Open surgical retrieval of an embolized PFO occluder system.

Device migration after intervention for persistent foramen ovale occlusion is a rare complication. In case of failure of endovascular device retrieval, open surgical removal is indicated, safe, and reliable.

The influence of gender on patency rates after iliac artery stenting.

OBJECTIVE: The purpose of this study was to investigate the influence of gender on the long-term outcome after iliac artery stenting and to assess gender-specific differences of the influence of risk factors on treatment success and patency rates. METHODS: Between January 2000 and December 2006, 404 percutaneous transluminal angioplasties with primary stent deployment for symptomatic iliac artery occlusive disease were performed at our center. These included 128 interventions in women and 276 interventions in men. RESULTS: Whereas average age was significantly higher (65.9 ± 12.9 years; P = .007) and arterial hypertension more frequent (60.9% vs 49.3%; P = .032) in women, hyperuricemia (7.0% vs 14.1%; P = .047) and a positive smoking status (61.7% vs 74.3%; P = .014) were more frequently observed in men. Fontaine stage was more advanced (stages III and IV) in women than in men (P = .028; P < .001). Technical success was 97.7% in women and 99.3% in men. Overall complication rate was higher in women compared with men (P = .002), mostly caused by access site hematomas (4.7% vs 0.4%) and pseudoaneurysms (8.6% vs 2.5%). Patients were followed up for 45.0 ± 33.3 months. Restenosis developed in 16.8% of cases in women and in 14.6% of cases in men and was treated in 73.7% by an endovascular approach. Primary patency rates at 1, 3, 5, and 7 years were 90.3%, 77.2%, 60.2%, and 46.4% in women and 89.9%, 71.5%, 63.6%, and 59.7% in men, respectively (P = .524; log-rank, .406). Secondary patency rates were 97.2%, 91%, 81.5%, and 70.3% in women and 97.1%, 89.1%, 82.6%, and 78% in men, respectively (P = .959; log-rank, .003). Multivariate analysis identified lower age as the only independent risk factor for recurrent disease in both groups. Age-defined subgroup analysis showed a restenosis/reocclusion rate of 23.9% in men and 22.1% in women older than 63.5 years (P = .861) but 32.1% in men and 49.1% in women younger than that (P = .034). CONCLUSIONS: Our data suggest that although women are older and present with a more advanced stage of peripheral arterial occlusive disease, endovascular therapy is equally effective irrespective of gender. Surprisingly, the subgroup of young female patients had a specifically poor outcome.

Outcome after interposition of vein grafts for arterial repair of extremity injuries in civilians.

OBJECTIVE: The objective of this study was to report on immediate and long-term outcomes after vein graft interposition in patients with upper- and lower-limb arterial injuries. METHODS: In the retrospective data analysis, all patients who underwent vein graft repair of limb arterial injuries in our civilian institution since 1990 were included, analyzed, and followed. Study end points were crude early and long-term patency, vascular reintervention, limb salvage, and perioperative death. RESULTS: A total 152 consecutive patients (127 men; median age, 31.7 years; range, 5.3-77.2) who presented with 158 lesions of limb arteries (lower limb: n = 90; upper limb: n = 68) underwent repair with the use of vein graft interposition. The vast majority of lesions were caused by blunt trauma (n = 144; 91%). In early results, the 30-day mortality rate was 3.3%. In-hospital limb loss rate was significantly lower in the upper limb (n = 2; 2.9%) than in the lower limb (n = 12; 13.3%; P < .05). Primary early patency was 93% (upper limb) and 89% (lower limb): early graft occlusions occurred both in the upper limb (n = 5; 7%) and the lower limb (n = 10; 11%; P = .59). Occlusions were followed by amputation in six cases (upper limb: one of five; lower limb: five of 10) despite successful revision of the occluded grafts. Long-term results after a median follow-up period of 6.0 years (range, 0.3-23.4) showed upper limb (62% of patients were followed): no late limb loss, no vascular reintervention; patency: 97.6%; lower limb (66% of patients were followed): one late limb loss, one redo bypass for vein graft dilation, patency: 98.3%. CONCLUSIONS: Emergency repair of civilian artery injuries with the use of vein grafts is associated with considerable risk of early occlusion and limb loss. When compared with the upper limb, limb loss rate is significantly higher in the lower extremity. Early graft occlusion is frequently followed by limb loss, especially in the lower limb. During long-term follow-up, occlusions of interposed vein grafts, vascular reinterventions, and late amputations are uncommon.

