Endovascular treatment of carotid injury.

This is a systematic review of the International Literature regarding the role of endovascular treatment in cases of carotid injury. Injury to the carotid artery is not very common but is a serious consequence associated with either blunt or penetrating cervical trauma. They are difficult to evaluate due to associated injuries. The frequent coexistence of traumatic brain injuries seems to obscure its presentation and concurrent systemic injuries make the management somewhat challenging from the perspective of both diagnosis and treatment. Although bleeding is a serious and potentially fatal complication of these injuries, the main concern should be the impairment of cerebral blood supply. In the modern era of increasing usage of minimally invasive treatment options and technological advances, endovascular approach seems to gain acceptance as a sufficient alternative treatment modality in carefully selected groups of these trauma population. Interesting issues facing this emerging technology include the adequate definition of the types of injuries ideally indicated for endovascular treatment. Those traumatic carotid lesions located proximal to aortic arch or near the skull base are particularly hazardous to approach and difficult to repair surgically and may benefit of an endovascular approach. Specifically, iatrogenic injuries of carotid vessels are often occur in patients with significant comorbidities that make their management challenging.

The role of aortouniiliac devices in the treatment of aneurysmal disease.

PURPOSE: Many studies have shown that aortouniiliac (AUI) devices have comparable outcome in high risk patients as the treatment with bifurcated devices. The purpose of this article is to review the relevant literature and discuss the outcomes. METHODS: A systematic search from 1991 until 2010 was performed on PubMed and Medline databases for studies evaluating the role of AUI devices accompanied with occlusion of one iliac artery and crossover femoral-femoral or iliac-femoral bypass, for the treatment of abdominal aortic aneurysmal disease. Keywords used were abdominal aortic aneurysms (AAA), endovascular aortic aneurysm repair (EVAR), aortouniiliac, aortomonoiliac, stent graft, outcome analysis, in various combinations. The reference lists of the gathered reports were also manually searched. Only articles with series of more than twenty (20) patients were included in this review. RESULTS: Seven articles were found referring to the results of endovascular aortic aneurysm repair with AUI stent grafts, three are comparing AUI, tube, bifurcated devices or between them or /and with open surgery repair, four are referring to the patency of the femoral-femoral bypass that couples the AUI stent graft deployment, and two are referring to the treatment of r-AAA with the AUI stent grafts. CONCLUSIONS: There is increasing evidence in the literature that the AUI configuration endoprosthesis placement is a safe procedure over the mid- and long-term period and compares well with the results of AAA endovascular repair with bifurcated endoprostheses that have been published.

Acute carotid stent thrombosis after carotid artery stenting.

BACKGROUND: Carotid artery stenting (CAS) is a reasonable alternative to carotid endarterectomy (CEA), especially in patients at high risk for surgery. Carotid artery thrombosis of the treated segment is a rare, early but potentially devastating complication of this endovascular procedure. The aim of this article is to identify and critically review cases of acute stent thrombosis reported in the literature. MATERIALS AND METHODS: Previous trials that compared CEA with CAS were rather heterogeneous and not large enough to allow reliable conclusions. Furthermore, because there is limited follow-up information to date, the long-term effect of CAS remains unclear. Acute carotid thrombosis after angioplasty and stenting is a very rare but potentially fatal complication, and there are very few reports in the literature. This article reviews twelve cases of acute carotid thrombosis published in the English literature from eight different Vascular and Radiology Departments around the world. RESULTS: The different ways of immediate treatment of this rare complication of acute carotid thrombosis after CAS are, open surgical procedure with thrombus removal and thromboendarterectomy with or without removing of the stent, selective local or facilitated thrombolysis with the rescue use of GPIs (glycoprotein IIb/IIIa receptor inhibitors), recanalization by instent percutaneous transluminal angioplasty with distal protection and additional stent placement on the stented portion of the internal carotid artery (ICA) in conjunction with the intravenous administration of recombinant tissue plasminogen activator (rtPA: 1300,000 IU). CONCLUSION: Carotid artery stenting has to be performed under specific pro- and post procedure protocol from experienced endovascular specialists. The treatment of acute carotid thrombosis after CAS must be urgent and immediate in order to regain restoration of blood flow and avoid major neurological adverse events.