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Background: We investigated the impact of a transvenous cardiac implantable electronic device (CIED) placement on outcomes and arteriovenous vascular access (VA) patency among chronic hemodialysis patients.Methods: This is a single-center, observational comparative study between chronic hemodialysis patients with ipsilateral and contralateral CIED and VA. Forty-two consecutive patients who underwent both CIED placement and upper-extremity VA for hemodialysis, regardless of the sequence and time interval between these 2 procedures, were identified between January 2001 and December 2017. Patients with ipsilateral (n = 22, 52%, the ipsilateral group) and contralateral (n = 20, 48%, the contralateral group) CIED and VA were compared retrospectively; the primary outcome was any-cause mortality and cardiac mortality or the composite of any systemic complications, defined as central venous stenosis or occlusion, any device infections or tricuspid regurgitation; the secondary outcome was CIED or VA malfunction.Results: During the median follow-up period of 101 months, primary outcome incidence was significantly higher in the ipsilateral group than the contralateral group (73% vs 40%, P = 0.03), although the incidences of any-cause mortality (P = 0.28) and cardiac mortality (P > 0.99) were similar between the groups. Secondary outcome incidence did not differ significantly between the 2 groups (55% vs 30%, P = 0.36). Kaplan-Meier survival analysis revealed similar primary and secondary VA patency rates in both groups. On subgroup analysis, patients with upper arm VA had similar primary and secondary patency to those with forearm VA.Conclusions: Despite some notable limitations of the study, the retrospective study design and small sample size, we found that the any-cause mortality incidence and VA patency did not differ between the 2 groups, but primary outcome incidence was significantly higher among patients with ipsilateral CIED and VA. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the impact of diabetes duration and carotid artery stenosis (CAS) on the occurrence of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) without clinical cardiovascular disease. Methods: A total of 2006 patients with T2DM, without clinical cardiovascular disease, aged >50 years and who underwent baseline carotid Doppler ultrasound screening with regular follow-ups at the outpatient clinic of our diabetes center, were stratified into four subgroups according to diabetes duration and CAS degree. The primary outcomes included the occurrence of MACE, defined as fatal or nonfatal stroke and myocardial infarction and all-cause mortality. Results: The difference in the MACE incidence was significantly greater in patients with a longer diabetes duration (⩾10 years) and significant CAS (50-69% luminal narrowing) (p < 0.001). Analysis of individual MACE components indicated a trend towards an increased incidence of stroke (p < 0.001), parallel to a longer diabetes duration and significant CAS. In contrast, the risk of myocardial infarction was significantly higher in patients with a diabetes duration <10 years and significant CAS (p = 0.039). Multivariate regression analysis showed that patients with both a longer diabetes duration and significant CAS demonstrated additive and very high risks of MACE (hazard ratio [HR], 2.07; 95% confidence interval [CI] 1.17-3.66; p = 0.012) and stroke (HR, 3.38; 95% CI 1.54-7.44; p = 0.002). Conclusions: The risk of MACE is significantly greater in patients with T2DM, without clinical cardiovascular disease, who have both a longer diabetes duration and significant CAS, compared with those who have a shorter duration and/or nonsignificant CAS. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate whether variant meso-Rex bypass with transposition of abdominal autogenous vein can be used as an alternative treatment modality for selected patients with symptomatic extrahepatic portal vein obstruction.Methods: This was a retrospective review of six consecutive patients who received this alternative procedure for the treatment of symptomatic portal hypertension secondary to idiopathic extrahepatic portal vein obstruction. Their clinical characteristics, operative procedures and outcomes were analyzed retrospectively.Results: The procedure was attempted in six patients, and all had a patent shunt established by intraoperative portography at the end of the procedure; the coronary vein was used in four patients and the inferior mesenteric vein was used in two. During the median period of 23.5 months (range 10-30 months), follow-up was uneventful except one patient; reduced portal hypertension and no new episodes of gastrointestinal bleeding were observed in all patients, with the exception of one patient with shunt stenosis and recurrent varix bleeding who had to undergo endovascular treatment to restore portal vein blood flow. Technical and clinical success was achieved in all patients.Conclusions: This procedure could be used safely and effectively to treat selected patients with portal hypertension secondary to extrahepatic portal vein obstruction. [ABSTRACT FROM AUTHOR]

