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Purpose This analysis aims to assess the theoretical impact of atrial flow regulator implantation on mortality by comparing the observed survival rate with the median predicted probability for one-year survival. Methods The prospective, multicentre, open-label, non-randomised PRELIEVE study assessed the safety and efficacy of the atrial flow regulator in patients with symptomatic HFrEF (left ventricular ejection fraction (LVEF) ≥15% and Results A total of 87 patients had undergone successful device implantation for the treatment of HFrEF (53%) and HFpEF (47%). Sixty patients had a complete twelve-month follow-up. The median follow-up was 351 days (interquartile range [IQR] 202–370). A total of six (7%) patients died during follow-up (8.6 deaths per 100 patient-years; 95% confidence interval [CI] 2.7 to 15.5), all of which had HFrEF. The median predicted mortality rate for the overall study population was 12.2 deaths per 100 patient-years (95% CI 10.2 to 14.7). While the observed mortality rate (0 deaths per 100 patient-years) was significantly lower than the median predicted mortality rate (9.3 deaths per 100 patient-years; 95% CI 8.4 to 11.1) in patients with HFpEF (−9.3 deaths per 100 patient-years; 95% CI −11.1 to −8.4), there was no difference in patients with HFrEF (−3.6 deaths per 100 patient-years; 95% CI −9.5 to 3.0) (Figure 1). Four deaths were HF-related deaths (5.7 HF-related deaths per 100 patient-years; 95% CI 1.4 to 11.9; 10.8 HF-related deaths per 100 patient-years; 95% CI 2.5 to 23.1 in the HFrEF subgroup). Conclusion In patients with HFpEF, the mortality rate following atrial flow regulator implantation was lower than the predicted mortality rate. These findings need to be confirmed by larger randomised, controlled trials. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Occlutech International AB

Background Targeting the correct spinal level is essential in dorsal root ganglion (DRG) stimulation. Anatomical selection of the DRG alone is not ideal since the pain area is not necessarily confined to the borders of the dermatomes. This study aims to establish the role of periradicular infiltration therapy (PRT) in the preoperative assessment of the correct level for DRG stimulation performed under general anesthesia. Method We report a prospective study of 20 patients selected for DRG stimulation and submitted to a PRT for identification of the spinal level. Lead implantation for the stimulation trial occurred under general anesthesia: 19 patients experienced positive results and underwent implantation of the pulse generator. All patients suffered from chronic neuropathic pain unresponsive to best medical treatment. PRT levels were compared with the levels targeted with DRG leads. Patients were followed for up to 12 months; pain intensity and coverage of the painful area were assessed. Results In 12 patients, the trial leads were placed on the same level as previously tested positive by PRT. In 6 patients, leads were placed in the PRT target and additionally in adjacent spinal levels. In one case, the selected target for the trial diverged from the PRT target because of intense fibrosis in the chosen level. Coverage of the target area of at least 50% was achieved by two-thirds of the patients. For the six subjects with additional implanted leads as a consequence of the PRT results, 80% achieved a coverage of at least 50%. A total of 47.4% of the patients achieved sustained significant pain relief in the last follow-up. None of the patients needed a repeated surgery for implantation of additional leads. Conclusions PRT is a helpful tool to confirm the stimulation targets. A PRT preceding the stimulation trial is an additional opportunity to optimize the coverage of the target area with stimulation-induced paresthesia for patients operated under general anesthesia.

Strukturelle Komplikationen stellen vergleichsweise seltene Komplikationen infolge akuter Myokardinfarkte dar, die aber mit einer sehr hohen Letalitat einhergehen. Nachdem herzchirurgische Verfahren lange die einzige Therapieoption darstellten, werden nun zunehmend auch interventionelle Verfahren zur Behandlung struktureller Akutkomplikationen eingesetzt. Der Vorteil der Katheterverfahren liegt dabei vor allem in der geringeren Invasivitat in der Behandlung der zumeist hamodynamisch instabilen Patienten, so z. B. in der Therapie der akuten Papillarmuskeldysfunktion oder des Infarkt-VSD. Daruber hinaus haben sich interventionelle Verfahren in der Behandlung der postinfarziellen funktionellen Mitralklappeninsuffizienz und der Volumenreduktion bei Aneurysmen des linken Ventrikels etabliert.

