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Ann Vasc Surg 2012; 26(4)Originals

1.Ann Vasc Surg. 2012 May;26(4):566-70. doi: 10.1016/j.avsg.2012.01.004.

Protective effect of antithrombin III against lung and myocardialinjury in lower-limb ischemia-reperfusion syndrome.

Zambas NA, Karkos CD, Kambaroudis AG,Karamanos DG, Spyridis CT,GerassimidisTS.

Source

5th Department of Surgery, Medical School, Aristotle University of Thessaloniki,Hippocratio Hospital, Thessaloniki, Greece.

Abstract

BACKGROUND:

Restoration of blood flow to an acutely ischemic limb can trigger systemic inflammation.We investigated whether antithrombin III (AT-III) exerts a protective action againstremote lung and myocardial injury in an experimental animal model of lower-limbischemia-reperfusion.

METHODS:

Ischemia was induced by lower-limb arterial occlusion for 6 hours in 60 male Wistarrats. Animals were divided into those receiving AT-III (dose, 250 mg/kg) 30 minutesbefore the reperfusion (group A, n = 30) and those receiving placebo (group B, n = 30).Animals were then sacrificed, and lung and myocardial tissue samples were taken atbaseline, 30 minutes, and 4 hours after reperfusion. Levels of malondialdehyde (MDA),a compound used as indirect index of oxygen free radicals, were estimated in lung andmyocardium, and the two groups were compared at different time points using theindependent sample t test.

RESULTS:

Animals administered AT-III had significantly lower levels of lung MDA compared withthe placebo group at baseline and at 30 minutes, but not at 4 hours (P = 0.001, P =0.01, and P = 0.9, respectively), indicating a protective action of AT-III against remotelung injury early in the reperfusion phase. With regard to myocardial MDA levels, nostatistically significant differences existed between the AT-III and placebo groups atbaseline, at 30 minutes, and at 4 hours (P = 0.07, P = 0.07, and P = 0.2, respectively)after reperfusion.

CONCLUSIONS:

In this experimental animal model, AT-III appears to exert a protective effect againstremote ischemia-reperfusion injury in the lung tissue, but not in the myocardium.

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Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rightsreserved.

PMID:22520394[PubMed - indexed for MEDLINE]

Related citations


Lysophosphatidic acid pretreatment prevents micromolaratorvastatin-induced endothelial cell death and ensures the

beneficial effects of high-concentration statin therapy onendothelial gene expression.

Garrido JM,Esteban M,Roda O,Alaminos M, Snchez-Montesinos I.

Source

Department of Cardiac Surgery, Ramn y Cajal Hospital, Madrid, [email protected]

Abstract

Because of the pleiotropic effects of statins, it may potentially be used as alocoregional adjuvant in vascular revascularization, tissue engineering, andregenerative procedures. Electron probe X-ray microanalyses and oligonucleotidemicroarrays were used to identify the global effects of micromolar concentrations ofatorvastatin on the gene expression and cell viability of endothelial cells in differentstates of lysophosphatidic acid (LPA)-induced activation. Treatment with 1-Matorvastatin for 24 hours significantly reduced the viability of human vascularendothelial cells (HUVECs). However, the same treatment of LPA-preactivatedHUVECs produced elevated cell viability levels and an optimal vascular geneexpression profile, including endothelial nitric oxide synthase overexpression,endothelin-1 repression, an anti-inflammatory genetic pattern, and upregulation of

molecules involved in maintaining the endothelial barrier (vascular endothelialcadherin, claudin 5, tight junction protein 1, integrin 4). The atorvastatin treatmentalso produced a repression of microRNA 21 and genes involved in cell proliferation andneointimal formation (vascular endothelial growth factor [VEGF] A, VEGF receptor 1,VEGFC). Results obtained suggest that micromolar atorvastatin therapy can enhanceglobal endothelial function, but its effects on cell viability vary according to the baselinestate of cell activation (preactivated, postactivated, or not activated). Preactivation withLPA protects HUVECs against atorvastatin-induced apoptosis and delivers optimallevels of cell viability and functionality.

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights

reserved.

PMID:
http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00058-1

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22520393[PubMed - indexed for MEDLINE]

Related citations


Hyperspectral image measurements of skin hemoglobincompared with transcutaneous PO2 measurements.

Jafari-Saraf L, Wilson SE, Gordon IL.

Source

Department of Surgery, St. Mary's Hospital, Waterbury, CT, USA.

Abstract

BACKGROUND:

Objective measurements of skin blood flow would have predictive value in assessingthe potential for wound healing. In this study, we evaluated the relationship betweentranscutaneous PO(2) (tcPO(2)) measurements and hyperspectral reflectancespectroscopy measurements of oxygenated hemoglobin (OxyHgb), deoxygenatedhemoglobin (DeOxyHgb), total hemoglobin (Sum = OxyHgb + DeOxyHgb), andhemoglobin saturation (Sat = 100 OxyHgb/Sum). The effect of varying tcPO(2) probetemperatures (37 C, 41 C, and 45 C) was also assessed.

METHODS:

A Hypermed Oxy-Vu system was used for hyperspectral imaging, with measurementsperformed 2 minutes after removing tcPO(2) probes (Radiometer). Twenty-threesections of foot or wrist skin in four healthy volunteers were measured at 37 C, 41 C,and 45 C using both modalities.

RESULTS:

TcPO(2) at 37 C was 23.1 24.8 mm Hg, increasing to 63.0 27.3 mm Hg at 45 C.OxyHgb levels increased from 52.4 25.4 at 37 C to 101.3 23.8 at 45 C. Linearregression analysis of the HSI data at 37 C showed a positive correlation betweentcPO(2) and OxyHgb (r(2) = 0.35, P = 0.003), tcPO(2) and DeOxyHgb (r(2) = 0.63, P 0.05). Superoxide dismutase and glutathione peroxidase enzymeactivities were found to be significantly higher in group 3 than in group 2 (P < 0.05).However, there was no difference between group 4 and group 2 in terms of theseactivities. Histological examination demonstrated that both MP and FM had protectiveeffects against I/R injury, but this effect was more potent for FM than for MP.

CONCLUSIONS:

FM has a protective effect against reperfusion injury in rat kidney after distant organischemia.



Related citations

7.Ann Vasc Surg. 2012 May;26(4):476-82. doi: 10.1016/j.avsg.2011.11.026. Epub 2012Mar 19.
http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00060-X

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Selective use of percutaneous endovascular aneurysm repair inwomen leads to fewer groin complications.

