Pararenal Aortic Ulcer Repair.

OBJECTIVE/BACKGROUND: In order to investigate techniques and outcomes of pararenal penetrating aortic ulcer (PAU) repair, a retrospective cohort study was performed. METHODS: Over the 6 year study period, 12 patients treated for a pararenal PAU were included. Outcome measures included technical success, survival, and peri-operative complications, as well as stent patency. RESULTS: Treatment modalities included hybrid procedures with endovascular aneurysm repair (EVAR) and bypass grafting, chimney EVAR (Ch-EVAR), and fenestrated EVAR (FEVAR). Four of the 12 patients were symptomatic, and eight patients underwent elective surgery. The technical success rate was 100%. Symptom resolution was recorded in all symptomatic patients immediately post-operatively. Complications encountered included one type I endoleak in a patient who underwent Ch-EVAR, and one case of post-operative stroke, paralysis, and death in a patient who underwent FEVAR. No adverse events were recorded in the remaining 10 patients. The PAU protrusion distance was significantly greater in symptomatic patients. Perforation and leakage were more prevalent in patients with pre-operative abdominal or back pain. CONCLUSION: Encouraging results of endovascular treatment of pararenal PAUs were observed. One major and fatal complication was encountered, which underlines the complexity and risks of the techniques. Another patient required re-intervention owing to an endoleak following off label use of covered stents for Ch-EVAR. FEVAR, which generally requires a custom made graft, was increasingly applied over the study period, potentially because of an increased awareness of this distinct pathology allowing for elective procedure planning. Ch-EVAR and hybrid procedures were predominantly used in symptomatic patients, whereas FEVAR was the preferred elective treatment option.

Long-term results of covered stent repair of internal carotid artery dissections.

BACKGROUND: Traumatic and spontaneous dissections of internal carotid arteries (ICA) are rare conditions. So far, these pathologies are primarily treated conservatively, surgical revascularization being an option only after recurrent thromboembolic neurologic episodes or continuous aneurysm growth. Successful endovascular treatment strategies with covered stents have been reported in patients with ICA dissections. However, no long-term results are published so far. Herein, we report our experience of a combined conventional and endovascular repair of ICA dissections under reversed flow and their respective long-term results. METHODS: In a prospective evaluation of clinical and morphologic outcome of 6 patients with carotid artery dissections, 2 patients were treated for continuous aneurysm growth and 4 patients for high-grade ICA stenoses with recurrent thromboembolic episodes during a 6-month follow-up period. A 6-mm polytetrafluoroethylene Hemobahn endoprosthesis was inserted under reversed flow of the internal carotid artery. RESULTS: No perioperative strokes were observed; one TIA occurred, lasting less than 3 hours; no peripheral cranial nerve injuries or deaths were observed. No occlusions, hemodynamically significant stenosis, or recurrent neurologic symptoms were seen during follow-up, which ranged from 6 to 54 months (mean, 38.3 months). CONCLUSION: Open endovascular repair of the ICA of symptomatic patients with dissections with a 6-mm covered endoprosthesis is a safe alternative to conventional surgery, with excellent long-term patency.

Bilateral stenting of symptomatic and asymptomatic internal carotid artery stenosis due to fibromuscular dysplasia.

Stent grafting of internal carotid artery (ICA) stenoses due to fibromuscular dysplasia has been rarely and only unilaterally carried so far. Bilateral carotid stent grafting of ICA stenoses due to fibromuscular dysplasia has not been reported previously. In a 37 year old woman with recurrent right hemispheric transitory ischaemic attacks, a non-disabling minor stroke, and recurrent right amaurosis fugax despite antithrombotic therapy, cerebral angiography disclosed a long segment narrowing, distal, high grade (95%) stenosis of the right ICA and a long narrowing, distal high grade (70%) stenosis of the left ICA. Morphological features of both stenoses were indicative of fibromuscular dysplasia. The right sided stenosis was stented with a PTFE-HEMOBAHN endoprosthesis; this was followed by a brief, postprocedural left sided hemiparesis. The left sided ICA stenosis was successfully stented by the same procedure. Nine months later, both stents were still patent and the patient was symptom free. Bilateral carotid stenting may remain an alternative to endarterectomy in bilateral ICA stenosis due to fibromuscular dysplasia when ischaemic events persist despite full antithrombotic therapy.

[The distal portion of the ulnar nerve--recording technic and normal values]. / Der distale Anteil des Nervus ulnaris--Ableitetechnik und Normwerte.

Normal values for the distal portion of the ulnar nerve are proposed. In 52 normals without clinical symptoms of peripheral nerve lesion the following neurographic parameters were recorded on the right side and in 45 cases on the left side, too: distal latency wrist-hypothenar, compound action potential from hypothenar, distal latency wrist-M, adductor pollicis, compound action potential from the M. adductor pollicis, antidrome nerve conduction velocity wrist-digit V, difference of latencies M. adductor pollicis-hypothenar, difference of compound action potential hypothenar-M. adductor pollicis and side differences of these parameters. A linear regression analysis was performed to investigate the dependence of these parameters from age. Our normal values allow an exact localisation of peripheral lesions of the ulnar nerve (Loge de Guyon, Ramus volaris superficialis, Ramus profundus).