Journal of vascular surgery
-
The value of motor evoked potentials in reducing paraplegia during thoracoabdominal aneurysm repair.
Paraplegia after thoracoabdominal aortic aneurysm (TAAA) repair mainly occurs in patients with Crawford extent I and II. We assessed the impact of monitoring spinal cord integrity and the subsequent adjusted surgical maneuvers on neurologic outcome in repairs of type I and II TAAAs. ⋯ Monitoring MEPs is a highly reliable technique to assess spinal cord ischemia during TAAA repair. A surgical protocol including cerebrospinal fluid drainage, left heart bypass, and monitoring of MEPs can reduce the paraplegia rate significantly. Adjusted hemodynamic and surgical strategies induced by changes in MEPs could restore spinal cord ischemia in most patients, preventing early and late paraplegia in all type I patients. In type II patients, early paraplegia occurred in 4.2% and delayed neurologic deficit in 2.9%. Despite all available measures, complete prevention of paraplegia in type II aneurysms seems to be unrealistic.
-
Carotid artery stenting (CAS) has emerged as an acceptable treatment alternative in patients with carotid bifurcation disease. Although early results of CAS have been promising, long-term clinical outcomes remain less certain. We report herein the frequency, management, and clinical outcome of in-stent restenosis (ISR) after CAS at a single academic institution. ⋯ Our study showed that ISR after CAS remains uncommon. Successful treatment of ISR can be achieved by endovascular interventions, which incurred no instance of periprocedural complications in our series. Patients who developed ISR after CEA were likely to develop restenosis after IRS intervention. Diligent ultrasound follow-up scans are important after CAS, particularly in patients with post-CEA restenosis.
-
This report describes a new approach for management of iliac vein injury. These injuries are often difficult to expose, and the associated hemorrhage further hinders visualization and subsequent repair. In this case, the use of an endovascular balloon from groin access controlled venous hemorrhage and permitted a primary repair of a torn left iliac vein. We believe that this approach is unique in that it uses a compliant, low-pressure balloon, thus preventing further iatrogenic injury in otherwise fragile venous structures and allowing direct access to the tear when exposure in the operative field is limited.
-
The preferential use of endovascular techniques to treat complex aortoiliac disease has increased in recent years. The purpose of this study was to review the outcomes and durability of recanalization, percutaneous transluminal angioplasty, and stenting for iliac occlusions based on the patient's TransAtlantic Inter-Society Consensus (TASC) stratification. ⋯ Complex long-segment and bilateral iliac occlusions can be safely treated via endovascular means with high rates of symptom resolution. Initial technical success, low morbidity, and mid-term durability are comparable to results with open reconstruction. A liberal posture to open femoral artery reconstruction extends the ability to treat diffuse TASC-C and -D lesions via endovascular means.
-
Randomized Controlled Trial
Upper- vs lower-limb aerobic exercise rehabilitation in patients with symptomatic peripheral arterial disease: a randomized controlled trial.
To investigate the effects of a 24-week program of upper- and lower-limb aerobic exercise training on walking performance in patients with symptomatic peripheral arterial disease (PAD) and to study the mechanisms that could influence symptomatic improvement. ⋯ Our results suggest that a combination of physiologic adaptations and improved exercise pain tolerance account for the improvement in walking performance achieved through upper-limb aerobic exercise training in patients with PAD. Furthermore, that both arm- and leg-crank training could be useful exercise training modalities for improving cardiovascular function, walking performance, and exercise pain tolerance in patients with symptomatic PAD.