As experiences with endovascular aortic devices increases over time, hybrid repair for the treatment of thoracoabdominal aortic aneurysms (TAAA) by using a combination of thoracoabdominal endovascular aneurysm repair and visceral revascularization has been reported with acceptable result. A 55-year-old man with type III TAAA involving visceral arteries has been treated successfully with tube stent-graft followed by right renal revascularization that was facilitated by a rare anatomic configuration. The authors present a type III TAAA patient with rare anatomic configuration of the visceral arteries successfully treated with hybrid endovascular-surgical TAAA repair. [ABSTRACT FROM AUTHOR]

This report describes a case of a delayed cerebral embolic infarction, after internal carotid artery (ICA) ligation secondary to carotid body tumor resection. We describe a 34-year-old woman who underwent left ICA ligation during a large carotid body tumor surgery. Immediately after surgery, the patient was neurologically asymptomatic; however, she subsequently developed a cerebral embolic infarction nine hours postoperatively. After beginning antiplatelet therapy, all symptoms ultimately resolved, although over a gradual course. Since the ligation of the ICA can cause thromboembolic infarctions of the cerebrum, we contend that antiplatelet agents be administered to prevent and/or treat embolic strokes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the efficacy and safety of closely sequential carotidendarterectomies (CEAs) for bilateral internal carotid artery stenosis. Methods: From September 1995 to December 2011, 953 CEAs were performed for internal carotid arteryocclusive disease in Asan Medical Center. Seven hundreds eighty-five patients received unilateral CEA, and 84 patients received bilateral CEAs. Of the 84 patients with bilateral CEAs, 15 who underwent closely sequential CEAs with an intersurgical period of 7 days were included in this study. Retrospectively, surgical outcomes were evaluated and compared, regarding CEA-related parameters, and early and late mortality andmorbidity rates between patients with closely sequential bilateral CEAs and unilateral CEA. Results: With this strategy, initial CEA was performed for the symptomatic side in symptomatic patients, or for the higher-grade carotid stenosis in asymptomatic patients. All 15 patients received contralateral CEA7 days after initial CEA, and sufficient revascularization was obtained in all procedures. With a mean follow-upof 11.7 months, there were no perioperative neurological complications or strokes. During the follow-up period, early and late complications, except for transient cranial nerve injury, occurred without statistically significant difference between unilateral CEA and closely sequential bilateral CEAs. Conclusion: Closely sequential bilateral CEAs showed excellent early and late clinical outcomes. Although the number of patients included in the study was few, our results demonstrated that closely sequential bilateral CEAs were safe and effective strategies for bilateral internal carotid artery stenosis. In addition, future clinical studies will be needed, with a greater number of patients. [ABSTRACT FROM AUTHOR]

Background: Removing carotid body tumors (CBTs) carry the risk of operative morbidity including stroke. We evaluated the risk factors for stroke related to resection of CBTs. Methods: We retrospectively reviewed the records of 17 procedures performed on 16 patients with CBT between March 1998 and September 2008. Results: The study population consisted of 5 men and 11 women, of mean age 41.7 years (range: 23-62 years). At surgery, 8 cases (47%) were localized and classified as Shamblin class I, 4 cases (23.5%) as class II, and 5 cases (29.4%) as class III. Four patients had postoperative stroke (23.5%), with Shamblin classification related to the incidence of stroke ( P = 0.041). In contrast, neither tumor size ( P = 0.412) nor heparin injection before internal carotid artery (ICA) manipulation ( P = 0.538) was associated with stroke. Although preoperative embolization of the tumor feeder did not significantly reduce the stroke rate ( P = 0.579), early external carotid artery (ECA) division in patients with class II and III tumors was effective ( P = 0.008). Internal carotid artery (ICA) manipulation, including reconstruction, ligation, and repair of injury, significantly increased the incidence of stroke ( P = 0.029), as did ICA ligation without reconstruction ( P = 0.044). Conclusions: Internal carotid artery manipulation, including reconstruction, ligation, and repair of injury, significantly increased the incidence of stroke. For uncomplicated CBT resection, careful preoperative planning, especially for patients with class II and III tumors, is mandatory to avoid inadvertent ICA manipulation necessitated by bleeding. Early ECA division during the operation rather than preoperative percutaneous embolization in patients with class II and III tumors was significantly effective in reducing the stroke rate [ABSTRACT FROM AUTHOR]