Al-Khatib WK,Zayed MA, Harris EJ, Dalman RL,Lee JT.

Source

Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA 94305,USA.

Abstract

BACKGROUND:

Endovascular aneurysm repair (EVAR) in women is often technically limited by smalleraccess vessel anatomy, particularly at the femoral and iliac artery levels. Percutaneous

femoral artery access and closure using the "Preclose" technique (PERC) is a lessinvasive alternative to open surgical femoral arterial exposure and has been reported tobe technically feasible, particularly in male cohorts. The purpose of this study was toevaluate the efficacy and access-related outcomes of PERC in women undergoingEVAR.

METHODS:

We identified female patients in a prospectively maintained EVAR database from 2000to 2009. An all-percutaneous approach was adopted in 2007 if technically feasible,based on preoperative computed tomography angiogram criteria including a femoraldiameter >7 mm,

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Selective percutaneous access of the femoral arteries for EVAR is safe and effective inthe female population, with fewer wound complications than open exposure.Approximately one-half of femoral arteries in women are eligible for PERC access, andcomplications can be limited with careful selection based on preoperative imaging.



Related citations

8.

Ann Vasc Surg. 2012 May;26(4):576-90. doi: 10.1016/j.avsg.2011.09.009. Epub 2012Mar 10.

Updated systematic review and meta-analysis of randomizedclinical trials comparing carotid artery stenting and carotidendarterectomy in the treatment of carotid stenosis.

Liu ZJ, Fu WG, Guo ZY, Shen LG,Shi ZY, Li JH.

Source

Department of General Surgery, Sir Run Run Shaw Hospital, Hangzhou, People'sRepublic of China.

Abstract

BACKGROUND:

To compare carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in thetreatment of carotid stenosis, including two recently published, large, prospective,randomized trials of these therapies.

METHODS:

We searched electronic databases for prospective, randomized, controlled trialsinvolving carotid stenosis patients who underwent CAS or CEA, focusing on studiespublished in 1995 to 2010. Primary outcomes were death, stroke, and myocardialinfarction.

RESULTS:

Thirteen trials containing 7,501 patients were analyzed, and odds ratios (ORs) werecalculated for CAS versus CEA. The risk of stroke or death within 30 days was higher

after CAS than CEA (OR = 1.57; 95% confidence interval [CI] = 1.11-2.22), especiallyin previously symptomatic patients (OR = 1.89; 95% CI = 1.48-2.41). However, the risk

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of stroke or death within 1 year was comparable (OR = 1.12; 95% CI = 0.55-2.30). In asubgroup analysis, the risk of death and disabling stroke at 30 days did not differsignificantly between CEA and CAS (death: OR = 1.43; 95% CI = 0.85-2.40; disablingstroke: OR = 1.28; 95% CI = 0.89-1.83), whereas the rate of nondisabling stroke within30 days was much higher in the CAS group (OR = 1.87; 95% CI = 1.40-2.50). The risksof myocardial infarction within 30 days and 1 year were significantly less for CAS.

CONCLUSION:

CAS is inferior to CEA with regard to the incidence of stroke or death for periproceduraloutcomes, especially in symptomatic patients. However, CAS was associated with alower incidence of myocardial infarction. These procedures may be consideredcomplementary rather than competing modes of therapy, each of which can beoptimized with careful patient selection.



Related citations


Long-term results of stenting of the aortic bifurcation.

Abello N, Kretz B, Picquet J, Magnan PE, Hassen-Khodja R, Chevalier J, Rosset E,Feugier P, Fleury M,Steinmetz E;Association Universitaire de Recherche en ChirurgieVasculaire (AURC).

Source

Service de Chirurgie Cardiovasculaire, CHU Le Bocage, et Universit de Bourgogne,Dijon, France.

Abstract

BACKGROUND:

To evaluate the long-term results in a multicentric continuous series of narrowinglesions of the aortic bifurcation treated with a kissing stent.

METHODS:

From January, 1st 1999 to the December, 31st 2001, all of the patients (n = 80)presenting with stenosis of the aortic bifurcation (n = 15) and/or the 2 common iliac

arteries (n = 65), treated with a kissing stent, in 8 teaching hospitals were collectedretrospectively. The risk factors were smoking (91%), dyslipidemia (60%), arterial

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hypertension (42%) and diabetes (27%). In 84% of cases, the indication for treatmentwas claudication. The lesions were stenotic < 70% (n = 76) and/or thrombotic (n = 18).The associated lesions were external iliac stenoses (n = 21), common femoralstenoses (n = 19), femoro-popliteal stenoses (n = 42), arteriopathy in the leg (n = 35).Follow-up was clinical examination and Doppler US scan.

RESULTS:

The success rate of the technique was 89%. There were 4 cases (5.3%) of residualstenosis and 4 cases (5.3%) of dissection. The length of the lesions treated in the aortaand the iliac arteries was respectively 17.1 7 and 17.3 9 mm. The stents were allplaced as kissing stents, and had a mean diameter and a mean length of 13.75 mmand 56 mm in the aorta and 9 mm and 48 mm in the iliac arteries, respectively. At 5years, 19 patients had required repeat angioplasty in the treated area, and 13 hadundergone open surgery. Primary and assisted primary patency at 5 years were 64.5%and 81.8%, respectively.

CONCLUSION:

Long-term follow-up of endovascular treatment with kissing stents for stenosis of theaortic bifurcation shows that this technique gives good results, though it does not justifydoing away with classical revascularisation surgery, in a population with majorcardiovascular risk factors.


PMID:

22410142[PubMed - indexed for MEDLINE]Related citations


Adoption of endovascular repair of abdominal aortic aneurysmin California: lessons for future dissemination of surgicaltechnology.

Chang DC,Easterlin MC,Montesa C, Kaushal K, Wilson SE.

Source

Department of Surgery, University of California San Diego, San Diego, CA 92103-8400, USA. [email protected]

Abstract

BACKGROUND:

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Knowledge of the pattern of adoption of endovascular approach (endovascular aorticrepair [EVAR]) to abdominal aortic aneurysm (AAA) could direct future dissemination ofcomplex surgical technology.

