Endovascular treatment of popliteal artery aneurysms: Results of a prospective cohort study

ObjectivePopliteal artery aneurysms can be treated endovascularly with less perioperative morbidity compared with open repair. To evaluate suitability of the endovascular technique and the clinical results of this treatment, we analyzed a prospective cohort of consecutive popliteal aneurysms referred to a tertiary university vascular center.MethodsAll popliteal artery aneurysms between June 1998 and June 2004 that measured >20 mm in diameter were analyzed for endovascular repair. Anatomic suitability was based largely on quality of the proximal and distal landing zone as determined by angiography. Endovascular treatment was performed by using a nitinol-supported expanded polytetrafluoroethylene lined stent graft introduced through the common femoral artery.ResultsWe analyzed 67 aneurysms in 57 patients. Ten aneurysms (15%) were excluded from endovascular repair, or from any repair at all, for various reasons. The remaining 57 (85%) were treated endovascularly, of which 5 were treated emergently for acute ischemia. During a mean 24-month follow-up, 12 stent grafts (21%) occluded. Primary and secondary patency rates were 80% and 90% at 1 year, and 77% and 87% at 2 years of follow-up. Postoperative treatment with clopidogrel proved to be the only significant predictor for success.ConclusionsEndovascular repair of a popliteal artery aneurysm is feasible. Changes in the material used and the addition of clopidogrel may improve patency rates

Is emergency endovascular aneurysm repair associated with higher secondary intervention risk at mid-term follow-up?

ObjectiveThe study assessed mid-term outcome of emergency endovascular repair for acute infrarenal abdominal aortic aneurysms, with special attention to secondary interventions.MethodsBetween May 1998 and August 2005, 56 patients underwent emergent endovascular repair for a ruptured abdominal aortic aneurysm (n = 34) or an acute nonruptured abdominal aortic aneurysm (n = 22). During the same period, 322 consecutive patients underwent elective endovascular aneurysm repair and were used as control group. Five types of stent grafts were used: Vanguard, Talent, Excluder, Zenith, and Quantum. Follow-up included abdominal radiograph, duplex ultrasound scanning, and computed tomographic angiography. Outcome measures included all-cause and aneurysm-related mortality, complications, and secondary interventions.ResultsMortality at 30 days was 18%, 5%, and 1% in the ruptured, acute nonruptured, and elective aneurysm groups, respectively. Overall mean follow-up was 38 ± 26 months. In the ruptured aneurysm group, survival was 67.8% ± 8.6% at 1 year and 62.1% ± 9.5% at 2 and 3 years. Seven secondary interventions (4 early and 3 late) were required in five patients (15%), with a cumulative risk of 9.2% ± 5.1% at 1 year and 16.2% ± 8.2% at 2 and 3 years. In the acute nonruptured aneurysm group, survival was 90.9% ± 6.1% at 1 year, 84.8% ± 8.2% at 2 years, and 76.4% ± 10.9% at 3 years. Four secondary interventions (1 early and 3 late) were required in four patients (18%), with a cumulative risk of 9.6% ± 6.5% at 1 and 2 years and 20.9% ± 12.0% at 3 years. In the elective aneurysm (control) group, survival was 95.2% ± 1.2% at 1 year, 89.9% ± 1.8% at 2 years, and 86.2% ± 2.1% at 3 years. A total of 51 secondary interventions (4 early, 47 late) were required in 38 patients (12%), with a cumulative risk of 4.2% ± 1.1% at 1 year, 7.6% ± 1.6% at 2 years, and 12.9% ± 2.2% at 3 years.ConclusionsTo our surprise, emergency endovascular aneurysm repair did not present with higher secondary intervention rate at mid-term follow-up

Torsion of the Gallbladder

A 77-year-old woman was seen with progressive abdominal pain. A CT scan was made and showed a large gallbladder extending into the right lower abdomen. Ultrasound was performed but demonstrated no gallstones. Laparoscopy showed a tordated, necrotic gallbladder that was attached to the liver only by the cystic artery and cystic duct. Cholecystectomy was performed. Torsion of the gallbladder is a rare but clinically important condition in which the diagnosis seldom is made preoperatively. In radiological and clinical signs of cholecystitis without gallstones, this condition should be considered

