Added Diagnostic Value of Intravascular Ultrasound Over Venography in "High Risk for Dialysis Circuit Vascular Access Failure" ESRD Patients.

Objectives: As a two-dimensional modality, venography has limitations in its capacity to measure lumen caliber and to assess stenotic disease accurately. This has implications in the management of end-stage renal-disease (ESRD) patients "no-option" candidates access for arteriovenous fistula (AVF) or graft (AVG) creation secondary to high risk of vascular access failure. The incremental diagnostic and clinical impact of intravascular ultrasound (IVUS) was quantified in this tunneled dialysis catheter dependent ESRD cohort.

Iliofemoral endarterectomy and stenting improves mid-term patency for advanced aortoiliac disease with concomitant common femoral disease.

ObjectiveCombined iliofemoral endarterectomy and iliac stenting (IFE + S) is a proven surgical approach for TransAtlantic Inter-society Consensus (TASC) C and D aortoiliac occlusive disease (AIOD). Iliac stenting alone (ISA) may be an attractive, minimally invasive option in select cases; however, untreated moderate-to-severe common femoral disease may threaten iliac stent patency and limit symptom improvement. This study evaluates the mid-term patency rates after IFE + S versus ISA for TASC C and D AIOD as well as the rate of interval femoral endarterectomies in those who underwent ISA.

Reintervention Rates for Restenting Versus Angioplasty Alone in Mesenteric Artery In-Stent Restenosis.

Background: Mesenteric artery in-stent restenosis (MAISR) is a common complication of endovascular interventions for mesenteric ischemia and the major cause of treatment failure. The objective of this study was to characterize the spectrum of endovascular interventions performed for MAISR at a large academic center and to compare 1-year clinical outcomes between the major treatment groups, angioplasty, and stenting to identify predictors of early reintervention.

Methods: Consecutive patients undergoing endovascular intervention for MAISR from 2008 to 2021 in the Cleveland Clinic Health System were identified.

Advanced imaging and management of superior vena cava syndrome.

Superior vena cava (SVC) syndrome results from stenosis and/or occlusion of the central venous system leading to symptomatology associated with head and neck as well as upper-extremity venous congestion. With the rise in central venous catheter use and increasing cases of malignancy, the incidence of SVC syndrome has steadily increased in recent years. This narrative review explores the clinical presentation of SVC syndrome, alongside its evolving etiologies within modern clinical practice and its pathophysiology.

The Role of Open Abdominal Aortic Aneurysm Repair in the Era of Fenestrated Endovascular Repair.

Background: Advances in endovascular aneurysm repair have been made with new commercially available devices for treatment of more complex aortic pathology. Despite that, adhering to instructions for use (IFUs) excludes multiple patients necessitating the need for open surgical repair (OSR). This study aims to review the need for OSR for abdominal aortic aneurysm (AAA) in a quaternary academic setting with a large volume of patients treated both with open and commercially available devices.

Postoperative Direct Oral Anticoagulants are Associated with Improved Amputation-Free Survival in Infrageniculate Bypasses Performed by Prosthetic Grafts in Patients with Chronic Limb-Threatening Ischemia.

Background: Autogenous single-segment great saphenous vein graft is the conduit of choice in infrainguinal bypasses particularly when the distal target of bypass is infra-geniculate. However, use of prosthetic grafts for infrageniculate bypass (IGB) is required in certain patients. Different measures have been used to increase the durability of prosthetic grafts in IGB.

Cross-sectional imaging for presurgical planning of dialysis circuit vascular access creation in the end stage renal disease patient population.

This systematic review explores the role of cross-sectional imaging modalities-computed tomography angiography (CTA) and magnetic resonance angiography (MRA)-in the preoperative planning of dialysis vascular access for patients with end-stage renal disease (ESRD). A systematic search was conducted using PubMed and Cochrane databases, yielding 45 studies meeting inclusion criteria. These modalities are particularly valuable in cases of complex vascular anatomy, central venous stenosis, and prior surgical interventions.

Surgical technique and outcomes associated with the use of femoral vein in venous reconstruction for superior vena cava syndrome.

Objective: Superior vena cava syndrome (SVC) is a debilitating disease, and surgical reconstruction has been described with some of the best results using spiral great saphenous vein (SGSV) grafts. SGSV grafts can be difficult to construct, and a long segment of saphenous vein is needed. Femoral vein has been an excellent conduit for infected aortic and peripheral reconstructions in our hands, and we sought to review outcomes using this conduit for SVC reconstruction.

Translumbar and Transhepatic Tunneled Dialysis Catheter Placements in the End Stage Renal Disease Population.

For end-stage renal disease (ESRD) patients requiring hemodialysis, reliable vascular access is crucial, especially when conventional supradiaphragmatic options are exhausted. This study reviews the technical aspects, clinical outcomes, and complications of translumbar and transhepatic tunneled dialysis catheter (TDC) placements. These alternative infradiaphragmatic approaches provide essential hemodialysis access for patients with central venous occlusions.

Concomitant Carotid and Coronary Artery Disease Management: A Review of the Literature.

This review examines current evidence regarding management of patients with both coronary and carotid artery disease. It highlights the elevated stroke risk after surgery for this cohort and scrutinizes approaches to minimize this risk. Various revascularization methods are outlined, including carotid endarterectomy (CEA), carotid artery stenting (CAS), and staged versus simultaneous surgical approaches.

Temporary mesenteric venous shunting for portal vein reconstruction: A novel technical adjunct.