METHODS:

Retrospective longitudinal analysis of the California Office of Statewide Health Planningand Development inpatient database from 2001 to 2008, accompanied by a cross-sectional survey of surgeons. The setting was all inpatient hospitals in California.Patients were those who underwent repair of AAA. The main outcome measure wasthe endovascular repair of AAA and the training experience of the surgeons.

RESULTS:

Of the 33,277 patients with AAA, 11,755 (35%) underwent endovascular repair; 76%were men, mean age was 73 (median, 75) years, 13% of aneurysms were ruptured,and 20% were treated at teaching hospitals. The rate of EVAR increased from 19% in

2001 to 55% in 2008. On multivariate analysis, calendar year, older age, male gender,nonruptured status, teaching hospitals, and high-volume hospitals, but not race orinsurance status, were identified as independent predictors of EVAR. The surveyrevealed that surgeons with 15 years of experience obtained their training primarilyfrom the manufacturer (58.8%), whereas those with

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Source

Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu,Sichuan, People's Republic of China.

Abstract

BACKGROUND:

The purpose of this article is to describe an additional choice of intraoperative shunt inthe surgical repair of complicated carotid body tumors (CBTs).

METHODS:

Between January 2005 and August 2010, 47 CBT resections were performed at ourdivision. Thirty-seven patients underwent routine tumor resection (78.7%). However, 10of the tumor resections were complicated because of severe adhesions and

involvement of the carotid artery. It was difficult to excise the tumors using routinemethods. Intraoperative shunts were used for resection of these 10 complicated tumors(21.3%).

RESULTS:

All patients underwent successful resection of the CBTs. No severe intraoperative orpostoperative complication was observed in the shunted group. There were two caseswith hypotension and one case with blood pressure fluctuation in the unshunted group.The mean follow-up duration was 35.3 (range, 12-60) months.

CONCLUSION:

Surgical resection is the treatment of choice for CBTs. Shunts are not routinely used inthe repair and represent just an additional choice for the resection of complicatedCBTs. In this study, shunts have been shown to maintain cerebral circulation, decreasethe size of tumor by excluding the vascular supply of the external carotid artery, andguide the resection when the tumors were complicated and difficult to excise. Shuntinsertion was found to be safe and not associated with severe cerebrovascularcomplications.



Related citations

12.Ann Vasc Surg. 2012 May;26(4):506-10. doi: 10.1016/j.avsg.2011.11.012. Epub 2012

Feb 8.

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A comparison between the treatments of functional andnonfunctional carotid body tumors.

Zeng G, Zhao J,Ma Y,Huang B,Yang Y,Feng H.

Source

Division of Vascular Surgery, West China Hospital, Sichuan University, Chengdu,Sichuan, People's Republic of China.

Abstract

BACKGROUND:

It is well known that carotid body tumors (CBTs) are rare and almost nonfunctional, andthat functional CBTs are even less frequently seen, with or without catecholamine-

induced symptoms. Objective of this study is to make comparison between thetreatment effects on functional and nonfunctional CBTs.

METHODS:

The medical records of 46 patients (16 men and 30 women) of our unit who underwentsurgical intervention for CBTs were retrospectively reviewed from January 2005 to July2010. Patients were divided into two groups by function: group A (n = 5, functionalCBTs) and group B (n = 41, nonfunctional CBTs). Perioperative and postoperativedetails were compared accordingly.

RESULTS:

All the patients successfully underwent tumor resection. Although symptoms werenonspecific, intraoperative hypertension (5/5, 100%) and persistent postoperativehypotension (3/5, 60%) were found in group A. No statistical difference was found inperioperative details and complications between two groups. No recurrence occurred intwo groups during the follow-up period for a mean of 35.3 months (with a range of 12-60 months).

CONCLUSION:

Surgical resection is safe and effective even if the CBT is functional. Besides routine

preparation, preoperative measurement of serum catecholamine, treatment with - and-adrenergic blockade and gentle manipulation during operation are necessary.



Related citations

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13.Ann Vasc Surg. 2012 May;26(4):483-90. doi: 10.1016/j.avsg.2011.08.018. Epub 2012Feb 2.

Surgically relevant aortic arch mapping using computedtomography.

Finlay A, Johnson M, Forbes TL.

Source

Department of Anatomy and Cell Biology, The University of Western Ontario, London,Ontario, Canada.

Abstract

BACKGROUND:

Recent advances in surgical repair of aortic arch pathologies have increasingly usedendovascular stent-graft technology. The purpose of this study was to map the aorticarch diameters, branch orientations, and center line distances using a commerciallyavailable three-dimensional computed tomography-based software package and topropose a prototype design.

METHODS:

TeraRecon 3D imaging software was used for morphological assessment of computed

tomography scans from 45 patients (mean age: 68 years; 26 males, 19 females). Ineach patient, 13 measurements were made in relation to the center line, includingdiameters at several preset points, distances, and branch vessel orientations.

RESULTS:

The mode of the proximal diameters (2 cm and 4 cm distal to coronary artery) was 32mm and 34 mm. The mode of the distance between the innominate and left commoncarotid arteries was 5 mm and 6 mm, and the mode of the distance between the leftcommon carotid artery and left subclavian artery was 8 mm. Most commonly, the leftcommon carotid artery was anterior to the other arch branches by 3 to 5 mm.

CONCLUSIONS:

These anatomic measurements provide useful information for the advancement ofminimally invasive and safer surgical repair of the aortic arch. Based on the mostcommonly observed measurements, a standardized off-the-shelf stent-graft isproposed that would be appropriate for the majority of patients.


PMID:


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Related citations

14.Ann Vasc Surg. 2012 May;26(4):454-61. doi: 10.1016/j.avsg.2011.09.004. Epub 2012Jan 27.

Endovascular stent-graft placement or open surgery for thetreatment of acute type B aortic dissection: a meta-analysis.

Zhang H,Wang ZW,Zhou Z,Hu XP, Wu HB, Guo Y.

Source

Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan,People's Republic of China.

Abstract

BACKGROUND:

Acute type B aortic dissection (ATBAD) is a life-threatening condition. Open chestsurgical repair using a prosthetic graft has been a conventional treatment for ATBAD.During the past decade, thoracic endovascular aortic repair (TEVAR), which isconsidered as a less invasive and potentially safer technique, has been increasinglyused to treat this condition. Evidence is needed to support the use of TEVAR for thesepatients. The aim of this review was to assess the efficacy of TEVAR versusconventional open surgery in patients with ATBAD.