Segmental disruption of the internal elastic lamina as a potential pathogenetic mechanism of a true posttraumatic femoral artery aneurysm, years after single blunt trauma.

We present an unusual case of a true posttraumatic aneurysm of the superficial femoral artery (SFAA) 7 years after a motorcycle accident including blunt trauma to the thigh. Surgical reconstruction was accomplished without any complications by aneurysm resection and interposition of an autologous reversed saphenous vein. Histopathological examination revealed a true aneurysm with segmental disruption and fragmentation of the internal elastic lamina (IEL) in van Gieson's stain. This is a first-time finding in context with SFAA and may represent the pathogenetic explanation for the rare formation of posttraumatic true aneurysms.

Phosphocreatine kinetics in the calf muscle of patients with bilateral symptomatic peripheral arterial disease during exhaustive incremental exercise.

PURPOSE: To investigate the relationship between the atherosclerotic lesion load determined on magnetic resonance angiography (MRA) and phosphocreatine (PCr) kinetics during incremental, exhaustive calf exercise in patients with bilateral, symptomatic peripheral arterial disease (PAD). PROCEDURES: Using a 1.5 Tesla MR scanner, 26 patients with bilateral symptomatic PAD and 24 healthy male controls underwent serial phosphorus-31 MR spectroscopy (31P MRS) during incremental exercise at 2, 3, 4, and 5 Watts. For each increment and recovery, PCr time constants, amplitudes of PCr changes and pH values were calculated from the MR spectra. In patients, the run-off resistance (ROR) was determined on MRA. RESULTS: The patients exhibited significantly (p

High-energy phosphate metabolism during calf ergometry in patients with isolated aorto-iliac artery stenoses.

OBJECTIVES: Patients with peripheral arterial disease (PAD) and aorto-iliac atherosclerotic lesions suffer from a broad range of complaints, such as pain at the hip, the thigh, and calf claudication. The purpose of this study was to investigate the high-energy metabolism in the calf muscle of patients with PAD with isolated aorto-iliac stenoses during incremental plantar flexion exercise. MATERIALS AND METHODS: Using a 1.5 T whole-body magnetic resonance (MR) scanner, 12 patients with PAD with uni- or bilateral aorto-iliac atherosclerotic lesions and 10 healthy male controls underwent serial phosphor-31 MR spectroscopy during incremental exercise at 2, 3, 4, and 5 W. The phosphocreatine (PCr) time constants were calculated for each increment and recovery using a monoexponential model. In the patient group, the run-off resistance was determined on MR angiograms. In both the patients and the controls, the ankle brachial pressure index was measured. RESULTS: The diseased legs exhibited significantly increased PCr time constants during the second and the third workload increment at 3 and 4 W, but not during the first increment at 2 W and recovery compared with normal controls. Only 3 diseased legs succeeded the last increment at 5 W. We detected significant correlations between the ankle brachial pressure index scores and the PCr time constants when including both the diseased and the control legs. The diseased legs showed a significant correlation with the run-off resistance only during the first increment. CONCLUSIONS: Our study shows that the impairment of muscle metabolism, expressed by prolonged PCr time constants, occurs with greater work intensities in patients with aorto-iliac disease compared with patients with multisegmental PAD, as recently published, whereas our patients collective exhibited normal PCr recovery time constants. Our findings may help to understand variability of clinical symptoms in aorto-iliac PAD.