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Objective To compare the results of elective open surgical repair (OSR) and total endovascular repair of juxtarenal aortic aneurysms (JAA), with either the Cook Zenith or the Vascutek Anaconda fenestrated stent grafts (F-EVAR) in a university hospital setting. Patients and methods Between April 1999 and July 2014, of 926 patients with an abdominal aortic aneurysm, 69 were juxtarenal, where 34 had an elective OSR and 35 had F-EVAR. A post-operative rise of baseline creatinine by >50% and/or deterioration of estimated glomerular filtration rate by 25% were defined as renal failure. Results The demographics of the patients were similar except for heart insufficiency, peripheral arterial disease, and pre-existing renal artery stenosis ( p < .05). Median aneurysm diameters were 57 mm (range 50–80 mm) and 56 mm (range 36–64 mm) ( p = .194), respectively, and the median pre-operative serum creatinine levels were 94 μmol/L (range 65–286 μmol/L) and 96 μmol/L (range 57–333 μmol/L) ( p = .871) with median estimated glomerular filtration rate of 68 mL/min (range 21–117 mL/min) and 70 mL/min (range 18–114 mL/min) ( p = .308) in the open and endovascular groups, respectively. The technical success (OSR versus F-EVAR) was 100% versus 94.3% with complete exclusion of the aneurysms in all cases. Median procedure time was 171 versus 188 min. During median in hospital stay of 11 versus 7 days ( p = .05), mortality was 0 versus 2.9% and new onset of post-operative renal insufficiency was detected in 26.5% versus 8.5% patients ( p = .05), although with 11.8% versus 5.7% being persistent ( p = .428). During follow up, statistically similar new (late or persistent post-operative) renal insufficiency was detected in 14.7% versus 8.8% with dialysis in 3% of patients in each group with similar mortality within the 24 months. Conclusions This retrospective analysis demonstrates that OSR might be combined with more acute post-operative renal impairment than F-EVAR for JAA, but with similar intermediate term procedure related mortality and renal outcomes. Article history: [ABSTRACT FROM AUTHOR]

Objective/Background Endovascular aneurysm (EVAR) repair of an aortic aneurysm extending to the iliac artery remains a challenge. Interventional occlusion of the internal iliac artery (IIA) intending to create a distal landing zone in the external iliac artery is a common approach with inherent morbidity (e.g., buttock claudication, impotence). Alternatively, iliac side-branched stent grafts can maintain pelvic blood supply, but the applicability is limited. The objective was to investigate the morphological applicability of the Cook Zenith branched graft (ZBIS) among patients with aorto-iliac or isolated iliac aneurysms. Methods This was a retrospective single centre analysis of 66 patients (60 men; median age 74 years, range 53–90 years) undergoing repair of aorto-iliac aneurysms (open repair, IIA occlusion prior to EVAR and ZBIS) between January 2008 and December 2012. All available computed tomography angiograms with post-processing imaging were compared with the criteria for morphological applicability to (i) the manufacturer's instruction for use (IFU), and (ii) to criteria published in the literature, as well as (iii) to the institutional protocol. Results In 66 patients, 88 targeted iliac aneurysms were studied. Of these, 36/88 (40.9%) were compliant with the manufacturer's IFU, 35/88 (39.8%) were compliant with the published criteria, and 51/88 (58.0%) were compliant with the in house protocol. The most common morphological exclusion criterion was an aneurysmal IIA. Conclusion In the present cohort with aorto-iliac aneurysm, a maximum of 58% could have been treated with an iliac side branch based on the current experience. In particular, an aneurysmal IIA seems to be a limiting factor for the use of the iliac side-branched stent graft. [ABSTRACT FROM AUTHOR]

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Objective Proximalization of arteriovenous inflow (PAI) is an established technique for treating patients with access-induced hand ischemia. However, a prosthetic graft, used as arterial inflow, could minimize the benefits of a purely native fistula. In this study, a new PAI technique is reported, which avoids the use of prosthetic grafts in patients with matured basilic and cephalic veins. Patients and methods Eight patients (seven men, one woman; mean age 62 (45–82) years old) with grade III/IV critical dialysis access-related ischemia (DARI) and with a pre-existing Gracz fistula underwent an operation using modified PAI. The basilic and cephalic veins were preoperatively matured. During the operation, the former arteriovenous anastomosis was closed and the basilic vein was used as arterial inflow. Results All procedures were technically successful. All patients but one could be discharged with a warm, neurologically improved extremity with a significant reduction in pain. After a mean follow-up of 43.5 (0–52) months, there were no recurrent steal symptoms and all necrotic hand lesions healed. Two patients died during the follow-up, but with well-functioning fistulae. One fistula failed during follow-up and one further fistula was ligated because of chronic neurological damage, which was not improved after the PAI procedure. Four AVFs are still available for hemodialysis. Conclusions The modification of the PAI technique with a basilic vein as presented here showed similar results to the original PAI procedure. This new procedure does not require prosthetic grafts as in the original PAI technique or a central venous catheter and leads to the enlargement of the puncture site as a result of the superficialization of the basilic vein. Therefore, it is believed that this new technique could be a good option for those patients with matured cephalic and basilic veins who suffer from severe access-related ischemia. [ABSTRACT FROM AUTHOR]