Orally Administrated Cinnamon Extract Reduces β-Amyloid Oligomerization and Corrects Cognitive Impairment in Alzheimer's Disease Animal Models

An increasing body of evidence indicates that accumulation of soluble oligomeric assemblies of β-amyloid polypeptide (Aβ) play a key role in Alzheimer's disease (AD) pathology. Specifically, 56 kDa oligomeric species were shown to be correlated with impaired cognitive function in AD model mice. Several reports have documented the inhibition of Aβ plaque formation by compounds from natural sources. Yet, evidence for the ability of common edible elements to modulate Aβ oligomerization remains an unmet challenge. Here we identify a natural substance, based on cinnamon extract (CEppt), which markedly inhibits the formation of toxic Aβ oligomers and prevents the toxicity of Aβ on neuronal PC12 cells. When administered to an AD fly model, CEppt rectified their reduced longevity, fully recovered their locomotion defects and totally abolished tetrameric species of Aβ in their brain. Furthermore, oral administration of CEppt to an aggressive AD transgenic mice model led to marked decrease in 56 kDa Aβ oligomers, reduction of plaques and improvement in cognitive behavior. Our results present a novel prophylactic approach for inhibition of toxic oligomeric Aβ species formation in AD through the utilization of a compound that is currently in use in human diet

Suprarenal Fixation Resulting in Intestinal Ischemia after Endovascular Aortic Aneurysm Repair

Endovascular aneurysm repair (EVAR) may be associated with specific stent- and procedure-related complications. Hepatic artery anatomic variability may lead to dramatic consequences when unanticipated. A 64-year-old man presented with a 6-cm abdominal aortic aneurysm, suitable for an EVAR procedure. The EVAR procedure was uneventful and the patient was discharged after 2 days. After 2 weeks, he was readmitted for recurrent upper abdominal pain due to acute cholecystitis. The postoperative EVAR computed tomography scan was revisited and the suprarenal bare-metal stent of the Zenith device overlapped the highly calcified origin of both the superior mesenteric artery (SMA) and the celiac trunk. Moreover, the patient appeared to have a right replaced hepatic artery originating from the SMA. He developed diffuse, patchy ischemia of both the large and the entire small bowel, and quickly became unresponsive to vasopressor drugs. He died shortly thereafter. An EVAR procedure may result in a highly complicated course when hepatic artery anatomic variability is present. Fenestrated EVAR or proximal graft scallops should be considered for cases in which the proximal sealing zone is diseased and flow to visceral vessels is compromised

Intraoperative salvage of a renal artery occlusion during fenestrated stent grafting

A 79-year-old man with a 6-cm juxtarenal abdominal aortic aneurysm was treated by endovascular means with a fenestrated stent graft. The completion angiogram revealed a left renal artery occlusion. A retroperitoneal surgical approach allowed for retrograde catheterization of the occluded covered stent through the left renal artery. The covered stent was reopened by balloon angioplasty. After 2 months, the left renal artery was patent and renal function normal. At 6 months, both renal arteries were fully open on duplex imaging. The open retroperitoneal approach with retrograde catheterization is a bailout technique to avoid loss of a kidney in fenestrated stent grafting

Treatment of a ruptured thoracoabdominal aneurysm with a stent-graft covering the celiac axis

Purpose: To present a case of successful emergency endovascular repair of a ruptured, probably mycotic, thoracoabdominal aortic aneurysm (TAAA) with a stent-graft deliberately covering the celiac axis. Case Report. A 79-year-old woman with significant pulmonary comorbidity presented with a ruptured mycotic TAAA extending to the celiac axis. The aneurysm was excluded with a stent-graft soaked in rifampicin and deployed to deliberately occlude the celiac axis for effective distal sealing and fixation. The patient recovered well and was prescribed antibiotic treatment for up to 6 months. Conclusion: Endovascular repair of a ruptured TAAA may be a life-saving option. In emergency situations when poor distal anatomy is present, covering the celiac artery with the stent-graft should be considered