Characterizing resolution of catheter-associated upper extremity deep venous thrombosis.

OBJECTIVE: Catheter-associated upper extremity deep venous thrombosis (CAUEDVT) is well known; however, resolution rates and factors affecting resolution of CAUEDVT are not well characterized. This study determined resolution rates and factors associated with resolution of CAUEDVT. METHODS: From January 1, 2002, to June 30, 2006, 1761 upper extremity venous duplex ultrasound (DU) studies were performed, and a new UEDVT was found in 253 (14.4%). Of these, 150 patients had routine follow-up and 101 had CAUEDVT. Demographics, follow-up DU results, and risk factors for venous thrombosis were recorded in the patients with follow-up studies and CAUEDVT. Univariate analysis and multivariate logistic regression analysis was performed to determine independent risk factors for complete thrombus resolution. RESULTS: There were 49 men (49%) and 52 women (51%) with CAUEDVT and follow-up studies. Mean age was 49 years (range, 5 months-80 years). Patients with CAUEDVT had risk factors for venous thrombosis that included malignancy in 34%, recent surgery/trauma in 34%, known hypercoagulable state in 11%, concomitant lower extremity DVT in 21%, and pulmonary embolism in 5%. Complete resolution of DVT on follow-up was documented in 46%. Thrombosis resolved in only 25% (6 of 24) when the catheter was not removed (P

Aortic aneurysm sac pressure measurements after endovascular repair using an implantable remote sensor: initial experience and short-term follow-up.

The purpose of this single-center study was to report our initial experience with an implantable remote pressure sensor for aneurysm sac pressure measurement in patients post-endovascular aneurysm repair (EVAR) including short-term follow-up. A pressure sensor (EndoSure, Atlanta, GA) was implanted in 12 patients treated with different commercially available aortic endografts for EVAR. Pressure was read pre- and post-EVAR in the operating room. One-month follow-up (30 days+/-6 days) was performed including sac pressure readings and IV contrast CT scans. Variables were compared using the paired Student's t test. An intraprocedure type-I endoleak and a type-III endoleak were successfully treated resulting in decreasing sac pressures. In all patients, post-EVAR systolic sac pressure decreased by an average of 33% (P

Duplex scan characteristics of bypass grafts to mesenteric arteries.

BACKGROUND: Mesenteric bypass grafts may be followed postoperatively with duplex scanning. It is unknown, however, if duplex-derived velocity measurements vary over time or if the type of procedure (antegrade vs retrograde) and the caliber of graft affect velocity measurements. The purpose of this study was to characterize duplex findings in mesenteric bypass grafts with respect to the type of revascularization, graft caliber, and changes over time. This study also sought to identify duplex characteristics that could predict subsequent graft failure. METHODS: Duplex examinations of mesenteric bypass grafts were reviewed. Peak systolic velocities (PSV) from the inflow artery, proximal anastomosis, mid graft, distal anastomosis, and outflow arteries were analyzed with respect to timing of the examination (index study vs follow-up exam), inflow source, distal target, and graft diameter. The results were compared with analysis of variance (P < .05). Univariate and multivariate analyses were used to determine any association with mid-graft PSV. RESULTS: Fasting postoperative duplex scans were reviewed from 43 mesenteric bypass grafts in 38 patients (28 superior mesenteric artery [SMA] alone, 3 celiac alone, 5 celiac and SMA, 2 SMA and renal). A total of 167 duplex exams were analyzed (mean of 4.5 studies per patient; range, 1 to 14). Inflow artery velocities were significantly lower in antegrade vs retrograde configurations (93 +/- 73 cm/s vs 154 +/- 73 cm/s, P < .05); however, proximal and mid-graft PSVs were not significantly different between the two groups. In addition, no effect was noted on mid-graft PSV when distal targets were compared (SMA vs celiac, 149 +/- 42 cm/s vs 160 +/- 78 cm/s, P = NS). An association between smaller graft diameter and higher mid-graft PSV was seen with univariate analysis (P = .03), with a trend toward significance with multivariate analysis (P = .06). In 18 bypass grafts where a follow-up examination was available >1 year (mean 38 +/- 25 months) after the index postoperative exam, velocity did not significantly change over time. No duplex scan characteristics were predictive of graft thrombosis. CONCLUSION: This is the first study, to our knowledge, to fully characterize duplex-derived flow velocities in mesenteric artery bypass grafts. Although surveillance duplex scans after mesenteric bypass procedures may be affected by graft diameter, they are not significantly affected by the choice of inflow artery. These data can serve as standards for postoperative surveillance of mesenteric bypass grafts.