METHODS:

For this review, we searched the Cochrane Central Register of Controlled Trials(CENTRAL) in The Cochrane Library (last searched: 2010, issue 4), MEDLINE,EMBASE, CINAHL, Web of Science, and the Chinese Biomedicine Database forclinical trials until January 18, 2011. Controlled trials in which patients with ATBADwere assigned to TEVAR or open surgical repair were included. For each outcome, weevaluated the quality of the evidence with reference to the Grading of

Recommendations Assessments, Development, and Evaluation criteria. At the end, weused RevMan 5.0 software to analyze the datum.

RESULTS:

Five trials (318 participants) are included in this review. As determined by the Gradingof Recommendations Assessments, Development, and Evaluation approach, the resultquality was low for 30-day mortality and very low for other variables. TEVAR cansignificantly reduce the short-term mortality for ATBAD (Mantel-Haenszel fixed oddsratio [95% confidence interval]: 0.19 [0.09-0.39], P < 0.001). TEVAR cannotsignificantly improve postoperative complications or long-term mortality.

CONCLUSIONS:

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TEVAR can be weakly recommended as an alternative for the selective treatment ofATBAD but cannot always be used in case of surgery.



Related citations


Increased pulse wave velocity and arterial hypertension inyoung patients with thoracic aortic endografts.

Tzilalis VD, Kamvysis D, Panagou P, Kaskarelis I, Lazarides MK, Perdikides T,Prassopoulos P, Boudoulas H.

Source

Department of Vascular Surgery, 401 General Army Hospital, Athens, [email protected]

Abstract

BACKGROUND:

Hypertension after thoracic endovascular aortic repair (TEVAR) is a medicalcomplication not widely investigated. The aim of the study was to test the hypothesisthat TEVAR in young patients suffering from thoracic aortic transection alters pulsewave velocity (PWV) and reflected wave velocity and induces arterial hypertension.

METHODS:

The data concerning 11 young patients (all men with a mean age of 26.9 years [range:18-33]) treated with TEVAR for thoracic aortic transection were retrospectivelycollected and analyzed. PWV, systolic blood pressure (SBP), and pulse pressure (PP)were evaluated and compared with those recorded in 11 healthy young individualsmatched for age and gender.

RESULTS:

Nine patients had postoperative arterial hypertension after TEVAR, and four haddurable hypertension during the follow-up period (13-66 months after TEVAR). The

SBP, the PP, and the PWV of the patients were greater compared with those of thecontrol group (SBP: 134.1 13.7 vs. 121.36 7.1 mm Hg, P = 0.016; PP: 60.45

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19.42 vs. 44.1 4.37, P = 0.020; and PWV: 10.41 2.85 vs. 7.45 0.66 m/sec, P =0.006).

CONCLUSIONS:

Aortic endografts could produce a discontinuation of the pulsatile waves with asubsequent increase of aortic PWV. Increased PWV is an important risk factor forfuture cardiovascular events and should be evaluated in all patients after TEVAR.



Related citations


Short-term outcomes for open revascularization of chronicmesenteric ischemia.

Davenport DL, Shivazad A, Endean ED.

Source

Department of Surgery, University of Kentucky College of Medicine, Lexington, KY40536-0298, USA.

Abstract

BACKGROUND:

Surgical bypass as treatment for chronic mesenteric ischemia (CMI) is performed to

alleviate symptoms of weight loss and postprandial pain and to prevent catastrophicintestinal necrosis. Among the studies that report outcomes for mesenteric bypass, fewfocus on the type of conduit. The purpose of this study was to evaluate contemporaryshort-term outcomes of patients who underwent aortomesenteric bypass for CMI, withspecific attention given to the conduit used--prosthetic versus vein.

METHODS:

Data from the American College of Surgeons National Surgical Quality ImprovementProgram Participant Use File were analyzed for demographic and clinical risk variables,mortality, and 22 defined complications (morbidity) between 2005 and 2009 from more

than 200 participating hospitals. The database was queried for patients undergoingaortomesenteric bypass with vein (Current Procedural Terminology [CPT] 35531) ornonvein (CPT 35631) whose preoperative diagnosis was CMI (International

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Classification of Diseases, 9th Revision code 557.1). Outcomes and risk variables werecompared using univariate analysis and independent sample t tests for continuousvariables.

RESULTS:

One hundred fifty-six patients underwent mesenteric revascularization--119 (76%)women and 37 (24%) men with an average age of 65 13 years. The conduit usedwas vein in 44 (28%) and prosthetic graft in 112 (72%). There were no statisticallysignificant differences between the two groups in mean age, smoking history, recentweight loss, obesity (body mass index: >25) rates, length of operation, reoperationfrequency, and early graft failure. More patients undergoing bypass with vein had anassociated bowel resection and preoperative sepsis or systemic inflammatory responsesyndrome. Additionally, patients with a vein graft had a higher percentage of acontaminated surgical site (30% vs. 7%, P = 0.001) and underwent emergent surgerymore frequently (16% vs. 4%, P = 0.012). Mortality was higher in patients in whom avein graft was used (16% vs. 5%, P = 0.039). There were no differences noted

between the two groups in length of stay or postoperative complications, includinginfectious complications, renal insufficiency, myocardial infarction, and stroke.

CONCLUSIONS:

Thirty-day mortality was higher in patients who underwent mesenteric bypass with vein.However, this group also had a higher incidence of emergent surgery, bowel resection,and contaminated operative field. This suggests that vein grafts were preferentiallyused when bowel infarction was suspected. The higher mortality is likely due to patientfactors, such as the extent of bowel ischemia at the time of operation, rather than thetype of conduit used. If expeditious revascularization is done before development ofbowel infarction, vein or prosthetic conduit would be expected to function equally well.

Copyright 2012. Published by Elsevier Inc.


Related citations

17.Ann Vasc Surg. 2012 May;26(4):491-9. doi: 10.1016/j.avsg.2011.05.038. Epub 2011Dec 23.

A positron emission tomography/computed tomography(PET/CT) evaluation of asymptomatic abdominal aorticaneurysms: another point of view.

Palombo D, Morbelli S, Spinella G, Pane B, Marini C, Rousas N, Massollo M,CittadiniG, Camellino D, Sambuceti G.

Source

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Division of Vascular and Endovascular Surgery, IRCCS San Martino UniversityHospital-IST, University of Genoa, Genoa, Italy.

