Perspectives in vascular surgery and endovascular therapy
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Perspect Vasc Surg Endovasc Ther · Dec 2012
ReviewEndovascular stenting with open surgery for reconstructions of the ascending aorta and the aortic arch: a review of indications and results of hybrid techniques.
Hybrid approaches for repair of aneurysms involving the ascending aorta and the aortic arch have been developed to avoid or reduce duration of cardiopulmonary bypass and circulatory arrest and to decrease operative time, blood loss, hospital stay, morbidity, and mortality. These include ascending aorta-based debranching or cervical extra-anatomical bypasses followed by stent-grafting. ⋯ A review of the literature of hybrid aortic arch reconstructions, published over past 7 years, reveals perioperative mortalities from 0% to 13%, stroke from 0% to 10%, and spinal cord injury in 0% to 13%. The outcomes are comparable to contemporary results from total open and total endovascular reconstructions in spite of the fact that the hybrid approach is generally taken in patients with high surgical risk for open repair and with prohibitive anatomy for total endovascular repair.
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Perspect Vasc Surg Endovasc Ther · Dec 2012
Case ReportsPercutaneous removal of a Bard Simon nitinol permanent inferior vena cava filter.
Inferior vena cava (IVC) filters are used to treat thromboembolic disease when there is a contraindication to anticoagulation or failure of therapeutic anticoagulation therapy. Although there are retrievable IVC filters available, permanent IVC filters remain the most commonly placed IVC filters worldwide. ⋯ Such complications may require removal of permanent IVC filters, which has been previously described with open surgery involving venotomy of the IVC. We report a case of a Bard Simon Nitinol permanent IVC filter that was removed by using percutaneous endovascular techniques.
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Perspect Vasc Surg Endovasc Ther · Dec 2012
Case ReportsA rare cause of obstructive jaundice: superior mesenteric artery pseudoaneurysm.
Visceral arterial aneurysm and pseudoaneurysm are uncommon forms of vascular disease that have a significant potential for rupture or erosion into an adjacent viscera, resulting in life-threatening hemorrhage. Pseudoaneurysms related to the superior mesenteric artery are a recognized complication of trauma to the vessel, and successful treatment with stenting has been previously described. Percutaneous techniques offer an alternative form of therapy, and the number of reported cases treated with embolization has been rising steadily. We present the case of a 26-year-old patient with a large pseudoaneurysm of the superior mesenteric artery complicated with obstructive jaundice.
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Perspect Vasc Surg Endovasc Ther · Jun 2012
Case ReportsResection of a giant primary synovial sarcoma of the inferior vena cava extending into the right atrium with caval reconstruction under cardiopulmonary bypass and circulatory arrest.
Synovial sarcoma primarily arises in para-articular locations of the extremities. However, numerous unique sites of origin have been reported. There are only 5 known cases of primary intravascular synovial sarcoma. ⋯ Primary synovial sarcoma of the IVC is rare. The use of cardiopulmonary bypass with or without deep hypothermic circulatory arrest may be required if there is tumor extension into the heart. Bovine pericardium is an excellent material for caval reconstruction.
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Perspect Vasc Surg Endovasc Ther · Mar 2012
ReviewEpidermal growth factor in the treatment of diabetic foot ulcers: an update.
Management of diabetic foot ulcers remains a rather challenging task. Epidermal growth factor (EGF) plays a central role in wound healing. It acts on epithelial cells and fibroblasts promoting restoration of damaged epithelium. ⋯ Generally, adverse events have been minor to mild. Finally, numerous issues need to be further clarified before widespread use of EGF becomes possible in everyday practice. Such issues include optimal dosage and administration route, characteristics of the ulcers most likely to heal (severity and ischemic/neuropathic or both), and cost-effectiveness.