Etwa 10 % aller ischamischen Schlaganfalle sind die Folge von Vorhofthromben verursacht durch Vorhofflimmern. 90 % der Vorhofthromben bei nicht valvularem Vorhofflimmern befinden sich im linken Vorhofohr. Antikoagulation mit Vitamin-K-Antagonisten hat sich wegen der erwiesenen Reduktion des Schlaganfallrisikos als Therapie der Wahl etabliert. Vitamin-K-Antagonisten haben jedoch ein enges therapeutisches Fenster und sind mit wichtigen Arznei- und Nahrungsmittelinteraktionen behaftet. Die Therapie mit Vitamin-K-Antagonisten erfordert deshalb Patientenkooperation und lebenslangliche Laboruntersuchungen. Neuere orale Antikoagulanzien mit breiterem therapeutischen Fenster und weniger Arznei- und Nahrungsmittelinteraktionen sind deshalb entwickelt und kurzlich auch zur Thromboembolieprophylaxe bei nicht valvularem Vorhofflimmern zugelassen worden. Dabigatran ist mindestens genauso wirksam wie Vitamin-K-Antagonisten in der Pravention des Schlaganfalls. Da alle Antikoagulanzien jedoch mit einem Blutungsrisiko verbunden sind, werden viele Patienten trotz erhohtem Schlaganfallrisiko nicht mit Antikoagulanzien behandelt. Daher sind alternative Konzepte erforderlich. Vor Kurzem haben 2 Vorhofohrokkluder CE-Mark erhalten. In einer randomisierten Studie hat sich der Vorhofohrverschluss mit dem Watchman-Okkluder als ebenso wirksam erwiesen wie die Antikoagulation mit Warfarin. Ein zweiter Okkluder, der Amplatzer Cardiac Plug, wird derzeit hinsichtlich seiner Wirksamkeit gegenuber Antikoagulation mit Vitamin-K-Antagonisten untersucht. In der bisher einzigen abgeschlossenen randomisierten Studie erhielten Patienten, die mit einem perkutanen Vorhofohrverschluss behandelt wurden, zwar vorubergehend Antikoagulation, es gibt jedoch Hinweise, dass der Vorhofohrverschluss auch bei Patienten mit absoluter Kontraindikation zur Antikoagulation auch ohne vorubergehende Antikoagulation sicher durchgefuhrt werden kann. Ahnlich der Therapie mit Antikoagulanzien ist der perkutane Vorhofohrverschluss nicht risikofrei. Insbesondere Perikardblutungen, Thrombusformation auf der Okkluderoberflache und unvollstandiger Verschluss sind zu bedenken. Ziel des vorliegenden Artikels ist eine kurze Zusammenfassung wichtiger Aspekte des perkutanen Vorhofohrverschlusses.

Kathetergestutzte Aortenklappenimplantationen sind innovative und wahrhaft minimal-invasive Eingriffe. Angesichts fehlender Langzeitnachuntersuchungen bleibt ihre Anwendung jedoch derzeit auf Patienten mit einem signifikant erhohten perioperativen Risiko beschrankt. Die Indikationen hierzu sind deshalb kritisch zu prufen. Dennoch gewinnt dieses Vorgehen gegenuber dem konventionellen Klappenersatz zunehmend an Bedeutung. Um diese Techniken erfolgreich anwenden zu konnen, sind sowohl eine profunde Kenntnis der strukturierten Operationsablaufe als auch Verstandnis und Beherrschung der interventionellen Verfahren notwendig. Um Komplikationen vorbeugen zu konnen, ist neben einer sorgfaltigen praoperativen Diagnostik auch ein eingespieltes und harmonierendes Team aus Herzchirurgen, Kardiologen und Kardioanasthesisten unabdingbar.

In six patients aged between 17 and 53 years with persistent ductus arteriosus a non-operative occlusion of the ductus developed by Porstmann was used. The procedure comprises the percutaneous insertion of an Ivalon plug via the femoral artery in local anaesthesia and lodging in the patent ductus. Placement is enabled by pre-placing of an arterio-ductus-venous wire catheter. In all six consecutively treated patients the procedure was successful. Follow-up assessment after three months confirmed positioning of the plug in the ductus. In one female patient with cardiac insufficiency the complaints had completely disappeared and cardiac size had greatly diminished. Thus a comparatively trouble-free catheter technique for occlusion of the ductus is available which may replace surgery.