Abstract

BACKGROUND:

To assess the prevalence of increased (18)F-fluorodeoxyglucose (FDG) uptake inaneurysmal walls, adopting a case-control approach in a population of asymptomaticpatients with abdominal aortic aneurysm (AAA).

METHODS:

This study included 40 males (mean age: 74 years, range: 59-93 years), consecutive,white Caucasian patients, with asymptomatic infrarenal AAA. The mean diameter ofAAA was 4.9 cm (range: 4.8-5.4 cm), detected by computed tomography (CT) scan.Control Subjects: 44 age-matched controls subjects (mean age: 71 years, range: 59-85

years, 24 males, 20 females) who were selected according to a case-control criterionamong a population of patients without any clinical evidence of atherosclerotic disease.Patients and controls underwent simultaneous FDG-positron emission tomography(PET) and CT imaging from the skull base to the femoral neck by using an integratedPET/CT scanner. PET/CT studies were analysed both visually and quantitatively. Forquantitative analysis, circular CT-based regions of interest (ROIs) were drawn on theAAA, on all the aortic segments, and on the large vessel included in the study (carotid,subclavian, and iliac arteries). FDG uptake was quantified by calculating the mean andmaximum standardized uptake values (SUVs) within each ROI and normalizing for theblood-pool SUV to obtain the final target-to-background ratio. Arterial calcium load wasgraded according to a semiquantitative five-point scale based on calcification of thearterial ring.

RESULTS:

Metabolic activity in the aneurysmal aortic segment was even lower with respect toboth the adjacent--nonaneurysmal--samples of patient group and the correspondingarterial segments of control subjects (P < 0.001 and P < 0.01, respectively). In visualanalysis, no patients showed an increased focal uptake of degree adequate to identifythe aneurysmal arterial wall. AAA patients showed significantly higher values of totalcalcium load (ACL) than controls in ascending aorta and subclavian and iliac arteries(P < 0.01), and only in AAA patient group, a significant correlation was presentbetween values of ACL in both iliac arteries and abdominal aorta on one side and wall

metabolic activity in the same arteries on the other (P < 0.05).

CONCLUSIONS:

In conclusion, our results suggest that FDG hot spot, as well an increased diffuseuptake of FDG, in PET/CT studies is an extremely rare finding in patients with AAA ofdiameter close to surgical indications.


PMID: 22197524[PubMed - indexed for MEDLINE]

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Related citations

18.Ann Vasc Surg. 2012 May;26(4):600-5. doi: 10.1016/j.avsg.2011.11.002. Epub 2011Dec 20.

Open surgical repair of thoracoabdominal aortic aneurysms.

Piazza M,Ricotta JJ 2nd.

Source

Clinica di Chirurgia Vascolare ed Endovascolare, Universita' degli Studi di Padova,

Padova, Italy.

Abstract

Despite much advancement in preoperative evaluation and perioperative care ofpatients with thoracoabdominal aortic aneurysms (TAAA), open surgical repair ofTAAAs remains a formidable challenge for the vascular surgeon. It requires extensivedissection and mobilization of the aorta and its branches, as well as cross-clamping ofthe aorta above intercostal and visceral arteries. Over the past decade, the mortalityand morbidity associated with open TAAA repair have improved significantly. However,it remains one of the most complex, extensive surgical procedures performed in thefield of vascular surgery. Recently, there has been much attention directed at less

invasive methods such as the so-called "hybrid" or "debranching" procedure, orcomplete endovascular repair with fenestrated and branched endografts for repairingTAAAs. However, the gold standard for repair of TAAA remains open surgery, and thisarticle summarizes the clinical outcomes of open surgical repair of TAAAs during thepast decade (2000-2010) to provide a benchmark for comparison with results fromprevious decades and also with which to compare the results of modern-day hybridand/or complete endovascular techniques.



Related citations

19.Ann Vasc Surg. 2012 May;26(4):516-20. doi: 10.1016/j.avsg.2011.07.011. Epub 2011Nov 1.

Endovascular treatment for acute aortic syndrome.
http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(11)00503-6http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(11)00510-3

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Arajo PV, Joviliano EE,Ribeiro MS, Dalio MB,Piccinato CE,Moriya T.

Source

Division of Vascular and Endovascular Surgery, Department of Surgery and Anatomy,

Ribeiro Preto School of Medicine, University of So Paulo, So Paulo, Brazil.

Abstract

BACKGROUND:

The term "acute aortic syndrome" (AAS) includes conditions of high mortality, such asruptured aneurysm, pseudoaneurysm and, aortic dissection. Open surgery for thesecases has demonstrated unsatisfactory results, and endovascular treatment hasbecome an excellent alternative.

METHODS:

We performed a retrospective review of patients with AAS who underwentendovascular treatment in our emergency department from July 2009 to February2011. They represent 64% (16 of 25) of all patients with AAS seen during this period.

RESULTS:

Sixteen patients underwent endovascular treatment: eight ruptured aneurysms, sixaortic dissections, one nonruptured painful aneurysm, and one pseudoaneurysm. Nointramural hematoma or penetrating atherosclerotic ulcer was found. The mean agewas 64.3 years, and arterial hypertension (100%) and smoking (64.7%) were the major

comorbidities. Technical success rate was 93%, and overall 30-day mortality was6.25%.

CONCLUSION:

Endovascular treatment for AAS was feasible. Technical success, 30-day mortality,hospital stay, and procedure time were similar to those of the other series reported inthe literature, and the endovascular approach has became the main technique for AASin our hospital.



Related citations

20.Ann Vasc Surg. 2012 May;26(4):591-9. doi: 10.1016/j.avsg.2011.06.008. Epub 2011

Nov 1.

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Lower-limb ischemia in the young patient: managementstrategies in an endovascular era.

Morbi A, Gohel MS, Hamady M,Cheshire NJ, Bicknell CD.

Source

Department of Surgery and Cancer, Imperial College London, London, UK.

Abstract

BACKGROUND:

The aim of this paper is to review the potential role of endovascular interventions foryoung patients with lower-limb ischaemia.

METHODS:

A literature search was performed of PubMed and Medline databases usingappropriate search terms and limits. Case reports, retrospective studies, andprospective studies evaluating treatment of lower-limb ischemia in patients aged

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Ann Vasc Surg 2012; 26(4)Case Reports

1.

Ann Vasc Surg. 2012 May;26(4):575.e1-3. doi: 10.1016/j.avsg.2011.08.024.