Objectives: This article aims to report for the first time the long-term bypass graft patency after visceral hybrid repair of thoraco-abdominal aortic aneurysms (TAAAs). Patients and methods: Between July 2004 and September 2012 the visceral hybrid procedure was performed in 46 patients with TAAAs, who did not qualify for an open or total endovascular repair. The inflow sites of visceral revascularisation originated either from the native artery or from aortic prosthetic grafts. All patients were included in the study and were followed up with subsequent computed tomography (CT) (mean follow-up 23.5 months). Results: In 46 patients (67.5 years in median; range 35–88), 164 grafts were performed. The 30-day primary patency of all grafts was 87.9%. The long-term patency remained 87.9 ± 2.7%, 86.1 ± 3.2% and 86.1 ± 3.2% after 1, 3 and 5 years, respectively. The patency of all hepatic grafts was 100%. The patency of grafts to the superior mesenteric artery was 88.8 ± 4.8% after 1, 3 and 5 years. The patency was 87.2 ± 6%, 87.2 ± 6% and 87.2 ± 6% for the left renal artery and 76 ± 7%, 69.6 ± 8.8% and 69.6 ± 8.8% for the right renal artery after 1, 3 and 5 years, respectively. Conclusions: Hybrid repair demonstrates excellent results regarding long-term bypass graft patency of renovisceral arteries except for the right renal artery. [Copyright &y& Elsevier]

We discuss ɣɣ → ππ reactions, starting from the two-pion threshold up to about √Sɣɣ = 6 GeV. Several reaction mechanisms are identified. We include the dipion continuum owing to pion exchange (for π+ π-) and ρ± exchange (for π0 π0), as well as the pronounced dipion σ(600), ƒ0(980), and ƒ2(1270) s-channel resonances. We discuss also a possible contribution of less pronounced scalar resonances ƒ0(1500) and ƒ0(1710), being glueball candidates, as well as the tensor resonances ƒ'2(1525), ƒ2(1565), and ƒ2(1950). While the contribution of ƒ0'(1525) is rather small, the contribution of ƒ0(1565) changes the spectrum around the resonance position. We find that the inclusion of the spin-four ƒ4(2050) resonant state improves the situation at √Sɣɣ ≈ 2 GeV. We estimate the relevant diphoton partial decay width to be ɣƒ4 → ɣɣ ≈ 0.7 keV. At higher energies, Brodsky-Lepage and handbag mechanisms are included in addition. We nicely describe the world data for ɣ ɣ → π π for the first time both for the total cross section and for angular distributions for ɣ ɣ → π+ π- and π0 π0 reactions simultaneously at all experimentally available energies. The cross section for the production of two pions in ultraperipheral ultrarelativistic heavy-ion collisions is calculated in the impact parameter space Equivalent Photon Approximation (EPA). We obtain the nuclear cross section of 46.7 mb for π+ π- and 8.7 mb for π0 π0 at the LHC energy √SNN = 3.5 TeV and minimal cut on pion transverse momentum pt > 0.2 GeV. Differential distributions in impact parameter, dipion invariant mass, single-pion and dipion rapidity, pion transverse momentum, and pion pseudorapidity are shown. The ɣ ɣ → π+ π- subprocess constitutes a background to the exclusive AA → Aρ0(→ π+ π-)A process, initiated by photon-pomeron or pomeron-photon subprocesses. We find that only a part of the dipion invariant mass spectrum associated with ɣ ɣ collisions can be potentially visible as the cross section for the AA → Aρ0A reaction is very large. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To report our early experience with total endovascular repair of aortic-arch aneurysm using double chimney-grafts and present a literature overview. Patients and methods: The double chimney-graft technique was performed in six male patients with contained ruptured aneurysm, dissecting aneurysm, pseudoaneurysm, penetrating aortic ulcer and proximal endoleak after TEVAR. Furthermore, a systematic electronic health database search of available articles was conducted according to PRISMA Guidelines. Results: In all cases, all supra-aortic vessels had to be covered with aortic stent-graft to receive a sufficient landing and sealing zone. Chimney-grafts were introduced to the ascending aorta slightly deeper than the thoracic stent-grafts through the cut-down exposure of the common carotid arteries. We deployed aortic stent-grafts and self-expandable chimney-grafts simultaneously and successfully. The patient with contained ruptured aneurysm died due to cardiopulmonary failure on day 19, the others survived. We detected two ‘gutter’ endoleaks. As a result of literature search, 12 articles met the inclusion criteria. Two articles described the double-chimney technique. Conclusions: The use of double chimney-grafts is possible in high-risk patients where the proximal landing zone of endograft would be in zone 0. The available data is still limited. The long-term follow-up remains to be evaluated with the increased number of patients treated. [Copyright &y& Elsevier]

