Five-year Outcomes With Conformable GORE TAG Endoprosthesis Used in Traumatic Aortic Transections.

BACKGROUND: The Conformable GORE TAG thoracic endoprosthesis (CTAG) device (W.L. Gore and Associates, Flagstaff, AZ) seeks to optimize thoracic endovascular repair of blunt aortic injuries by better apposition to the aortic arch. The Evaluation of the GORE Conformable TAG Thoracic Endoprosthesis for Treatment of Traumatic Transection (TAG 08-02) study assessed the safety and effectiveness of the CTAG device in the 5 years after treatment. METHODS: This prospective, single-arm study was conducted at 30 US sites with follow-up through 5 years. Patients were evaluated for all-cause mortality and device events through follow-up. An independent core laboratory reviewed pretreatment and posttreatment images. RESULTS: A total of 51 initial cohort patients and 50 continued access patients were enrolled and underwent placement of a total of 111 CTAG devices (mean, 1.1/subject; range, 1.0 to 3.0) during initial treatment. On average, patients were 42.7 ± 19.5 years old, with a mean Injury Severity Score of 31.5 ± 14.5, and most presented with polytraumatic injuries. The median time between injury and treatment was 21.0 hours (range, 3.2 to 334.4 hours). A total of 60 patients had partial or complete left subclavian artery coverage, but only 1 patient had a stroke that was unable to be attributed to the device or procedure. The freedom from all-cause mortality was 95% and 89% at 1 month and 5 years after the procedure, respectively. There were 2 minor endoleaks. No aortic ruptures, wire frame fractures, erosions, lumen obstructions, device compressions, or thrombus-related events were reported. CONCLUSIONS: The 5-year outcomes verify that the CTAG device is a safe, effective, and durable option for patients with blunt aortic injuries who are undergoing thoracic endovascular aortic repair.

Multifocal extracranial mycotic aneurysms in a patient with endocarditis.

This report describes the case of a 44-year-old man with Streptococcus gallolyticus (formerly S. bovis) endocarditis requiring surgical mitral valve replacement who developed multifocal extracranial mycotic aneurysms after the resolution of infection.

A rare complication of testicular infarction after femorofemoral bypass highlighting the importance of surgical technique.

We present an interesting case of a 66-year-old male who had acute testicular infarction following a right common femoral artery to left profunda femoris artery bypass with advanced symptoms of claudication. Angiography in the preoperative period demonstrated the extent of peripheral arterial disease present, revealing a calcified aorta, partially occluded left hypogastric artery, occluded left external iliac, common femoral and superficial femoral arteries and an occluded right hypogastric artery. A bypass was performed without any initial complications and subsequent relief of symptoms of claudication and rest pain. Postoperative scrotal pain and follow-up duplex demonstrated lack of perfusion of the testicle necessitating orchiectomy. This case serves to illustrate the importance of preserving collateral vessels as a technical consideration, as well as presenting a rare potential complication.

Laparoscopic Left Gastric Artery Aneurysm Resection.

Aneurysmal degeneration of the visceral branches of the abdominal aorta is a rare and potentially life-threatening disease entity. Visceral artery aneurysms (VAAs) are exceedingly rare and have a prevalence of 0.1 to 2%. The left gastric artery aneurysm (LGAA) is even more rare and accounts for less than 4% of all VAAs. There is scarce literature on treatment of LGAA by embolization; however, to date successful laparoscopic repair of an LGAA has not been described. We describe the successful treatment of an LGAA by laparoscopic ligation and resection in a 68-year-old male patient.

Venous Adventitial Cystic Disease: A Review of 45 Cases Treated Since 1963.

Purpose. To review and identify the most accurate ways of diagnosing and treating adventitial cystic disease (ACD) of the venous system. Methods. Cases of ACD were collected through three popular medical databases, including PubMed, Cochrane, OVID, and MEDLINE. After reviewing the literature, the sites of occurrence of 323 cases of adventitial cystic disease were documented, and all cases of arterial ACD were excluded. The clinical features, treatment, and subsequent course of 45 cases of venous ACD are included in this paper. Results. After reviewing all 45 cases of venous ACD , we have confirmed that the most common vessel affected is the common femoral vein, which reproduces the most common symptom of venous ACD: asymmetric lower extremity swelling worsening over time. Conclusion. Venous ACD most commonly affects the common femoral vein. When unilateral leg swelling occurs with or without a noticeable mass, ACD should be considered. It is best confirmed with CT venography and the treatment of choice is transluminal cyst evacuation and excision.

Primary balloon angioplasty plus balloon angioplasty maturation to upgrade small-caliber veins (<3 mm) for arteriovenous fistulas.

OBJECTIVE: Small-diameter veins are often a limiting factor for the successful creation of arteriovenous fistulas (AVFs). This study evaluated the use of intraoperative primary balloon angioplasty (PBA) as a technique to upgrade small-diameter veins during AVF creation. Sequential balloon angioplasty maturation (BAM) was evaluated as a technique to salvage failed fistulas, expedite maturation, and improve the patency of AVFs after PBA. METHODS: Sixty-two PBAs were performed in 55 patients with an intent-to-treat using an all-autologous policy. PBAs of veins were performed just before AVF creation using 2.5- to 4-mm angioplasty balloons (1- to 1.5-mm larger than the nominal vein diameter). PBAs were performed through the spatulated end of the vein for a length of up to 8 cm using hydrophilic guidewires and hand inflations without fluoroscopy. BAM was performed in 53 of the 62 PBAs at 2, 4, and 6 weeks after the PBA. Successful outcome was determined as the functional ability to use the fistula for hemodialysis without surgical revision. RESULTS: Of the 62 PBAs, 53 (85.4%), comprising 47 of the original AVFs and 6 new site AVFs created at other sites, remained patent and subsequently underwent BAM with a resulting functional AVF. Fifteen of the 47 original AVFs: 14 due to occlusion; one AVF with a steal was ligated. Seven of the 14 fistulas that occluded were salvaged using recanalization techniques during sequential BAMs. Two of the seven fistulas that were not salvaged required AVGs (3%), and five patients underwent redo AVFs using alternative veins. These five cases were also performed using PBAs and BAMs technique. One patient with a functioning fistula underwent intentional ligation for steal syndrome and also underwent an alternative site AVF, PBA, and BAM. At 3 months, 53 AVFs were functional and successfully used for dialysis. Overall, a working AVF was obtained at the initial site in 47 of 55 patients (85.4%), and 53 (96.3%) received working AVFs that were functioning for dialysis access. CONCLUSIONS: Small or suboptimal veins can undergo PBA and then be matured to create functioning AVFs 90% autogenous AVF rates can be achieved using PBA and BAM. BAM can be successfully used to mature AVFs created from small veins and salvage thrombosed AVFs in many cases. The use of these techniques may decrease the number of patients requiring AVGs and indwelling catheters.