Hybrid repair of a hepatic artery aneurysm.

Yankovic W, Febrer G,Couture T,Mallios A, Koskas F.

Source

Department of Vascular Surgery, University Hospital Piti-Salptrire, Paris, [email protected]

Abstract

Visceral arterial aneurysm is a rare pathology. Currently, there are no sufficient data tosupport the superiority of surgical or endovascular treatment. The choice dependsmainly on patient characteristics and the anatomy of the aneurysm. We present a caseof a 12-cm fusiform aneurysm of the common hepatic artery. A combined approachincluding endovascular exclusion of the celiac trunk and surgical closure of theaneurysm was chosen. The postoperative course was uneventful. To our knowledge,this is the first case in the literature describing this combined approach.



Related citations

2.Ann Vasc Surg. 2012 May;26(4):574.e1-7. doi: 10.1016/j.avsg.2011.08.023. Epub 2012

Mar 22.

Hybrid stent-graft repair of an iatrogenic complex proximalright common carotid artery injury.

Marine L, Sarac TP.

Source

Department of Vascular Surgery, Pontificia Universidad Catolica, Santiago, [email protected]

Abstract

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BACKGROUND:

Iatrogenic carotid trauma requires early diagnosis and adequate treatment. Classicopen repair may be technically challenging if trauma is in base of the neck. We presenta case of an iatrogenic carotid pseudoaneurysm treated with endovascular repair.

METHODS:

An 87-year-old woman presented with a pulsatile neck mass 10 days after coronaryartery bypass graft surgery. A computed tomographic angiogram showed a 1.6 1.0 2.0-cm pseudoaneurysm arising from the posterior wall of the proximal right commoncarotid artery. Endovascular management was considered, and a percutaneousangiogram demonstrated an arteriovenous fistula in addition to the pseudoaneurysm.Through a cervical cut-down, retrograde percutaneous access was obtained throughthe common carotid artery, which allowed easier access to the area of trauma owing tovessel tortuosity. Subsequently, a 5 mm 2-cm Viabahn was deployed. Thepostdilation angiogram showed a significant endoleak that kept filling the

pseudoaneurysm. A second 6 mm 5-cm Viabahn was placed and successfullypostdilated with a 6 mm 4-cm balloon. No endoleaks or fistulas were noted on thecompletion angiogram.

RESULTS:

The patient remains asymptomatic after 15 months. Follow-up images showedthrombosis of pseudoaneurysm.

CONCLUSION:

Endovascular treatment with self-expanding stent-grafts and open cut-down access areexcellent options to treat major vessel injuries at the base of the neck, where anatomyand cumbersome access make open surgery a more difficult option.



Related citations

3.Ann Vasc Surg. 2012 May;26(4):575.e5-9. doi: 10.1016/j.avsg.2011.08.025. Epub 2012Mar 19.

Endovascular management of iliac vein rupture duringpercutaneous interventions for occlusive lesions.

Adams MK,Anaya-Ayala JE,Davies MG, Bismuth J, Peden EK.

Source

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Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Centerand The Methodist Hospital Research Institute, The Methodist Hospital, Houston, TX77030, USA.

Abstract

Iatrogenic Iliac vein rupture is a rare and potentially lethal complication. We presentherein two different clinical scenarios of iatrogenic iliac vein rupture that resulted fromperforming percutaneous endoluminal interventions to treat symptomatic veno-occlusive lesions. The first case was due to the presence of surgical clips from thepatient's previous gynecologic surgery, which caused iliac vein compression andeventually led to acute deep vein thrombosis. The second case resulted from centralvenous outflow obstruction ipsilateral to a lower extremity arteriovenous dialysis accesssite. Both Iliac vein ruptures were the result of percutaneous attempts to correct theoutflow lesion (delayed in the first case and acute in the second case). Hemorrhagewas successfully controlled in both cases using a self-expandable Viabahn (W. L. Goreand Associates, Flagstaff, AZ) covered stent while maintaining vessel patency and

resolving symptoms related to veno-occlusive disease.



Related citations

4.Ann Vasc Surg. 2012 May;26(4):574.e15-7. doi: 10.1016/j.avsg.2011.10.018. Epub2012 Mar 19.

Perforation of the aorta by a rib edge: an unusual complicationafter chest wall resection.

El Husseiny M,Karam L, Haddad F,Tabet G.

Source

Department of Vascular and Thoracic Surgery, Htel Dieu de France UniversityHospital, Beirut, Lebanon. [email protected]

Abstract

Thoracic aortic perforation in the context of a minor trauma is extremely rare. In thisarticle, we describe a case of an 80-year-old man who presented with an aorticperforation after a fall from his height during his hospitalization. The patient hadpreviously undergone a left superior lobectomy, a partial chest wall resection, andreconstruction for a locally invasive lung cancer. He was directly transferred to the

operating room, as he presented with hemodynamic instability. A 4-mm laceration inthe descending thoracic aorta was identified and repaired. The postoperative course

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was uneventful. This case illustrates the importance of applying a solid fixation to therib stumps when performing a chest wall resection, irrespective of the size of the walldefect.



Related citations

5.Ann Vasc Surg. 2012 May;26(4):573.e9-12. doi: 10.1016/j.avsg.2011.04.015. Epub

2012 Mar 10.

A rare case of visceral arterial stenoses in Williams-Beurensyndrome treated by complex revascularization.

Roux N, David N, Godier S,Plissonnier D.

Source

Department of Vascular Surgery, Rouen University Hospital, Charles Nicolle, Rouen,France. [email protected]

Abstract

Williams-Beuren syndrome is a rare neurodevelopmental disorder. We present thecase of a 27-year-old patient with Williams-Beuren syndrome and a juxtarenalabdominal aorta coarctation. As arterial hypertension (AHT) was not controlled,bilateral renal artery bypasses were performed at the age of 2 years by means of ahepatorenal bypass and a splenorenal bypass. Twenty years later, the patientpresented with abdominal pain, diarrhea, and recurrence of AHT, and severe celiacartery and superior mesenteric artery stenoses were discovered. The distal arterialcomplications of this syndrome are uncommon. After 5 years of medical treatment,

aggravation of the patient's symptoms prompted us to consider possible surgicalmanagement. The patient was successfully treated using a complex direct and indirectprocedure that consisted of a bypass between the celiac aorta and infrarenal aorta,associated with a celiac artery bypass. Instead of endovascular management, thissurgical procedure could be considered effective and long lasting for treating this rarecause of renal AHT.