Transcatheter closure of atrial septal defects (ASDs) has become a routine procedure in many countries of the world. It spares many patients cardiac surgery and has proven efficacy in long-term studies. Device improvements have resulted in a continuous reduction of complications and of residual shunt frequency. ASD closure devices are also used for transcatheter closure of patent foramen ovale (PFO) for prevention of paradoxical embolism. In the past few years, there has been increasing interest in developing devices specifically designed for PFO closure. Although transcatheter closure of ASDs is well established, interventional closure of the left atrial appendage is in its development stage. Closure of the left atrial appendage is designed to reduce the risk of stroke in patients with atrial fibrillation in whom anticoagulation with Warfarin-type drugs is contraindicated. This article describes the latest developments in catheter closure of PFO and the left atrial appendage.

In den letzten Jahren wurden in der Katheterbehandlung nicht nur bei der koronaren Herzkrankheit, sondern auch bei vielen anderen Erkrankungen, die zu einer Herzinsuffizienz fuhren, erhebliche Fortschritte erzielt. Die groste Bedeutung hat momentan sicherlich die Ballondilatation der Koronararterien, es konnen aber auch stenosierte Herzklappen aufgedehnt werden. Gute Akut- und Langzeitergebnisse werden mit der Dilatation von Pulmonalstenosen erreicht - ein risikoarmes Verfahren. Dies gilt auch fur die Dilatation der angeborenen Aortenstenose. Werden verkalkte Aortenstenosen dilatiert, sind Rezidive relativ haufig, sodass wiederholte Eingriffe erforderlich sind. Hier wird in Zukunft die kathetergesteuerte Implantation von Herzklappen eine neue Perspektive eroffnen. Die Akut- und Langzeitergebnisse der Mitralklappendilatation sind mit denen der operativen Kommissurotomie zu vergleichen. Sind bestimmte morphologische Kriterien der Klappen gegeben, ist wegen der geringeren Invasivitat die Dilatation der Operation vorzuziehen. Shuntvitien werden heute wenn irgend moglich primar kathetertechnisch behandelt. Bei der Aortenisthmusstenose kann in den meisten Fallen eine Dilatation und/oder eine Stentimplantation erfolgen. In naher Zukunft wird auch die kathetertechnische Behandlung der Mitralinsuffizienz moglich sein. Cardiac catheterization is not only a diagnostic but also an interventional therapeutic tool. Mainly used for treating coronary stenosis, cardiac catheterization can also be performed for therapeutic dilatation of calcified stenotic heart valves. The short- as well as the long-term results of dilatation in pulmonary valve stenosis are good, and can be done with low risk, as in congenital aortic valve stenosis. Recurrence of stenosis is common in dilatation of calcified aortic valves. Thus, repeated procedures are necessary. The development of catheter-based implantation of heart valves promises favorable prospects for the near future. Short- and long-term results of mitral valve dilatation are similar to surgical commissurotomy. If special morphologic criteria are present, the interventional therapy is preferred because it is less invasive. Today, in atrial septum and ventricular septum defects, cardiac catheterization techniques are first-line therapy. In aortic coarctation, dilatation with or without stent implantation can be performed in most cases. The near future will bring catheterization techniques for treatment of mitral regurgitation. In summary, much progress has been made not only in coronary interventional therapy but also in many other diseases which are associated with heart failure.

In the past several years, carotid angioplasty as an alternative to carotid endarterectomy has developed as an evolving technology performed routinely in many centres worldwide. In this article we review the current status of the results of carotid artery stenting based on observational series and randomised trials. We highlight the acute outcome, the long-term results and the occurrence of restenosis of the endovascular therapy and present a brief description of the latest stenting studies compared to randomized surgery trials.

Transcatheter closure of VSD has been successful in defects of the muscular septum distant from the aortic and mitral valve apparatus. Attempts to close subaortic VSDs have been largely unsuccessful because of device-related aortic insufficiency. The NitOcclud device is a Nitinol spiral coil device which has been evaluated in animals with subaortic VSD. Results of the animal study are promising, and the device has also been implanted in a few humans. This paper describes the device, the implant technique in subaortic VSD, and the results of animal and human implants.

In a 25-year-old female patient with pulmonary valve stenosis valvuloplasty could be successfully performed using a balloon catheter inserted via the femoral vein. Balloon measurements were 2 cm width and 3 cm length, the required pressure was 5 atm. There was a decrease of the pressure gradient form 60 to 25 mm Hg, systolic right ventricular pressure decreased from 88 to 50 mm Hg. Besides transluminal angioplasty of coronary stenoses and non-surgical occlusion of patent ductus arteriosus thus a further catheter technique for treatment of organic heart disease has become available, being able to replace surgery.

