Search

Objective: Cervical hematoma (CH) following carotid endarterectomy (CEA) is a serious complication. We reviewed 12 years of CEA for CH requiring operative evacuation to determine its impact on the patient outcome and relationship to perioperative pharmacotherapy. Methods: A total of 2643 CEAs were reviewed. In all, 57 CHs requiring operative evacuation were compared to all the patients for general characteristics and with a case-controlled cohort group for pharmacologic details. Results: The occurrence of CH was stable from 1994 to 1998 and then increased from 1999 to 2003. The CH increased operative mortality, neurologic complications, adverse cardiac events, and cranial nerve injury. Combined platelet inhibition and dextran alone increased the risk of CH. The CH rate dropped by 65% after the observations were reported to the vascular surgeons. Conclusion: The CH following CEA requiring operative evacuation is associated with increased postoperative mortality and cardiac and neurologic morbidity. Combined platelet inhibition, use of dextran, and elevated creatinine are causally related to CH. Physician awareness and modified pharmacotherapy have decreased the problem. [ABSTRACT FROM AUTHOR]

There is increasing interest in using endovascular methods instead of surgical reconstruction to treat popliteal artery aneurysms. Exclusive use of the Viabahn stent-graft, a nitinol stent covered with expanded polytetrafluoroethylene, was assessed in the treatment of patients who presented with popliteal artery aneurysms in the absence of acute limb ischemia. Technical success, endoleaks, graft patency, freedom from amputation, and aneurysm sac flow and size changes were assessed by duplex ultrasound. From June 2004 to March 2006, 16 men (mean age, 76 years; range, 65–83) underwent endovascular exclusion of 23 popliteal artery aneurysms (mean diameter, 2.5 cm; range, 1.3–6.7 cm). Nine lesions had partial thrombus on preprocedural duplex imaging. Nineteen of the 23 limbs treated had at least 2-vessel tibial artery runoff. Procedures were performed under local anesthesia using ipsilateral percutaneous antegrade arterial access. All patients received 75 mg/day of clopidogrel afterward. Follow-up assessments included direct clinical examinations and duplex ultrasonography performed 1, 3, 6, and 12 months after the procedure. Primary patency and amputation-free survival were calculated using Kaplan-Meier analysis. Complete aneurysm exclusion (technical success) was achieved in all cases. During the mean follow-up of 7 months (range, 1–21 months), 22 of 23 treated limbs remained asymptomatic. One stent-graft thrombosis occurred 6 months after the procedure and was successfully treated with percutaneous mechanical thrombectomy, balloon angioplasty of a stent-graft stenosis, and insertion of an uncovered nitinol stent. No popliteal artery aneurysm sac size enlargements or endoleaks were detected. At 12 months, the treated limb mean ankle-brachial index was 1.0 (range, 0.82–1.31) and the primary and secondary patency rates were 93% and 100%, respectively. Early results with Viabahn endovascular stent-graft exclusion of asymptomatic popliteal artery aneurysms are promising. Patient selection for endovascular repair depends on suitable popliteal artery anatomy, extent of aneurysmal degeneration, and quality of tibial arterial runoff. [ABSTRACT FROM AUTHOR]

Branchial cleft sinuses are congenital anomalies that usually present in childhood or early adulthood. It is uncommon that such a sinus will remain asymptomatic to the sixth decade of life. This case describes the presence of a second branchial cleft sinus in the setting of carotid artery disease, where both were treated surgically simultaneously without complication. [ABSTRACT FROM PUBLISHER]