Troutman, Douglas A.

Madden, Nicholas J.

Dougherty, Matthew J.

Calligaro, Keith D.

Douglas A. Troutman

Nicholas J. Madden

Matthew J. Dougherty

Keith D. Calligaro

Crossref

Journal of Vascular Surgery

RR27. Duplex Ultrasound Diagnosis of Failing Stent Grafts Placed for Occlusive Disease

Imprenta de El Compostelano (Santiago de Compostela)

Galiciana

El Compostelano : diario independiente: Ano VIII Número 2190 - 1927 xullo 8

Elsevier - Publisher Connector 

JOURNAL OF VASCULAR SURGERY
106S Abstracts June Supplement 2014RR26.
Splenic Artery Aneurysms (SAA) and Rupture Risk: A
Closer Look at the Association With Pregnancy
Liliana Nanez, Martyn Knowles, J. Gregory Modrall, R.
James Valentine. Vascular Surgery, UT Southwestern
Medical Center in Dallas, Dallas, Tex
Objectives: Pregnancy is cited as the most important
risk factor for SAA rupture, but the true prevalence of
SAA rupture in pregnancy is unknown. Our objectives
are to determine the natural history of SAA and identify
risk factors for rupture in a hospital with the highest num-
ber of births in the United States.
Methods: Patients diagnosed with SAA during a
recent 5-year period were identiﬁed using International
Classiﬁcation of Diseases, Ninth Revision, and Current
Procedural Terminology codes. Risk factors for rupture
and demographics were reviewed.
Results: Thirty-ﬁve patients (80% female), who were
a median age of 63 years (interquartile range [IQR],
54-74 years) were identiﬁed with SAA. Median SAA size
was 1.3 cm (IQR, 1-1.9 cm). Eight SAA (20%) were >2
cm. Despite the very large number of deliveries recorded
during the study period (67,616 live births) there were no
women younger than 45 years diagnosed with SAA. How-
ever, 89% of women with SAAs had previous pregnancies.
Three patients (8.6%) presented with rupture, resulting in
one death (one of 35 [2.9%]). All three patients had
abdominal pain before rupture. Nineteen patients (54%)
had serial imaging for a median of 32 months (IQR, 7-
76 months); three patients ultimately came to elective
repair, whereas the majority had no SAA change. Six pa-
tients (17%) had concurrent aneurysms, including 3 renal
artery aneurysms, 1 aortic aneurysm, and 3 intracranial an-
eurysms. No demographic risk factors for enlargement or
rupture were identiﬁed.
Conclusions: Ruptured SAA are exceedingly rare in
young women. The purported association of pregnancy
with SAA rupture is not supported by our data. SAA are
frequently diagnosed as an incidental ﬁnding in middle-
aged adults, and tend to remain stable over time.
Fig.Author Disclosures: M. Knowles: Nothing to disclose; J.
Modrall: Nothing to disclose; L. Nanez: Nothing to
disclose; R. Valentine: Nothing to disclose.RR27.
Duplex Ultrasound Diagnosis of Failing Stent Grafts
Placed for Occlusive Disease
Douglas A. Troutman, Nicholas J. Madden, Matthew J.
Dougherty, Keith D. Calligaro. Pennsylvania Hospital,
Philadelphia, Pa
Objectives: We have previously shown that duplex ul-
trasonography (DUS) is beneﬁcial in the diagnosis of
failing vein and prosthetic grafts performed for arterial
occlusive disease. The purpose of this study is to evaluate
whether DUS can also reliably diagnose failing stent grafts
(covered stents) placed for arterial occlusive disease.
Methods: Between July 1, 2005 and June 30, 2013, we
placed 142 stent grafts in 73 patients (1.9 stent grafts/ste-
notic artery) for lower extremity occlusive disease who also
underwent at least one DUS surveillance study documenting
a patent stent graft. Stent grafts were placed in 27 iliac and
36 femoropopliteal arteries and 11 failing infrainguinal
bypass grafts. Devices used were Viabahn in 116 (82%),
Wallgraft in 23 (16%), Fluency in 2 (1%), and iCast in 1
(1%). Mean follow-up was 16 months (range, 1 week-86
months). Postoperative DUS surveillance was performed in
our Intersocietal Commission for the Accreditation of
Vascular Laboratories (ICAVL) accredited noninvasive
vascular laboratory at 1 week, then every 3 months the ﬁrst
year and every 6 months thereafter. DUS measured peak sys-
tolic velocities (PSVs) and ratio of adjacent PSVs (Vr) every 5
cms within the stent graft and adjacent arteries.
Results: We retrospectively classiﬁed the following fac-
tors as “abnormal DUS ﬁndings”: focal PSV >300 cms/s,
uniform PSVs <50 cms/s throughout the graft, and Vr
>3.0. Fifteen of 20 patients with one or more of these
abnormal DUS ﬁndings underwent prophylactic interven-
tion (8) or occluded without intervention (7), whereas
only one of 53 with normal DUS ﬁndings occluded (P ¼
.001). Excluding the eight patients who underwent pro-
phylactic intervention, seven of 12 patients with abnormal
DUS ﬁndings went on to occlude without intervention vs
one of 53 with normal DUS ﬁndings (P ¼ .001).
Conclusions: These ﬁndings suggest that follow-up
DUS surveillance can predict failure of stent grafts placed
for lower extremity occlusive disease. Focal PSV >300
cm/s, uniform PSVs <50 cm/s throughout the stent graft,
or Vr >3.0 were statistically reliable markers for predicting
stent graft thrombosis.
Author Disclosures: K. D. Calligaro: Nothing to
disclose; M. J. Dougherty: Nothing to disclose; N. J.
Madden: Nothing to disclose; D. A. Troutman: Nothing
to disclose.RR28.
Care of Vascular Surgery Patients at Safety Net Public
Hospitals (SNPH) is Associated With Higher
Mortality and Costs
Mohammad H. Eslami1, Denis Rybin2, Gheorghe Doros2,
Alik Farber1. 1Division of Vascular and Endovascular


RR27. Duplex Ultrasound Diagnosis of Failing Stent Grafts Placed for Occlusive Disease 

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El Compostelano : diario independiente: Ano VIII Número 2209 - 1927 xullo 30

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RR27. Duplex Ultrasound Diagnosis of Failing Stent Grafts Placed for Occlusive Disease

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