Thoracic Stent-Graft Migration: The Role of the Geometric Modifications of the Stent-Graft at 3 years.

BACKGROUND: To date, clinical and experimental studies on stent graft (SG) migration have focused on aortic morphology and blood flow. However, thoracic endovascular aortic repair (TEVAR) is not an instant fixation of the SG in the aortic lumen but rather a continuous process of deformation and three-dimensional change in the configuration and the geometry of the SG. The aim of this study was to analyze the geometric evolution of the aortic SG in the proximal attachment zone at midterm follow-up and its impact on the SG migration. METHODS: Sixty-two patients underwent TEVAR for thoracic aortic aneurysm from 2007 till 2013. Thirty patients were treated and had a complete clinical and morphological follow-up at 1 month and 3 years. We calculated the SG radius of curvature (RC) change at the proximal attachment zone "P" on the postoperative computed tomography scan at 1 month and 3 years. RESULTS: There were 19 atheromatous aneurysms, 8 postdissection aneurysms, and 3 posttraumatic aneurysms. Two patients were treated at zone 1, seven at zone 2, and twenty-one at zone 3. The median decrease of the RC at "P" was 11 mm (interquartile range, 6.5 mm; range, 1-29 mm. A greater decrease in RC was identified in patients with hostile proximal neck having a large diameter (P = 0.006), short neck length (P = 0.04), and neck thrombus grade II and III (P = 0.02). In the migration group, the RC of "P" decreased significantly at 3 years (27.5 mm vs 18.25 mm; P = 0.03). Three patients had type I endoleak and showed a decrease of the RC at "P" (42 vs 13 mm; 28 vs 15 mm; 24 vs 9 mm). CONCLUSIONS: The SG seems to have geometric changes in the proximal attachment zone over time. The increase of SG curvature might be a predictor for SG migration and may prompt prophylactic reintervention.

Endovenous Celon radiofrequency-induced thermal therapy of great saphenous vein: A retrospective study with a 3-year follow-up.

OBJECTIVE: Our main objective was to evaluate the short- and long-term efficacy of Celon radiofrequency-induced thermal therapy for endovenous treatment of incompetent great saphenous vein. The secondary objectives were to report on possible short-term side effects and complications. METHODS: This was a retrospective study of 112 consecutive patients included between 2013 and June 2015. These patients were treated (146 great saphenous vein, C2-C6) either at the hemodynamic room using local anesthesia or at the operating theater under general anesthesia with or without phlebectomy. All patients received radiofrequency-induced thermal therapy at 18 W power, 1 s/cm pullback rate and 5-7 pullbacks per segment of 10 cm (i.e. maximum 10 pullbacks). A clinical follow-up via ultrasound monitoring was done at 1 week, 1 month, 6 months, 1 year, 2 years and 3 years. RESULTS: The 3-year survival occlusion rate was 96.71% and 98% for overall and radiofrequency-induced thermal therapy patients, respectively. No major side effects were observed. A case of endovenous heat-induced thrombosis was reported. Slight neurological disorders were reported (0.88%). CONCLUSION: Our unit's endovenous Celon radiofrequency-induced thermal therapy of incompetent great saphenous vein was efficient, well tolerated, without major side effects. Moreover, in order to reduce possible neurological disorders, we advise multiple pullbacks at 1 s/cm and using tumescence anesthesia.

Endovascular Treatment of Atherosclerotic Iliac Stenosis: Local and Systemic Complications of the Open Brachial Access.

BACKGROUND: The femoral access is the approach of reference for iliac angioplasty. In the current context of an early ambulation and a minimization of in-hospital stay period, the brachial access seems to be an appropriate approach, especially that long and small diameter equipments are available. Furthermore, it is extremely useful in case of inappropriate or unavailable femoral access. The aim of this study was to evaluate the complication risk factors of the brachial approach in the treatment of iliac stenosis. METHODS: Between January 2012 and December 2013, we performed 281 iliac transluminal angioplasties of which 57 (20%) consecutive left brachial artery accesses were performed in 54 patients. The choice of brachial access was justified in 68% of the cases by an unavailable femoral access, in 29% of the cases by the presence of bilateral iliac lesions, and in 3% of the cases after failure of retrograde femoral approach. RESULTS: The patients were of a male majority (81%) with a mean age of 66 ± 9 years. The procedure was performed under local anesthesia in 65% of the cases. No upper limb ischemia or nervous complications had been reported. No cerebrovascular stroke has been identified. One patient presented with dysarthria associated with disorientation without the presence of cerebrovascular ischemia on the computed tomography scan and on the magnetic resonance imaging. There were 3 major hematomas at the brachial access site, which required reoperation; these 3 patients were on dialysis. There was no statistically significant relationship between a complication occurrence and the diameter or length of the introducer. The mean in-hospital stay period was 2 days. The procedure was considered successful in 91% of the cases. We reported 5 cases of failure: 4 of which was due to a difficulty in crossing the lesion and 1 due to a very short material. The only significant risk factor of failure was the thrombosis of the iliac axis (odds ratio 23.3, 95% confidence interval 2.5-264.6, P = 0.003). CONCLUSIONS: The femoral access remains the recommended approach for the treatment of iliac occlusive lesions. However, brachial artery access seems to provide a safe and secure alternative approach for patients when femoral artery access is unavailable. It allows a rapid ambulation and an ambulatory care.

Exostoses and vascular complications in the lower limbs: two case reports and review of the literature.

Exostosis is a very common bone tumor. Complications occur in 4% of the cases (nerve compression, exostosis degeneration, orthopedic complication); however, vascular complications are rare. This is the report of 2 cases of vascular complications that occurred in 2 patients-one with a solitary form and the other with hereditary multiple exostoses. A review of the literature found 57 cases of lower limb vascular complication, secondary to an exostosis. The most common vascular complication was the popliteal aneurysm. Femoral exostosis topography was found in 89% of the cases. A triggering trauma was found in 36% of the cases and the most common form was the solitary exostosis (58%). The treatment of these complications is surgical, and it treats the vascular lesion and the bone tumor at the same time. Surgical treatment of exostosis vascular complications is recommended as an urgent procedure to prevent the occurrence of irreversible damages.