Patent foramen ovale (PFO) is a common anatomical variant occurring in 20-25% of the population. In most cases, a PFO remains asymptomatic. However it allows for any venous particle such as thrombus, air or vasoactive substances to bypass the lung and enter the arterial circulation. Accordingly, PFO's have been linked to cryptogenic stroke, migraine and decompression illness. While the number of device closures have been increasing the therapy remains controversial as ‑ until recently ‑ data supporting PFO closure came from non randomized studies only. In this review we will discuss the existing data on PFO closure including results of the three randomized controlled trials comparing device closure with medical therapy in patients with cryptogenic stroke. We will also focus on the implantation technique, the complications and the different devices that are used for this procedure.

Two relatively young women died suddenly due to myocardial sarcoidosis. Necropsy in both cases revealed compact infiltration of the ventricular septum by fibrous tissue. Histologic sections elucidated extensive granulomatous degeneration and giant cells of the Langhans' and foreign body type without central necrosis of the granulomas. Both women had been entirely free of symptoms, but in the second case of a 35-year-old, who had been 6 months pregnant, an ultrasound sonography of the heart had documented a suspicious area in the ventricular septum interpreted as a scar. Further investigations had been postponed until delivery. Isolated myocardial sarcoidosis should be taken into account as one possible cause of sudden death, especially in young people.

Any percutaneously implanted foreign device carries the potential risk of thrombus formation. If a thrombus is detected after device implantation during follow-up, in most cases anticoagulation therapy is sufficient to resolve the thrombus. If the anticoagulation concept fails, surgery has been the only alternative option to remove thrombotic masses. This case of a patient with a large thrombus formation attached to a PFO closure device who denied surgery demonstrates that mechanical percutaneous clot retrieval is feasible with the AngioVac aspiration system (Vortex Medical, Inc., Norwell, MA). © 2013 Wiley Periodicals, Inc.

Though distal filter protection during carotid stenting reduces the risk of cerebrovascular events, periprocedural stroke remains a risk despite their broad usage. This observation may be related to the pore size of common filters. The FiberNet distal filter system is unique by its very small pore size (40 µm) as well as its low profile and flexibility. Little data is available regarding the clinical performance and safety of this device.The aim was the evaluation of the safety of the FiberNet embolic protection system during carotid artery stenting.All consecutive patients treated with carotid stenting at our institution using the FiberNet device were systematically followed. Primary endpoint was the rate of all death and stroke within 30 days of the procedure.Carotid artery stenting using the FiberNet embolic protection system was performed in 54 patients. The procedure was technical successful in all patients. Three patients (5.5%) had a TIA. Amauosis fugax occurred in two patients (3.7%). One patient (1.9%) had a minor stroke with hemiparesis of the left arm and face which resolved completely within 48 hr after the procedure. No patient died or suffered a major stroke.The safety and feasibility of the FiberNet distal protection system appears to be at least equivalent to that reported in studies using conventional distal filter protection.

Carotid stenting has become a commonly used procedure for the treatment of carotid artery stenosis. Though equipment and techniques have improved tremendously over the recent 3 decades, complications do occur. It is important for carotid operators to be familiar with potential complications and adverse events. In this article complications and adverse events of carotid stenting including those that are related to the vascular access site, vessel spasm, dissection, perforation, thrombotic occlusion and hemodynamic instability and arrhythmias are reviewed. In addition, management strategies are discussed.

The sympathetic nervous system via its effect on the kidney maintains a key role in blood pressure regulation and in the pathogenesis of hypertension. In turn, the kidney receives a dense innervation of afferent sympathetic fibers allowing it to effectively modulate the sympathetic tone. Hence, the kidney can be both culprit and victim of increased sympathetic activity. In addition, conditions such as congestive heart failure, chronic renal failure or the metabolic syndrome are associated with an increased sympathetic activity whether or not hypertension is present. On this account, both the sympathetic nervous system and the kidney were identified as potential therapeutic targets in the treatment of hypertension and other conditions associated with a high sympathetic tone. Initial investigations focused on surgical removal of the sympathetic trunk, unfortunately accompanied by operative mortality and major side effects. More specific methods of disrupting interactions between the sympathetic nervous system and the kidneys were subsequently explored including the removal of diseased kidneys and, more recently, minimally invasive severance of the renal sympathetic nerves. Currently, most hypertensive patients can be treated by effective antihypertensive drugs. Notwithstanding, a small group of hypertensive patients remains suboptimally controlled despite identification of potential causes and appropriate treatment. In this group an elevated sympathetic tone may be a significant contributor to treatment resistance and selective renal sympathectomy may be beneficial. The role of the sympathetic nervous system in blood pressure control and the effect of selective sympathectomy are discussed in this review.