Reinfection is a major issue of surgical treatment for patients with infected abdominal aortic aneurysm (AAA). The present report describes outcomes after use of our procedure for treating patients with infected aneurysm of the infrarenal abdominal aorta. The procedure involved an in situ polytetrafluoroethylene (PTFE) graft bypass and omental wrapping of the graft. The procedure was used regardless of the presence of Gram-stain-positive pus or tissue or the type of pathogen identified. We retrospectively reviewed nine consecutive patients with primary infected aneurysms of the infrarenal abdominal aorta treated from June 2001 to August 2006 at the Asan Medical Center, Seoul, Korea. Diagnosis was based on preoperative abdominopelvic CT scans. Treatment involved removal of all infected tissue, including infected aorta tissue, in situ PTFE graft reconstruction, and wrapping of the graft with retrocolically transposed great omentum. Sensitive antibiotics were administered before and after the operation. In all cases, aneurysms were the result of aortitis and aortic wall perforation, and presented as aortic pseudoaneurysms with rupture. The pathogens identified were Salmonella non-typhi ( n = 4), Klebsiella pneumoniae ( n = 2), Streptococcus pneumoniae ( n = 1), Citrobacter freundii ( n = 1), and Brucella abortus ( n = 1). There was no infection-related morbidity or mortality during a median follow-up period of 49 months. Surgical treatment comprising complete removal of all infected tissue, in situ PTFE graft reconstruction, and omental wrapping of the graft was effective in treating infected AAA. Key adjunct procedures were a precise preoperative diagnosis using abdominopelvic CT scans, and pre- and postoperative sensitive antibiotic treatment. [ABSTRACT FROM AUTHOR]

B-mode ultrasound (duplex) imaging is a technique that enables the evaluation of plaque characteristics. The purpose of this study was to determine the accuracy and usefulness of duplex imaging by comparing a relationship between the preoperative clinical neurologic status, preoperative duplex findings, and operative findings in patients who had carotid endarterectomy (CEA) for symptomatic high-grade internal carotid artery (ICA) stenosis-Sixty patients with symptomatic ICA stenosis who underwent CEA from September 1995 to August 1998 were included in this study. Plaque morphology was categorized in terms of echogenicity by preoperative duplex imaging. A correlation between the frequency of preoperative ischemic stroke and duplex and operative findings was prospectively evaluated. Thirty-eight patients had recent and multiple cerebral ischemia, and 22 experienced a single episode more than 1 month before CEA. Recent and multiple events occurred in 24 (72.7%) of 33 patients with echolucent plaques, but only 6 (40.0%) of 15 with echogenic plaques (p<0.05). Thirty-six (75%) of 48 patients with soft plaques by operative findings had recent and multiple events, but only two (16.7%) of 12 with calcified plaques experienced recent and multiple events Cp<0.01). Overall sensitivity, specificity, and accuracy of duplex imaging were 79.5%, 77.8%, and 79.2%, respectively. Duplex imaging is reliable in determining ICA plaque characteristics. Recent and multiple cerebral ischemia occurred more frequently in patients with echolucent plaques by preoperative duplex and soft plaques by operative findings. The presence of echolucent plaque may be used as a strong indication for CEA in patients who have asymptomatic high-grade ICA stenosis. [ABSTRACT FROM AUTHOR]

Abstract Buergers disease is almost always a disease of the blood vessels in the extremities. Conversely, mesenteric involvement of Buergers disease is rare, and no true series have been reported. We report the case of a 37-year-old man with clinical symptoms of upper extremity Buergers disease, who underwent surgery for extensive small bowel infarction. Histopathologic findings revealed that the mesenteric arteries were swollen and infiltrated with neutrophils, but not associated with fibrinoid necrosis. The lumen was occluded by a highly cellular thrombus with the appearance of a microabscess. These findings were compatible with acute-stage mesenteric Buergers disease and postoperative studies revealed multiple occluded segments in the small and medium-sized arteries of both legs and the left arm, suggestive of Buergers disease in the extremities. [ABSTRACT FROM AUTHOR]