Pancreatic resection not infrequently requires portal vein (PV) repair or replacement. PV reconstruction often requires bypass grafting or patch venoplasty, and these grafts and patches require time to thaw or harvest. Mesenteric ischemia and congestion with associated bowel edema may result from prolonged venous occlusion during thawing, harvesting, and reconstructing.

No difference in midterm outcomes and complication rate between retroperitoneal and transperitoneal open aortic aneurysm repair in females.

ObjectivesAbdominal Aortic Aneurysms (AAA) in females are less prevalent, have higher expansion rates and experience rupture at smaller diameters than in males. Studies have compared outcomes of the retroperitoneal (RP) and transperitoneal (TP) approach in open aortic aneurysm repair (OAR) with conflicting results. No study to date has compared the two approaches solely in females.

Explant of an infected, endo-trashed IVC filter in an immunosuppressed patient with chronically occluded iliocaval stents.

Background: In the absence of a contiguous bowel perforation or intraabdominal source, infection of a retained vena cava filter in an occluded IVC has never been described.

Objective: To describe a case of an infected IVC filter in a chronically occluded iliocaval segment.

Methods: Here we present a case of an immunosuppressed 35-year-old female with chronically occluded iliocaval stents and an extensive staphylococcus hominis infection of a previously endo-trashed Bard Eclipse® filter.

Natural history of superior mesenteric artery in-stent restenosis.

Objective: Superior mesenteric artery (SMA) stenting is the preferred approach for patients with symptomatic SMA-associated chronic mesenteric ischemia (CMI). The durability of this modality is impacted by in-stent restenosis (ISR). Duplex ultrasound (DUS) and computed tomographic angiography (CTA)-measured ISR may be weakly correlated and not uniformly associated with recurrence of presenting symptoms.

Association between socioeconomic deprivation and presentation with a ruptured abdominal aortic aneurysm.

Objective: Given the ongoing nature of research in the social determinants space and urges to improve United States Preventive Services Task Force screening efforts for abdominal aortic aneurysms (AAAs), this project aims to characterize the association between the level of socioeconomic deprivation, rurality, and ruptured AAA (rAAA) presentation across the United States.

Methods: We queried the Vascular Quality Initiative registry (2010-2019) for patients with AAAs. The area deprivation index (ADI) is an index from 1 to 100 used to capture socioeconomic status.

Management of patients with chronic mesenteric ischemia across three consecutive eras.

Background: Endovascular intervention (EI) is the most commonly used modality for chronic mesenteric ischemia (CMI). Since the inception of this technique, numerous publications have reported the associated clinical outcomes. However, no publication has reported the comparative outcomes over a period of time in which both the stent platform and adjunctive medical therapy have evolved.

Late Referral and Patient Transfer is Associated with Worse Outcomes for Patients Presenting with Initially Uncomplicated Type B Aortic Dissections.

Background: Acute type B aortic dissections (TBADs) can become complicated at any time point, necessitating surgical repair. We sought to investigate the effect of interhospital transfer on the development of delayed complications in acute type B aortic dissection (dcTBAD).

Methods: All patients who presented with acute TBAD to a tertiary aortic center from 2015 to 2019 were analyzed.

Effects of abdominal aortic aneurysm appropriateness dashboard on clinical practice.

Objective: The Society for Vascular Surgery published abdominal aortic aneurysm (AAA) practice guidelines in 2003, 2009, and 2018 to improve the management and treatment of AAAs. In 2014, our vascular surgery department implemented a quarterly AAA dashboard (AAAdb) to record the perioperative outcomes and guideline compliance with a focus on intervention appropriateness and procedural follow-up, which supplemented our Vascular Quality Initiative data. From the available reported evidence and expert consensus opinions, nine additional criteria for the appropriate treatment of AAAs <5 cm in women and <5.

Prevalence of intracranial aneurysms in Marfan syndrome.

Objective: Aneurysmal pathology of the aorta is well-defined in the Marfan syndrome (MFS) population. Owing in part to the rarity of pathologies, the prevalence of intracranial aneurysms (IA) in MFS is poorly defined. There is debate as to whether or not there is an association between the two.

Value of Routine Troponin Measurement in Open Abdominal Aortic Aneurysm Repair.

Background: Cardiovascular complications are a major cause of morbidity and mortality in the postoperative period after major vascular surgery. Depending on the study population, up to 25% of patients have troponin elevation after noncardiac surgery, yet many do not meet the diagnosis of myocardial infarction (MI). Although outcomes of routine troponin elevation in patients undergoing mixed major vascular surgery have been evaluated, this has not been studied exclusively in elective, open abdominal aortic aneurysm repair (oAAA), especially regarding perioperative and overall mortality.

Hypogastric artery luminal diameter predicts common-external iliac stent patency and major adverse limb events in patients with aortoiliac occlusive disease.

Objective: Hypogastric coverage may be required for occlusive disease at the iliac arterial bifurcation. In this study, we sought to determine patency rates of common-external iliac artery (C-EIA) bare metal stents (BMS) spanning the hypogastric origin in patients with aortoiliac occlusive disease (AIOD). In addition, we sought to identify predictors of C-EIA BMS patency loss and major adverse limb events (MALE) in patients requiring hypogastric coverage.

A Novel Technique and Outcomes for Transcaval Endoleak Embolization.

Background: Strategies for embolization of type 2 endoleaks include translumbar, transgraft, transarterial, and transcaval approaches. The transcaval approach is limited by an inconsistent ability to access the aortic sac and the risk of puncturing and damaging the endograft or adjacent structures. We describe a novel technique for caval to aortic aneurysm sac access and report early outcomes.