Catheter-based renal sympathetic denervation for resistant hypertension: A multicenter safety and proof-of-principle cohort study. Lancet 373: 1275–1281, 2009 {#article-title-2} 1886 1888 Upon the initiative of Smithwick and Thompson (1) of the Massachusetts General Hospital, resection of the splanchnic nerves through a posterior infradiaphragmatic approach plus removal of the sympathetic chain from the level of the eighth dorsal ganglion to the second lumbar ganglion had been used with relative frequency in cases of desperate hypertension at the time when antihypertensive medication was not yet available. In the hands of other investigators, the results were spectacular in a minority of patients but not quite satisfactory in many patients (2,3). Despite improvement of headache, reversal of papilledema in malignant hypertension, etc. , the long-term reduction of BP was quite variable and the 5-yr mortality remained approximately 40% (2). A 10-yr follow-up compared 100 patients who were subjected to thoracolumbar sympathectomy with 1500 patients who received symptomatic therapy. Lasting BP reduction was seen only in one third of the patients (4). Whereas the average BP levels were reduced, occasional BP spikes were not. The average difference of preoperative to postoperative systolic BP values was 21 mmHg. The authors saw reduction of cerebrovascular accidents and less progression of proteinuria and renal dysfunction, but 10-yr mortality was still 41%. Against this background, once effective antihypertensive medication was available, this relatively crude procedure fell out of favor and remained a sleeping beauty. With today's better insight into the role of sympathetic activity in the genesis of hypertension and particularly the role of the kidney in sympathetic activation, there has been a renaissance in the interest of the renal sympathetic nervous system, including its role in primary hypertension—apart from its undoubted role in the hypertension of chronic kidney disease (5–10). Renal disease and, in animal experiments, even minor renal tissue damage such as injection of minute volumes of phenol, trigger afferent signals that ascend via …

Intracardiac defects such as atrial septal defect (ASD) and patent foramen ovale (PFO) are common forms of congenital intracardiac apertures which can be successfully closed percutaneously. Since the initial description of an atrial septal defect closure device in the mid 1970s by King and Mills, transcatheter closure of atrial septal defects and patent foramen ovale using various devices has now become an established practice in many centers. The left atrial appendage is a trabeculated remnant of the embryonic left atrium. This is an important source of emboli related to atrial fibrillation. Closure of the left atrial appendage is designed to reduce the risk of stroke in patients with atrial fibrillation. This article reviews the current indications and latest developments in catheter closure of PFO, ASD and left atrial appendage.

Bei Patienten mit Vorhofflimmern und einem erhohten Risiko zur Ausbildung thrombembolischer Komplikationen besteht die derzeitige Standardtherapie in einer lebenslangen Antikoagulation mit Marcumar, unter gewissen klinischen Bedingungen ggf. in einer Kombination mit Aspirin. Die Limitationen einer oralen Antikoagulationstherapie mit Vitamin-K-Antagonisten sind bekannt. Unter anderem sind neben diatetischen Einschrankungen und Wechselwirkungen mit anderen Medikamenten haufige Laborkontrollen und Dosisanpassungen notwendig, um den INR-Wert stabil zu halten. Ein stabiler INR im empfohlenen therapeutischen Bereich von 2,0–3,0 kann nach kontrollierten Studienergebnissen lediglich bei ca. 60% der Patienten erreicht werden. Nebenwirkungen sind haufig und in relevanter Zahl Grund fur stationare Krankenhausbehandlungen. Die Rate lebensbedrohlicher Komplikationen ist nicht irrelevant. Neben den genannten Grunden fuhren wesentliche Faktoren der Patientencompliance und die Uberzeugung der behandelnden Kollegen dazu, dass weniger als 40% der Patienten, die fur diese Therapie geeignet waren, uberhaupt Marcumar [15] erhalten. Gemas der gegenwartig vorliegenden Studienlage erreicht eine Antikoagulation mit Aspirin alleine keinen gleichwertigen Schutz vor thrombembolischen Komoplikationen bei Patienten mit Vorhofflimmern [5].

