric ischemia and bowel injury has been associated with higher short-term mortality. The vascular protection of estrogens has been investigated and is mainly mediated by increasing the availability of nitric oxide (NO). Therefore, this study investigated the role of 17β-estradiol on visceral ischemia-reperfusion (I/R) injury after descending aorta occlusion in male rats. ⋯ The prophylactic treatment with 17β-estradiol showed better overall repercussions and was able to prevent any fatal occurrence, increase eNOS expression, thus preserving mesenteric perfusion and intestinal integrity, and reduce inflammation.