Endovascular Treatment of Popliteal Artery Aneurysms

AbstractObjective. To present the results of the endovascular treatment of popliteal artery aneurysms.Methods. From April 1999 to January 2002, 11 patients, aged 40–94 years, with 12 popliteal aneurysms were treated. Nine (75%) underwent an endoluminal repair, of whom three were done emergently due to a aneurysm rupture. Aneurysm diameter was 28–105 (mean 69) mm. A Hemobahn stent graft was inserted in six, Wallgraft in two and Passager in one case.Results. During a mean follow-up of 14 (3–31) months, four (44%) thromboses occurred: two in the early postoperative period (30 days) and two during the late postoperative period. Two of the four occluded grafts were successfully reopened, and in the one a stenosis of the distal end of the stent graft was treated with balloon dilatation. Patency rates at 1 and 12 months were 64/47% (primary patency) and 88/75% (secondary patency), respectively.Conclusion. Initial experience with endovascular treatment of the popliteal aneurysm in high-risk patients yielded modest results. Larger number of patients and further follow-up time is necessary to evaluate the long-term results

Periodontitis and carotid atheroma: is there a causal relationship?

Periodontal diseases are highly prevalent in the population. Several studies implicated that chronic periodontitis may affect the arterial wall inducing subclinical atherosclerosis by triggering a systemic inflammatory response. Three theories have been put forward to explain potential mechanisms involved: the theory of bacterial invasion, the cytokine theory and the autoimmunization theory. Periodontal inflammation could have a role in the initiation and progression of arterial diseases such as coronary artery disease and carotid atherosclerosis. Further clinical studies are required to investigate if there is a causal relationship of chronic periodontitis with echolucent unstable carotid plaques. [Int Angiol 2010;29;27-9

Cranial Nerve Injury After Carotid Endarterectomy: Incidence, Risk Factors, and Time Trends

Objective/Background To review the incidence of post-carotid endarterectomy (CEA) cranial nerve injury (CNI), and to evaluate the risk factors associated with increased CNI risk. Methods The study was a meta-analysis. Pooled rates with 95% confidence intervals (CIs) were calculated for CNIs after primary CEA. Odds ratios (ORs) were calculated for potential risk factors. A fixed-effects model or a random effects model (Mantel–Haenszel method) was used for non-heterogeneous and heterogeneous data, respectively. Meta-regression analysis was performed to examine the influence of publication year upon CNI rate. Results Twenty-six articles, published between 1970 and 2015, were included in the meta-analysis, corresponding to 20,860 CEAs. Meta-analysis revealed that the vagus nerve was the most frequently injured cranial nerve (pooled injury rate 3.99%, 95% CI 2.56–5.70), followed by the hypoglossal nerve (3.79%, 95% CI 2.73–4.99). Fewer than one seventh of these injuries are permanent (vagus nerve: 0.57% [95% CI 0.19–1.10]; hypoglossal nerve: 0.15% [95% CI 0.01–0.39]). A statistically significant influence of publication year on the vagus and hypoglossal nerve injury rate was found, with the injury rate having decreased from about 8% to 2% and 1%, respectively, over the last 35 years. Urgent procedures (OR 1.59, 95% CI 1.21–2.10; p = .001), as well as return to the operating room for a neurological event or bleeding (OR 2.21, 95% CI 1.35–3.61; p = .002) were associated with an increased risk of CNI, whereas no statistically significant association was found between CNIs and the type of anaesthesia, the use of a patch, redo operation, and the use of a shunt. Conclusion The vagus nerve appears to be the most frequently injured cranial nerve after CEA, followed by the hypoglossal nerve, with only a small proportion of these injuries being permanent. The CNI rate has significantly decreased over the past 35 years to a point indicating that CNIs should not be considered a major influencing factor in the decision making process between CEA and stenting. © 2016 European Society for Vascular Surger

Visceral Venous Aneurysms: Clinical Presentation, Natural History and Their Management: A Systematic Review

Aim: Aneurysms of the visceral veins are considered rare clinical entities. The aim is to assess their clinical presentation, natural history and management. Methods: An electronic search of the pertinent English and French literature was undertaken. All studies reporting on aneurysms of visceral veins were considered. Cases describing patients with arterial-venous fistulae and extrahepatic or intra-hepatic portosystemic venous shunts were excluded. Results: Ninety-three reports were identified, including 176 patients with 198 visceral venous aneurysms. Patients' age ranges from 0 to 87 years, and there is no apparent male/female preponderance. The commonest location of visceral venous aneurysms is the portal venous system (87 of 93 reports, 170 of 176 patients, 191 of 198 aneurysms). Aneurysms of the renal veins and inferior mesenteric vein are also described. Portal system venous aneurysms were present with abdominal pain in 44.7% of the patients, gastrointestinal bleeding in 7.3%, and are asymptomatic in 38.2%. Portal hypertension is reported in 30.8% and Liver cirrhosis in 28.3%. Thrombosis occurred in 13.6% and rupture in 2.2% of the patients. Adjacent organ compression is reported in 2.2% (organs compressed: common bile duct, duodenum, inferior vena cava). The management ranged from watchful waiting to intervention. In 94% of the cases, aneurysm diameter remained stable and no complications occurred during follow-up. In most of the cases, indications for operation were symptoms and complications. Six cases of renal vein aneurysm are reported; three of them were asymptomatic. Three of these patients were treated surgically. Conclusion: The most frequent location of visceral venous aneurysms is the portal venous system. They are often associated with cirrhosis and portal hypertension. They may be asymptomatic or present with abdominal pain and other symptoms. Watchful waiting is an appropriate treatment, except when complications occur. Most common complications are aneurysm thrombosis and rupture. Other visceral venous aneurysms are extremely rare. (c) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved

Hybrid procedures for the treatment of multi-focal ipsilateral internal carotid and proximal common carotid or innominate artery lesions

We report three cases with concomitant ipsilateral proximal common carotid and internal carotid artery stenosis treated in one stage with carotid endarterectomy and retrograde primary stenting of the common carotid artery. The internal carotid artery was clamped during stenting to avoid cerebral embolization. All procedures were successfully completed and all patients remain asymptomatic at 18 months follow up. The one-stage hybrid approach appears to be a safe and effective procedure for the treatment of ipsilateral multifocal significant lesions

Endovascular Stent-Graft Repair of Major Abdominal Arteriovenous Fistula: A Systematic Review

Purpose: To evaluate the outcomes of endovascular stent-graft repair of major abdominal arteriovenous fistulas. Methods: The English literature was systematically searched using the MEDLINE electronic database up to January 2009. All reports on endovascular stent-graft repair of major abdominal arteriovenous fistula were considered. Our experience of abdominal arteriovenous fistula was involved in the data analysis. The primary outcome measures were technical success and perioperative, 30-day, and overall mortality. Results: Data for the final analysis were extracted from 21 papers reporting on 22 patients and from the medical records of a patient treated at our institution. The most common causal associations of these fistulae were the presence of an aortoiliac aneurysm and previous endovascular aneurysm repair, accounting for 56% and 13% of all associations, respectively. The technical success rate was 96% (22/23). No perioperative or 30-day mortality was noticed during a mean follow-up of 9 months. The most common procedure-related complication was type II endoleak, which was found in 22% (5/23) of the patients. This event was either self limiting or required minimal percutaneous intervention. Conclusion: Endovascular stent-graft repair of major abdominal arteriovenous fistula is a safe and effective treatment option, with good short- and midterm results. However, no long-term data exist, and larger series are required to draw solid conclusions regarding the outcomes of this method. J Endovasc Ther. 2009;16:514-52