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Twelve-Year Results of Fenestrated Endografts for Juxtarenal and Group IV Thoracoabdominal Aneurysms
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
Technology evolution heavily weighted outcomes in this series. One of the changes in technology that occurred over time was the transition from an un-supported fenestration to the use of primary nitinol-reinforced fenestrations. The alteration in this stent graft morphology provided a secure link with the bridging stents and the aortic component that allowed for more extensive aneurysms to be treated. This is linked to the transition away from the use of bare metal bridging stents, utilized only to keep the fenestrations aligned, to balloon-expandable stent graft systems such as the Jomed (Abbott Vascular, Santa Clara, CA) and iCAST stents (Atrium Medical, Hudson, NH). This program was able to demonstrate, during this time, that there was improved renal artery patency if covered stent grafts were used as opposed to bare metal stents.4 In addition, in that same analysis, duplex criteria for assessing renal artery stenosis was shown to be altered, thus adjusting follow-up assessment paradigms. In addition to improved patency, the use of reinforced fenestrations and balloon-expandable stent grafts aneurysms of the aorta could be treated in which the fenestrations on the stent graft did not abut the aortic wall—the exclusion of the aneurysms became dependent upon obtaining a seal between the bridging stent and the fenestrations. And while this interaction seemed tenuous at first glance, it resulted in relatively low rates of stenosis, occlusion, component separation, or endoleak development.5
Complex lower extremity revascularization
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
Other options include cryoplasty, atherectomy, stent–grafts, and cutting balloon angioplasty. These are described in Chapter 20. The advantage of stent–graft placement is that there is no potential for tissue ingrowth, since there are no open spaces in the stent. These tend to fail at the ends (“candy wrapper lesion”) or thrombose if adequate lumen cannot be created along its length, due to external impingement from bulky plaque. Atherectomy is particularly useful for heavily calcified lesions, especially if the disease is diffuse or eccentric. Atherectomy may find a new role now that drug-coated balloon angioplasty is readily available to ameliorate the negative or inflammatory effects of shaving the plaque.
Mechanical Effects of Cardiovascular Drugs and Devices
Published in Michel R. Labrosse, Cardiovascular Mechanics, 2018
Vascular prostheses for large vessels are designed to treat patient with occlusive or aneurysmal diseases and trauma patients that require vascular replacement and to provide dialysis access. The simplest of these prostheses are woven conduits that rely on controlled thrombosis of the graft surface, which is then encapsulated by fibrous tissue, forming a neointimal surface that is thromboresistant. These conduits often replace the native vessel, which is removed. Catheter- delivered vascular grafts have been very successful in treating abdominal aneurysms, with less mortality and morbidity risks for the patient. Abdominal aortic aneurysm results from weakening of the abdominal aortic wall, which causes bulging, further thinning the wall, and increased risk of rupture. These devices consist of a vascular graft mounted within a stent, which is expanded into the vessel with a dual-catheter procedure. The stent graft covers the native vessel, creating a new flow path with a normal aortic diameter.
Contemporary review of management techniques for cephalic arch stenosis in hemodialysis
Published in Renal Failure, 2023
Gift Echefu, Shivangi Shivangi, Ramanath Dukkipati, Jon Schellack, Damodar Kumbala
Placing appropriately sized stent at the inflow mitigates stent migration and guttering which can lead to turbulent flow and precipitate restenosis. Stent protrusion into the veins can lead to axillary or subclavian stenosis or even jailing of the basilic vein and may cause arm swelling and preclude future fistula formation [41]. Cahalane et al. [43] conducted a retrospective study investigating the association between anatomic characteristics and the primary patency of BC fistulas following stent graft placement in CAS management. The SG placed were 0–1 mm larger than the adjacent segment. The investigators reported primary patency rates of 64%, 49.9%, and 23.5%, at 6, 12 months and 3 years respectively among 63 patients that underwent stent graft placement. They also reported an association between stent graft size and CAS but not with cephalic arch anatomy. They posit that under sizing the stent graft (determined by the diameter of the adjacent healthy cephalic vein segment) would not accommodate for potential expansion of the cephalic venous outflow that may occur over time resulting in access aneurysm and subsequent dysfunction. One of the limitations of this study is the small patient population that precluded meaningful small group analysis to make substantial conclusions [43]
Incidental descending thoracic aortic thrombus: the conundrum of medical versus surgical therapy
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Kay Khine, Amit Toor, Koroush Khalighi, Mahesh Krishnamurthy
In accordance with the knowledge of the pathophysiologic mechanisms, appropriate therapy for an aortic thrombus is still controversial, varying between long-term anticoagulation and surgical options. The conventional method is conservative therapy. In our case report, the thrombus was successfully treated with warfarin anticoagulation therapy for about 3 months in duration. In acute patients who are hemodynamically unstable, aortic surgery was found to be beneficial. Combined therapy such as pharmacotherapy and surgery can sometimes be used for treatment. One emerging technology is an aortic stent graft which is used in emergency situations. However, in some previous studies, it is said that long-term anticoagulant is more reliant than surgery. [13] As our patient was asymptomatic and hemodynamically stable, conservative treatment with warfarin was prescribed along with follow-up. There was no incidence of recurrent thrombosis or distal embolization after termination of therapy.
Behçet’s disease; A rare refractory patient with vena cava superior syndrome treated with infliximab: a case report and review of the literature
Published in Acta Clinica Belgica, 2019
Oguz Abdullah Uyaroglu, Abdulsamet Erden, Levent Kilic, Bora Peynircioğlu, Omer Karadag, Umut Kalyoncu
In 2008, when he was 15 years old, the patient was referred to the outpatient rheumatology clinic of Hacettepe University Hospital from an university hospital in an another city; with an abdominal CT that revealed thrombus in inferior vena cava and iliac veins. He had abdominal pain. His vital signs were normal. He had oral aphthous lesions, acneiform rash on his face, scalp and shoulders skin area and discomfort with abdominal palpation. Laboratory tests revealed leukocytosis with value of 13.3 × 103/μL (4.3–10.3 × 103/μL). His erythrocyte sedimentation rate (ESR) was 49 mm/h (0–20 mm/h) and C-reactive protein (CRP) level was 23.3 mg/dL (0–0.8 mg/dL). He was currently using azathioprine, prednisolone, colchicine and warfarin for anticoagulation. We performed CT-angiography that revealed bilateral internal iliac artery aneurysms and thrombus in vena cava inferior that extends to common iliac veins and external iliac veins. Bilateral stent-graft implanted to the iliac aneurysms in Vascular and Interventional Radiology Department (See Figure 1).