Interventional treatment of extracranial carotid stenoses: current status, requirements and indications Around 30000 strokes per year in Germany are caused by extracranial obstructions of the carotid arteries. Besides the well established surgical endatherectomy, which has been proven to be superior to medical treatment alone in randomized multicenter trials, percutaneous treatment by balloon angioplasty and stent placement is increasingly performed. This consensus paper summarizes the present status of scientific studies and controlled treatment registries of carotid angioplasty and stenting and yields to recommendations regarding its performance and indication. A Medline search was done until August 2005 including all randomized comparative studies with clinical endpoints and all controlled registries with more than 500 patients included. Both completed randomized trials comparing angioplasty and stenting with surgery (CAVATAS and SAPPHIRE) did not show a significant difference with respect to stroke and death within 30 days. The incidence of this combined endpoint was between 3.3 and 6.9% in large multicenter registries. Thus, the current endovascular treatment results in a perlinterventional complication rate comparable to that which is commonly accepted for vascular surgery. A systematic preferably external quality monitoring as well as interdisciplinary cooperation most importantly with neurologists is recomendedfor all interventionalists. Based on available clinical data, this consensus paper defines recommendation classes I or II with a level of evidence B or C depending on symptoms, operative risk status of the patient and severity of the underlying stenosis.

Although the first long-term results of Carotid Artery Stenting (CAS) became available only recently, CAS has become an accepted treatment for carotid artery disease. We report CAS data up to 5 years, both late stroke rate and patency rates as observed in 4 high-volume European centers.Between February 1, 1993 and December 31, 2004, 2 172 patients were selected over the 4 participating centres, with intention to treat endovascularly. Conscientious follow-up was done according to the in-hospital stipulations of each centre and was entered into a database both retrospectively and prospectively. Long-term restenosis and stroke-death rates were investigated and statistically analysed and stratified using the Kaplan-Meier method.Of the 2 172 patients with intention to treat 2 165 (99.7%) were technically successful. Of these 306 (14.1%) were performed without and 1 859 (85.9%) with embolic protection device (EPD); 96 patients (4.4%) received balloon dilation only and stenting was performed in 2 069 (95.6%) cases. Kaplan-Meier analysis of major stroke/all death and of significant restenosis (50%) for the total population showed stroke/death rates of 4.1% (nar=1 356), 10.1% (nar=476) and 15.5% (nar=138); and restenosis rates of 1% (nar=1 363), 2% (nar=480) and 3.4% (nar=139), after 1, 3 and 5 years respectively.The patency and stroke/death rates resulting from our database analysis are pleasing and indicate that CAS also on longer term is a valuable treatment method for carotid artery disease. Due to the fact that our dataset contains prospective as well as retrospective data, it may have its limitations. Until this moment, data indicating that certain patient subgroups are at increased risk for neurological complications and in-stent restenosis during and after CAS are sparse. Further multivariant analysis on this unique dataset is mandatory in order to identify any potential links in between plaque morphology, preprocedural neurological complications, risk factor distribution, procedural steps and clinical outcome.

It is common clinical practice to perform an arteriotomy for the endovascular treatment of infrarenal and thoracic aortic aneurysms. Instead we used the percutaneous endovascular Perclose device to perform the aneurysm repair without arterial cut-down.The Perclose device contains four needles with two suture loops for closing the femoral artery access site. The sutures were deployed after the arterial puncture, before introduction of sheaths (diameter 12 - 27 F = 4 - 9 mm). After the procedure the sutures were used to close the puncture site. We attempted to achieve hemostasis with the Perclose system in 104 femoral arteries in 60 patients (7 females, mean age 69 +/- 12 years). The mean vessel diameter was 10 +/- 2 mm.The percutaneous graft implantation was successfully achieved in 58 of 60 patients. The graft could not be forwarded into the aorta in two cases because of calcified iliac arteries. The Perclose suture technique was successfully used in 97 femoral arteries. In one case a false aneurysm developed and in another case a secondary hemorrhage occurred. Seven patients needed additional manual compression to achieve complete hemostasis. A surgical repair was not necessary. The time to hospital discharge ranged from 4.5 hours to 32 days (median: 18 hours). 20 patients stayed longer than 24 h in the hospital, only 2 of them for reasons related to the puncture site.Closing the access site with the Perclose system is technically feasible and effective, even with large sheaths up to 27 F = 9 mm. This technique reduces the invasiveness of the endovascular repair of aortic aneurysms and decreases the length of hospital stay, i. e. it allows treatment in outpatients.

Mit der operativen Thrombendarteriektomie steht ein Verfahren zur Behandlung der Carotisstenose zur Verfugung, dessen prophylaktischer Nutzen sowohl bei symptomatischen als auch bei asymptomatischen Carotis-interna-Stenosen nachgewiesen werden konnte [1, 3, 6, 7].