Abstract: Objectives: Several studies have documented a slight but significant deterioration of renal function after endovascular repair of abdominal aortic aneurysm (AAA) (EVAR). The aim of this retrospective study was therefore to investigate whether medication with statins may favourably affect perioperative renal function. Material and Methods: From January 2000 to January 2008, out of a total cohort of 287 elective patients receiving endovascular repair of their AAA or aortoiliac aneurysm, 127 patients were included in the present study, as their medication was reliably retrievable. Patients were divided according to whether their medication included statins (>3 months). Second, they were subdivided according to their supra- (SR) or infrarenal (IR) endograft fixation. Serum creatinine (SCr) and creatinine (CrCl) clearance were determined preoperatively, postoperatively, at 6 and 12 months. Patients with known pre-existing renal disease, with incorrect placement of the stent graft resulting in severe renal artery stenosis, and with occlusion or renal parenchymal infarction were excluded from the study. Results: Patients receiving an infrarenal fixation of their graft had no change in the renal function, regardless whether they were on statins or not. In patients with SR fixation not receiving statins, a deterioration in renal function was observed in the early postoperative period ((SCr) preoperative vs. SCr postoperative: 1.02±0.2 vs. 1.11±0.28, p <0.001 and (Cr.Cl) preoperative vs. Cr.Cl postoperative: 74.1±21.4 vs. 68.0±21.4, p <0.001), whereas patients on statins experienced no change in renal function (SCr preoperative vs. SCr postoperative: 0.99±0.24 vs. 1.02±0.20n.s. and Cr.Cl preop vs. Cr.Clpostop.: 76.4±19.1 vs. 74.28±20.50, n.s.). During follow-up, a constant worsening of renal function at 6 and 12 months was observed, irrespective of the medication with statins. Conclusions: The present study suggests a slight immediate deterioration of the renal function using (SR) fixation, and this could be prevented by the use of statins. During follow-up, statins did not protect from further renal deterioration. Broader studies are needed to confirm a definitive relation between statin use and renal protection during the endovascular repair of AAA. [Copyright &y& Elsevier]

Hypothenar hammer (HH) syndrome and vibration-induced white finger (VWF) syndrome are the main occupation-related vascular diseases of the upper extremity. The clinical presentation is similar to that of Raynaud's phenomenon. The characteristic history will lead to the appropriate diagnosis being confirmed by angiographic features in HH and by functional tests in VWF. While in HH the underlying cause, which is mostly thought to be an aneurysm of the ulnar artery, might be cured surgically, in VWF only medical treatment offers relief from the symptoms. The knowledge of these entities is necessary to suspect such disorders so that further exposure to risk factors like repetitive hypothenar trauma or work with vibrating hand-held tools can be avoided, which is of great importance for the overall prognosis of these patients. [ABSTRACT FROM AUTHOR]

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Copyright of Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 37-year-old patient with back pain and somatomegaly was found to have a penetrating aneurysm of sections IV and V of the abdominal aorta. Results of a family history and clinical examination confirmed suspicions of Marfan's syndrome. Further angiologic studies depicted an aneurysmatic dilatation of the left popliteal artery. Aneurysmatic dilatations are primarily located in sections I and 11 of the thoracic aorta, whereas aneurysms in sections IV and V are much rarer. The rare combination of an abdominal aortic aneurysm and left-sided popliteal aneurysm accompanying Marfan's syndrome is presented. [ABSTRACT FROM PUBLISHER]

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)