PMID:22410145

[PubMed - indexed for MEDLINE]Related citations

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6.

Ann Vasc Surg. 2012 May;26(4):574.e9-13. doi: 10.1016/j.avsg.2011.09.010. Epub2012 Mar 10.

Symptomatic fibromuscular dysplasia of the external iliacartery.

Rastogi N,Kabutey NK,Kim D,Farber A.

Source

Department of Radiology, Boston Medical Center, Boston, Massachusetts 02118, USA.

[email protected]

Abstract

The aim of this article is to report a case of symptomatic fibromuscular dysplasia (FMD)involving the external iliac arteries (EIAs). An 88-year-old woman was admitted to thevascular service, with a painful right posterior ankle ulcer that had progressivelyworsened during the course of a month. Her medical history included diabetes andhypertension. Bilateral lower-extremity pulses were absent, and femoral and tibialDoppler waveforms were monophasic. Pelvic and bilateral lower-extremity angiogramswere obtained, which revealed findings in both EIAs consistent with a diagnosis ofextrarenal FMD. Percutaneous transluminal angioplasty with subsequent stenting ofthe right EIA was performed, using a self-expanding stent. Completion digitalsubtraction angiography demonstrated a widely patent right EIA with brisk flow ofcontrast across the stent. Postprocedural arterial duplex scan showed a biphasicwaveform pattern in the common femoral artery. FMD can involve the EIA and beassociated with critical limb ischemia. FMD of the EIA responds well to endovascularmanagement.


PMID:


Related citations

7.Ann Vasc Surg. 2012 May;26(4):571.e11-6. doi: 10.1016/j.avsg.2011.08.019. Epub2012 Feb 8.

Rupture of chronic type B aortic dissection in a Jehovah'sWitness: successful surgical repair without blood transfusion.

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Yamamoto H, Yamamoto F, Yamaura G,Motokawa M,Tanaka F, Sato H, Ishibashi K,Shiroto K.

Source

Department of Cardiovascular Surgery, Akita University School of Medicine, Akita,Japan.

Abstract

The patient, a 55-year-old female Jehovah's Witness who had suffered type B aorticdissection since the age of 53 years, presented with enlargement of the false lumen inthe distal aortic arch and was subsequently admitted to our hospital. Whilehospitalized, her enlarged false lumen ruptured and she underwent replacement of thedistal aortic arch and descending thoracic aorta without blood transfusion. Bloodconservation strategies for this patient included the following: 1) meticulous hemostasiswhen incising muscle or soft tissue, 2) minimal use of gauze and discard suckers, 3)

exclusive use of a cell salvage device "from skin to skin," 4) low-prime cardiopulmonarybypass, 5) minimal laboratory blood sampling, and 6) preoperative and postoperativeerythropoietin treatment. Hemoglobin (Hb) values were 12.5, 15.5, 10.0, and 9.7 g/dLon admission, before rupture, after rupture, and just after the operation, respectively.The patient had an uneventful postoperative course, except for prolongedrehabilitation. The postoperative lowest Hb value was 5.2 g/dL on postoperative day 5,and the Hb value at hospital discharge (postoperative day 55) was 11.0 g/dL. Ourexperience with blood conservation surgery on this Jehovah's Witness patient suggeststhat ruptured chronic type B aortic dissection can be safely repaired on bypass througha left thoracotomy with no blood transfusion if the preoperative Hb value is >10.0 g/dL.



Related citations

8.

Ann Vasc Surg. 2012 May;26(4):571.e1-6. doi: 10.1016/j.avsg.2011.07.023. Epub 2012Feb 8.

Middle colic artery aneurysm: a case report and review of theliterature.

Huo CW.

Source

Department of Vascular Surgery, St. Vincent's Hospital, Melbourne, Australia.

[email protected]

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Abstract

We report a case of a ruptured middle colic artery (MCA) aneurysm in a 48-year-oldpreviously healthy man. Coil embolization was attempted without success. The patientthen underwent resection of the MCA and the transverse colon with a satisfactoryoutcome. Twenty-six previously published cases dating back to 1930 were reviewed,revealing the cause of the MCA aneurysm to be idiopathic in most cases. However,necrotizing arteritis, polyarteritis nodosa, and hypertension have been associated. Theaneurysm is commonly managed with laparotomy, as well as arterial resection with orwithout transverse colectomy, although transcatheter arterial embolization has beensuccessful in four published cases.


PMID:22321489

[PubMed - indexed for MEDLINE]Related citations

9.Ann Vasc Surg. 2012 May;26(4):571.e7-9. doi: 10.1016/j.avsg.2011.07.022. Epub 2012Feb 8.

Combined emergency abdominal aortic aneurysm repair and valve

replacement in a patient with severe aortic stenosis.

McMahon GS,Rayt HS,Galianes M,Nasim A.

Source

Department of Vascular and Endovascular Surgery, University Hospitals of Leicester,Leicester, UK. [email protected]

Abstract

Simultaneous open surgery has been advocated in the elective management ofabdominal aortic aneurysm patients with significant ischemic heart disease, as stagedprocedures risk worsening myocardial ischemia or aortic rupture, depending on whichis the first intervention. The argument for combined aneurysm and valve repair is lessestablished. We describe the case of a 70-year-old female who while awaiting aorticvalve replacement suffered rupture of an abdominal aortic aneurysm. The patient wassuccessfully managed with emergency combined open abdominal aortic aneurysmrepair and open aortic valve replacement. We would advocate that such a strategy beconsidered as a salvage technique in similarly difficult management dilemmas.


PMID:

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Related citations


Challenging treatment of multiple late complications afterendovascular aneurysm repair.

Vakhitov D,Suominen V,Pimenoff G,Uurto I,Saarinen J,Salenius JP.

Source

Division of Vascular Surgery, Department of Surgery, Tampere University Hospital,Tampere, Finland. [email protected]

Abstract

BACKGROUND:

To report a case of multiple additional procedures after successful endovasculartreatment of abdominal aortic aneurysm.

METHODS:

An endovascular abdominal aortic aneurysm repair with a bifurcated aortic Vanguardendograft successfully performed in 1999 resulted in multiple complications, includingendoleaks and a row separation, treated endovascularly. Subsequently, tuberculosissepsis and prosthesis infection resulted in long-term antibiotic treatment. Additionalgraft leaks, aneurysm sack growth, and sack ruptures were also treated endovascularlybecause the patient consistently denied open repair. Endovascular procedures,however, did not solve the problem, turning to be increasingly challenging. The patientfinally approved open graft removal and aortobifemoral reconstruction that weresuccessfully performed 11 years after the initial endograft implantation.

