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Background We describe an original method to treat tandem lesions of the internal carotid artery (ICA) and the common carotid artery (CCA). In this manuscript, we describe a “double eversion carotid endarterectomy” technique (DECE) and report our results. Methods A retrospective review in the medical records of patients that underwent DECE over a 15-year period was performed. Patient characteristics, operative details, preoperative imaging and lesion characteristics, perioperative outcomes, and follow-up data were documented and analyzed. Patients with ostial and mediastinal lesions were excluded from our study. Operations were divided into 2 categories: “planned,” when the lesions were identified during preoperative imaging, and “necessary” when performed for secondary defects of the CCA detected intraoperatively. Results Between 1996 and 2011, a total of 15 patients with 17 tandem lesions underwent DECE. The mean age was 74.3 years. The mean degree of stenosis was 76.3% for the ICA and 61.5% for the CCA, with the majority of the lesions being asymptomatic (12/17). All procedures were performed under general anesthesia, and in 1 case an intraluminal shunt was used. The mean operative time was 83.4 min, with a mean primary clamping time of 29.2 min. In cases of secondary lesions, the mean reclamping time was 16.2 min. There was no mortality or major neurologic event within 30 days postoperatively. Postoperative complications included 2 major cardiac events and 1 case of cranial nerve XII injury that resolved during follow-up. There were no deaths or neurologic events during a mean follow-up of 27.5 months (range: 1–188 months). One patient required a reintervention after 5 years because of restenosis of the ICA. Conclusion DECE is an alternative surgical technique for select tandem, nonostial carotid lesions. In addition, DECE can be performed as a “bailout” procedure for secondary CCA defects during conventional eversion carotid endarterectomy.

ObjectiveMost clinicians regard angioplasty with or without stent placement to be the treatment of choice for transplant renal artery stenosis (TRAS). However, published results regarding its effectiveness are heterogeneous. The aim of this study was to assess the safety and efficiency of TRAS endovascular therapy.MethodsAll cases of TRAS admitted for treatment in our unit from January 2009 to December 2012 were reviewed retrospectively. The primary end point was the stenosis-free primary transplant renal artery patency. Secondary end points were freedom from reintervention, graft survival, postoperative serum creatinine level, blood pressure evolution, and the number of antihypertensive drugs pre- and postprocedure.ResultsA total of 17 patients (10 men, 7 women) presenting with TRAS were referred to our institution. During the early post-transplantation process (

A 60-year-old male patient presented with a false aneurysm of the common iliac artery and methicillin-resistant Staphylococcus aureus septicemia complicating previously placed kissing covered stents of the aortic bifurcation. We removed the prosthetic material and repaired the aortic bifurcation with a composite saphenous vein panel graft. To our knowledge, this technique is presented for the first time in the literature.

The prevalence of iliac artery aneurysms is extremely rare in children. The most common etiologies for developing an aneurysm in children are infections, inflammatory diseases, and trauma. An idiopathic or congenital etiology is the least common cause in the pediatric population. We report a case of a 9-year-old girl with no previous history of trauma, intervention, or family history of vascular diseases who presented with a sudden severe right lower quadrant pain suggesting appendicitis. Upon examination, a large tender pulsatile mass was felt in the right lower quadrant. Ultrasound and computed tomography scans revealed a large right common iliac aneurysm. The aneurysm was noted to have a high risk of rupture due to the sudden symptomatic presentation and its large size. Therefore, the patient underwent an urgent operation, during which an aneurysmal repair was performed with an interposition graft. Postoperative ultrasound imaging showed a patent graft and no residual aneurysm. The patient has been followed up for two years, and no complications were found.

Recent advances in imaging technology allow the projection of volumetric imaging data from the preacquired computed tomography angiography over live fluoroscopy during interventions. This "fusion" technology is currently underused, although its application carries distinct advantages. We introduce a case in which fusion technology was used for the placement of two thoracic and one branched abdominal aortic endograft and to treat late dislocation of its side branch using a hybrid technique.

Background The aim of this retrospective study was to examine the impact of graft oversizing on gutter area and stent compression in chimney graft (CG) for complex abdominal aortic aneurysm (CAAA) repair. The influence of stent-graft oversizing on type Ia endoleaks and bridging stent occlusion rates was also examined. Methods Preoperative and postoperative computed tomographic angiography scans of patients requiring CGs for CAAA between June 2009 and April 2013 in our institution were analyzed. Two groups were identified: proximal oversizing of the stent-graft component 25% (group 2). Relative gutter areas were calculated and compared between both groups. Incidence of target vessel stent compression, target vessel occlusions, and type Ia endoleaks was also analyzed. Results Of 39 patients treated with CG during the study period, 23 fulfilled the selection criteria for analysis. Group 1 included 10 patients and group 2 included 13 patients (mean oversizing: 18.4 ± 4.9% and 34.5 ± 6% respectively). Relative gutter areas were significantly higher in group 1 when compared with group 2 (6.1 ± 2.1% vs. 4.2 ± 3.2%, P = 0.03). No stent compression and no target vessel occlusion occurred in either groups. There was no statistical difference in type Ia endoleak in both groups (group 1 n = 0, group 2 n = 2; P = 0.48). Conclusions In our study, a >25% stent-graft oversizing reduced the gutter area without modifying the bridging stent patency. However, no benefit in terms of type Ia endoleak was observed.

We report a case of a 63-year-old man presenting with abdominal pain and hydronephrosis secondary to periaortic fibrosis (PAF) 8 months after an endovascular aortic repair (EVAR) using a woven polyester bifurcated graft. De novo delayed PAF after open repair is rare and even more infrequent after EVAR. All 3 previously reported cases occurred after woven polyester grafts and no reported cases after polytetrafluorethylene grafts. Management included steroidal anti-inflammatory treatment and bilateral double J tube placement. Satisfactory results were obtained.

Preservation of native arteriovenous fistulas (AVFs) in the long term can be technically challenging. Various anatomic or functional problems can occur and multiple open and/or endovascular interventions may be required for extended preservation of native accesses. In this report, we review vascular access maintenance in a 72-year-old woman during a 5-year period. Multiple complications of her native radiocephalic AVF included recurrent occlusions, a central venous stent fracture and symptomatic venous outflow stenosis. We present this case to illustrate the various techniques and combination of approaches used in the long-term preservation of a native AVF.

Objectives This review article provides an overview of the current state of imaging of synovitis in osteoarthritis (OA), looking at recent advances and controversies and focusing particularly on the application of ultrasound and magnetic resonance imaging (MRI) in the assessment of the hand and knee joint. Computed tomography and nuclear medicine including positron emission tomography are also briefly discussed. Methods PubMed and MEDLINE search for articles published up to 2010, using the keywords synovitis, osteoarthritis, rheumatoid arthritis, pathogenesis, imaging, radiography, computed tomography, nuclear medicine, magnetic resonance imaging, ultrasound, and pain. Results Synovitis is defined as inflammation of the synovial membrane. Modern imaging techniques have demonstrated that synovial pathology is common in the early and late stages of OA and may be associated with pain. The current standard for OA imaging in clinical practice is conventional radiography but it does not allow direct visualization of synovitis. MRI without contrast administration, although widely used in clinical studies, cannot assess synovitis directly. Contrast-enhanced MRI and ultrasound, however, both allow direct visualization of synovitis including early inflammatory changes. They are regularly used to image synovitis in rheumatoid arthritis and increasingly in OA. Conclusions Synovitis is increasingly recognized as an important feature of the pathophysiology of OA, although there is conflicting evidence with respect to its association with disease severity and clinical parameters. Contrast-enhanced MRI and ultrasound are the most important methods for assessing synovitis associated with OA.

Perforation of an inferior vena cava filter by one the filter device hooks is a recognized possible complication of this device. We describe a case of surgical excision of a permanent inferior vena cava filter associated with multiple perforations of surrounding structures by each of the 6 hooks of the device. Structures affected include the third lumbar vertebral body, transverse mesocolon, the infrarenal aorta, the duodenum, and the psoas muscle. A thorough understanding of the filter design and adequate preoperative imaging were vital in planning the safe surgical excision of this device.

controlled trial of dipyridimole plus aspirin for newly placed AVG. Methods: Participants in the Dialysis Access Consortium trial with upper extremity prosthetic grafts of the brachial artery were studied. Multivariable analyses adjusting for treatment group, center, gender, race, BMI, diabetes, current dialysis, and prior access or catheter were performed to compare outcomes of forearm (fAVG) and upper arm (uAVG) grafts including loss of primary unassisted patency (LPUP) and cumulative primary graft failure (CGF). Subgroup analyses of graft configuration and outflow vein used were conducted. Results: Of the 522 participants with an upper extremity brachial artery graft, 269 had fAVG and 253 had uAVG. Participants with fAVG were less often male (33% vs 43%; P 1⁄4 .03), black (62% vs 77%; P < .001), dialysisdependent at time of surgery (20% vs 36%; P < .001), and had a higher mean BMI (32 vs 29; P < .001) compared to those with uAVG. There was no difference in LPUP (69% vs 78%; P 1⁄4 .22) or CGF (32% vs 36%; P 1⁄4 .53) between fAVG and uAVG at 1 year follow-up. Multivariable adjustment did not change the statistical significance of the association between AVG location and either LPUP (HR, 1.26; 95% CI, 0.98, 1.62; P 1⁄4 .07) or CGF (HR, 1.09; 95% CI, 0.80, 1.49; P 1⁄4 .58). LPUP did not differ significantly between fAVG and uAVG among subgroups based on AVGconfiguration (P1⁄4 .23) or outflow vein used (P1⁄4 .53). Conclusions: Patency of fAVG and uAVG was similar despite the larger caliber veins often encountered in the upper arm. Therefore, to preserve a maximal number of access sites, the forearm location should be considered first before resorting to an upper arm graft.