Perspectives in vascular surgery and endovascular therapy
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Office-based procedures have witnessed a veritable explosion with more than 10 million procedures being performed in the United States yearly. This is partially because of improvements in technology that allow these procedures to be performed safely in the office. ⋯ This is changing nationwide. The authors review the new regulations in New York State as a model of the future of this rapidly evolving field and their effect on vascular surgery office procedures.
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The introduction of the minimally invasive, endovenous thermal techniques of superficial reflux ablation have revolutionized the treatment of varicose veins in the last 8 years. The ease of performance even in an office setting, reduced discomfort, and quicker return to normal activity have resulted in universally superior patient acceptance and have made these endovenous procedures the mainstay of present treatment of varicose veins. ⋯ The incidence of groin neovascularization and its significance needs to be determined. Ultrasound-guided foam sclerotherapy is also emerging as a competitor to other endovenous techniques and is particularly useful in superficial and tortuous veins not ideally suited for endovenous thermal ablation, as well as recanalized segments of ablated veins.
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Perspect Vasc Surg Endovasc Ther · Sep 2008
Carotid artery stenting: technical issues and role of operators' experience.
Major criticism of randomized clinical trials comparing carotid artery stenting (CAS) and carotid endarterectomy (CEA) focused on the incomplete learning curve of interventionists and the inadequate and outdated technology employed, which might have contributed to the high stroke and death rates in the CAS arm. The effect of the learning curve related to technical expertise and patient selection strongly influences the results of CAS. Due to the devastating potential complications when compared with other endovascular minimally invasive procedures, CAS requires a more strict analysis of operator training and outcome, because improvement in the learning curve is accompanied by a comparative reduction in complication rates. ⋯ Training experience attempts to sensibly reduce strokes that may occur during the unprotected phases of catheterization/approach to the target vessel and the protected phase of ballooning/stenting and cerebral protection device retrieval. Mandatory training, familiarity with the indications and contraindications, and knowledge of the technology and devices are paramount for the success of CAS, and preprocedure, intraprocedure, and postprocedure patient management is essential for reducing morbidity and mortality. These prerequisites are essential to allow CAS to be accepted as a potential alternative to CEA.
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Perspect Vasc Surg Endovasc Ther · Sep 2007
ReviewTreatment of celiac artery compression syndrome: does it really exist?
Celiac artery syndrome exists, although it remains controversial, and in some patients a firm diagnosis cannot be established. Duplex scanning or computed tomographic, magnetic resonance, or contrast aortography will confirm intermittent or permanent compression of the celiac artery by the crus of the diaphragm, the median arcuate ligament, or fibrous ganglionic tissue. Preoperative ganglion block and exercise gastric tonometry are useful diagnostic tools to predict better outcome after treatment. ⋯ Patients with atypical pain or history of psychiatric disorders only occasionally benefit from surgical repair. The role of primary stenting of celiac artery compression is still not well defined, and current data do not support the use of balloon-expandable stents. Laparoscopic division of the median arcuate ligament followed by celiac artery stenting is an effective, minimally invasive technique to manage selected patients with celiac artery compression syndrome.
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Perspect Vasc Surg Endovasc Ther · Jun 2007
Comparative StudyCommentary on: Mas JL, Chatellier G, Beyssen B, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660-1671.
Carotid stenting is less invasive than endarterectomy, but it is unclear whether it is as safe in patients with symptomatic carotid-artery stenosis. ⋯ In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting.