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Traumatic popliteal artery injury is associated with an increased propensity for limb loss, morbidity, and mortality above an already elevated baseline risk to life and limb. Previous studies of outcomes in this patient group have been limited by selection bias. This study analyzed outcomes after blunt popliteal artery injury using propensity matching to reduce confounding variables associated with multiple mechanisms of traumatic vascular injury and to identify factors associated with amputation.A retrospective review was conducted of prospectively collected data from the National Trauma Data Bank. Patients were identified using International Classification of Diseases, Ninth Revision codes related to patterns of blunt injury associated with popliteal arterial injury or intervention. Using Trauma Quality Improvement Program variables as a reference, specific characteristics were collected. Variables found significant on univariate analysis were used to generate propensity-matched amputation and nonamputation cohorts. Multivariate logistic regression was used to assess for risk factors associated with amputation and inpatient mortality.In total, 3029 patients with blunt popliteal artery injury were identified; 628 (20.7%) underwent amputation. Patients who underwent amputation presented with more frequent hypotension (systolic blood pressure of 0-99 mm Hg, 22.7% vs 12.8%; P .001) and tachycardia (heart rate120 beats/min, 28.5% vs 14.5%; P .001). Limb loss was also associated with concurrent popliteal vein injury (18.3% vs 8.7%; P .001) and tibial nerve injury (5.3% vs 1.3%; P .001) as well as with elevated Injury Severity Score (median, 13 vs 9; P .001) and lower extremity Abbreviated Injury Scale score (3 vs 2; P .001). Subsequently, 794 patients were divided into equal number propensity-matched amputation and nonamputation cohorts. Regression analysis revealed that patients with diabetes mellitus (odds ratio [OR], 1.763; P = .049), popliteal vein injury (OR, 1.657; P = .012), or tibial nerve injury (OR, 3.537; P = .007) were more likely to undergo amputation. Further regression analysis with patients matched for Injury Severity Score revealed that age ≥86 years (OR, 38.092; P = .009), patellar fracture (OR, 3.445; P = .036), and elevated Abbreviated Injury Scale score (OR, 1.101; P .001) were associated with higher risk of inpatient death.Trauma patients who sustain blunt popliteal artery injury are at an increased risk of amputation. Propensity-matched analysis revealed that concurrent popliteal vein and tibial nerve injury but not severity of tissue injury predicted limb loss.

Ruptured abdominal aortic aneurysm is often a fatal event without immediate intervention for the associated hemorrhagic shock and impending cardiovascular collapse. We report a case of a ruptured abdominal aortic aneurysm managed with partially occlusive resuscitative endovascular balloon occlusion of the aorta (P-REBOA) as a means to gain proximal control, tailor blood pressure goals, while allowing time to obtain access and repair the ruptured aneurysm.

ObjectivesLow intra-aneurysm sac pressure has been shown to correlate with sac shrinkage following endovascular aneurysm repair (EVAR) whereas high pressure results in sac enlargement. The Resilient AneuRx (RSA) has higher density Dacron compared with the standard AneuRx (STA) and was developed in an attempt to reduce type 4 and 5 endoleaks, thereby more effectively reducing sac pressure. The purpose of this study is to compare the ability of RSA and STA in reducing sac pressure in a chronic canine aneurysm model.Materials and MethodsArtificial polytetrafluoroethylene (PTFE) aneurysm (26 × 50 mm) with an Endosure wireless pressure sensor (CardioMEMS, Atlanta, Ga) attached to the inner surface was implanted in the abdominal aorta of 10 mongrel dogs. Two weeks after creation of the aneurysm, each animal underwent EVAR with either STA (n = 5) or RSA (n = 5). Following EVAR, intra-sac pressure was measured with the implanted wireless pressure sensor up to 3 months postoperatively when the animals were sacrificed.ResultsEVAR was successful with no signs of an endoleak in all 10 dogs. Pressure sensing with the wireless sensor was also successful in each animal until the end of the study. Systolic intra-sac pressure remained at a high level in the STA group, whereas it gradually lowered over time in the RSA group. This difference reached statistical significance at 2 months and lasted to 3 months. No endoleak was detected in either group at the time of sacrifice. Gross analysis confirmed that all the aneurysm sacs were thrombosed without any flow inside the sac.ConclusionDespite absence of an endoleak, intra-sac pressure remained high in the STA group. RSA effectively reduced sac pressure over time. Graft porosity appears to be an important factor that may determine the outcome of EVAR. These findings may be useful in designing improved endograft.Clinical RelevanceOur objective was to use an animal model to confirm that type 4 and 5 endoleaks depend on the porosity of the endograft fabric. Our results suggest that low porosity endograft is preferable. These findings will also be useful in designing improved aortic endografts.