RESULTS:

The patient has recovered from surgery well and is asymptomatic. No evidence ofbacterial colonization was found according to the specimen taken during thelaparotomy.

CONCLUSION:

Vanguard and other first-generation aortic endografts are associated with highincidence of complications and reinterventions. Open surgery is a method of choice in

similar cases.

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Related citations


Percutaneous mechanical thrombectomy for extensive acute

lower-extremity deep venous thrombosis in a patient afterdouble-lung transplantation.

Telich-Tarriba JE,Anaya-Ayala JE, Davies MG, El-Sayed HF.

Source

Department of Cardiovascular Surgery, Methodist DeBakey Heart and VascularCenter, The Methodist Hospital Research Institute, Houston, TX 77030, USA.

Abstract

Venous thromboembolism, which includes deep venous thrombosis (DVT) andpulmonary embolism (PE), has been estimated to affect 25% of patients after majorsurgery; however, the literature on venous thromboembolism after thoracictransplantation and optimal approach remains limited. We report the status of a 67-year-old female who developed massive right lower-extremity DVT after double-lungtransplantation. Because her surgery had taken place a week before this event, it wasdecided that pharmaco-thrombolysis was contraindicated due to the high risk ofbleeding complications in a fresh double-lung transplant recipient. The patient wastaken emergently to the operating room for percutaneous mechanical thrombectomy,which provided grade III (complete lysis) and restored venous patency in the affectedextremity. This report highlights the successful use of purely percutaneous mechanical

thrombectomy for acute DVT in a double-lung recipient, and also advocates inferiorvena cava filter placement to prevent embolic events during the mechanicalthrombectomy.



Related citations

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Distalization of the anastomosis: an effective treatment fordialysis access-associated steal syndrome.

Corfield L,Muller J, Ryan J, Bond R.

Source

Department of Vascular Surgery, Fremantle Hospital, Perth, Western [email protected]

Abstract

Steal syndrome after arteriovenous fistula formation for dialysis access can causeischemic pain and tissue loss. This is an indication for surgical revision, usually eitherbanding (or ligation) or the distal revascularisation and interval ligation procedure.However, banding is inexact, and distal revascularisation and interval ligation canfurther compromise the arterial supply to the arm. We report three cases in which analternative approach of moving the arteriovenous anastomosis distally was used,thereby protecting arterial inflow to the hand. In all three cases, the steal resolved andthe fistula remained patent.



Related citations


Popliteal artery entrapment syndrome in a young girl: casereport of a rare finding.

Molinaro V, Pagliasso E, Varetto G,Castagno C, Gibello L,Zandrino F, Suita R, RispoliP.

Source

Division of Vascular Surgery, Department of Medical and Surgical Disciplines,

Molinette Hospital, University of Turin, Turin, Italy.

Abstract

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The popliteal artery (PA) entrapment syndrome, a rare cause of arterial thrombosis, ismost often encountered in young male athletes. Here, we report a very unusual case ofPA entrapment syndrome in a 14-year-old girl who presented with a 1-month history ofcalf claudication to our observation facility. Diagnostic work-up revealed obesity,sedentary lifestyle, and an aberrant accessory slip of the medial head of gastrocnemiusaround the PA. Arterial echo color Doppler ultrasonography and computed tomographicangiography studies were performed. Surgical treatment involved revascularizationwith resection of the medial head of gastrocnemius, the cause of the arterialentrapment, and enlargement angioplasty using an autologous saphenous vein patch,in combination with antiplatelet therapy, resulting in restitution ad integrum of theaffected limb and, finally, an improved quality of life of the patient. This caseunderscores the importance of clinical suspicion, diagnosis, and treatment of lower-limb claudication in very young patients presenting with unusual symptoms. If missed,the condition may evolve dramatically. Prompt diagnosis and surgical treatment are keyto complete recovery and the prevention of irreversible complications that may result inlimb loss.



Related citations


Unusual positional compression of the internal carotid arterycauses carotid thrombosis and cerebral ischemia.

Keshelava G, Nachkepia M,Arabidze G,Janashia G,Beselia K.

Source

Department of Cardiovascular Surgery, West Georgian National Centre ofInterventional Medicine, Kutaisi, Georgia. [email protected]

Abstract

This article reports an unusual case of positional compression of internal carotid arteryresulting in carotid thrombosis and stroke in a 37-year-old man. A patient was operatedurgently for a free-floating thrombotic mass in the internal carotid artery. Openthrombectomy was performed in acute phase of stroke for prevention of therecapitulative cerebral thromboembolism. Hemiplegia completely disappeared within 7months.


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Related citations


Endovascular repair of aortic isthmus coarctation with a self-expanding covered stent.

Oberhuber A, Muehling BM,Orend KH,Schelzig H.

Source

Department of Thoracic and Vascular Surgery, University of Ulm, Ulm, [email protected]

Abstract

BACKGROUND:

Coarctation is one of the most often seen congenital aortal defects. In the majority,diagnosis will be made in newborns. Endovascular repair is critical in children owing totheir growth, but in adult patients, it is an interesting alternative.

METHODS:

A 31-year-old man presenting with hypertension of upper extremities and pulselesslower extremities was admitted to our hospital. Systolic blood pressure was 190 mmHg, although a triple antihypertensive medication was administered. Computedtomographic angiography showed a nearly total occlusion of the aortic isthmus.Coarctation was treated by an endovascular approach with a self-expanding coveredstent-graft (Medtronic Talent; Medtronic World Medical, Sunrise, FL) after predilatationwith a Reliant balloon (Medtronic World Medical, Sunrise, FL).

RESULTS:

After a follow-up of 40 months, the patient is normotensive and antihypertensivemedication could be reduced. Lower extremities showed normal pulses and normalankle-brachial index. Computed tomographic scans showed unchanged stent-graftposition, with constant slight waist.

DISCUSSION:

Endovascular repair of atresia or coarctation of the thoracic aorta is a minimal invasive

debatable option. Not only reduction of blood pressure but also reduction of leftventricular mass and prolongation of life expectancy can be achieved by endovasculartreatment.

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