Objective Proximal neck dilatation (PND) and/or endograft migration with the subsequent development of type I endoleak is a significant cause of late endograft failure after endovascular abdominal aortic aneurysm repair (EVAR). Although there are numerous reports examining PND in patients receiving endografts that use self-expanding stents (SES) for proximal fixation, there are no such reports for patients treated with endografts that use balloon-expanding stents (BES). The purpose of this study was to investigate PND and endograft migration after EVAR with BES endografts. Methods We retrospectively reviewed all charts and all serial computed tomographic scans available for patients who underwent EVAR with a BES endograft (surgeon-made, aortounifemoral polytetrafluoroethylene graft with a proximal Palmaz stent) between August 1997 and October 2002. Only patients with longer than a 12-month follow-up were analyzed. Neck diameter was measured at the level of the lowest renal artery and at 5 mm below it. PND was defined as neck enlargement of 2.5 mm or more. To assess endograft migration, the distance between the superior mesenteric artery and the cranial end of the BES was measured. Stent migration was defined as a change of 5 mm or more. Results A total of 77 patients received this device during the study period. The technical success rate was 99%. The 1-, 3-, and 5-year survival was 66%, 48%, and 29.5%, respectively. Complete serial computed tomographic scans were available in 41 of the 48 patients who survived 12 months or longer after the operation. The mean follow-up period for these patients was 31 months (range, 12-66 months). The maximum aneurysm diameter was either unchanged or decreased in 35 patients (85%). The immediate postoperative proximal neck diameter was 19 to 29 mm (median, 24 mm). This was unchanged at the latest follow-up. None of the patients had significant PND. The cranial end of the BES was located in the area between 14 mm proximal and 36 mm distal to the superior mesenteric artery (median, 6 mm). None of the patients developed significant endograft migration. Conclusions Neither PND nor endograft migration was observed with the BES endograft. The nature of the SES may be responsible for the observed neck dilatation and device migration after EVAR with SES endografts. This study suggests that BES may be a better fixation method for EVAR.

Connected health platform delivers continuous monitoring, reporting and storing of patient data in ER, hospital care, long-term care and remote settings thus providing a way of managing health and chronic diseases. In this paper, we present a mobile connected health platform infrastructure that provides anytime, anywhere connectivity solution where the user’s health data is recorded, transmitted, extracted and deposited on a central repository. This capability assists in monitoring progression of chronic diseases and also provides decision assistance to the caregiver.

Alfimeprase is an analog of a fibrolase that disrupts formed thrombi through the hydrolysis of fibrin, rather than by activation of plasminogen. Nuvelo Inc, under license from Amgen Inc and together with Bayer AG, is developing this thrombolytic for the potential intravenous treatment of peripheral arterial occlusions and for other cardiovascular indications. Pharmacokinetic studies showed that alfimeprase was rapidly absorbed and achieved therapeutic concentrations at relatively low doses. Preclinical studies showed that adjunctive therapy with antiplatelet agents was necessary to maintain luminal patency. In phase I and II clinical trials alfimeprase effectively thombolysed clots with no drug-related adverse events. However, phase III clinical trials of alfimeprase did not meet their primary endpoints and enrollment in ongoing trials has been suspended pending further analyses and discussion with outside experts and regulatory agencies. In spite of this, the authors conclude that alfimeprase seems to be a lytic agent with much potential. Refinement in its use and dosing needs to be addressed, and further investigation into its pharmacokinetic properties may be worthwhile. Alfimeprase is a drug that is a 'work in progress'.