Indications for balloon-expandable stent (BES) placement in the great vessels include occlusive atherosclerotic disease as well as vessel origin protection when thoracic endografts are placed with overlap of the vessel origin. We compared early outcomes of in-stent restenosis in these two groups of patients: those being treated for occlusive disease and those treated as an adjunct to TEVAR.

Carotid access for stenting can be problematic due to anatomic variations and/or aortic arch pathology. For rare cases best treated by direct puncture of the common carotid artery (CCA), there is added difficulty due to ergonomic and angulation issues, even with surgical exposure. A newly designed access sheath, the H2H Guiding Sheath, facilitates short access surgery (SAS) and reduces arterial damage.

The optimal method for predicting when carotid shunting during carotid endarterectomy (CEA) is unnecessary is controversial. This study analyzed the correlation of carotid stump pressure (CSP) and the status of contralateral carotid/cerebral collaterals and determined whether preoperative duplex ultrasound (DUS)/cerebral angiography (angio) can predict when CEA can be done without shunting.

Surgeons, payers, and providers have recently placed increasing emphasis on risk assessment and outcomes reporting in vascular surgery. Accordingly, we studied the change in the risk profiles of patients undergoing lower extremity bypass surgery (LEB) in New England.

This study evaluated outcomes after endovascular intervention (EVI) for chronic critical limb ischemia (CLI) by Rutherford class (RC4: rest pain; RC5: tissue loss). The medical records of all EVI performed for RC 4-5 by vascular surgeons at a single institution during a 3-year period were reviewed for the following outcomes. Sustained clinical success (SCS)—Rutherford Improvement Score (RIS): 2+, without target extremity revascularization (TER). In RC5 patients, patency until healing; healing ≤4 months without recurrence or new ulceration. Secondary sustained clinical success (SSCS)—RIS: 2+ with TER. In RC5 patients; patency until healing; healing at any time during follow-up, without recurrent or new ulceration. Data were analyzed using SPSS. Significance was established at the 0.05 level.

Distal embolization (DE) during percutaneous lower extremity revascularization (LER) may cause severe clinical sequelae. To better define DE, we investigated which lesion characteristics and treatment modalities increase the risk for embolization.

To determine the results of simultaneous TEVAR and EVAR. Records were retrospectively reviewed. Seven patients (5 men; mean age, 73 years) underwent simultaneous TEVAR and EVAR between 1999-2009 at a single center. All patients had concomitant thoracic and abdominal aneurysms. The average diameters of the thoracic and abdominal aneurysms were 6.6 and 6.3 cm, respectively. Three patients were treated emergently, and the remainder had urgent indications for simultaneous repair. All patients had significant comorbidities (HTN, CAD, CHF, smoking, COPD).

Clinical experience has revealed that most nitinol AAA stent grafts suffer from suprarenal stent fracture that could potentially result in caudal prosthesis migration and/or type I endoleak. There is limited understanding of the mechanism of suprarenal stent fracture. The aim of this study was to investigate the root cause of fracture based on theoretical analysis, in vitro testing, in vivo image observation, and clinical follow-up.

Improving patient safety has become a national priority. Patient Safety Indicators (PSIs) are validated tools to identify potentially preventable adverse events. No studies exist evaluating lower extremity (LE) vascular procedures and the occurrence of PSIs.

Although it is well established that patients with peripheral arterial disease (PAD) have a higher incidence of hypertension (HTN), studies have not examined if patients with HTN are at higher risk for PAD. We prospectively investigated the incidence of PAD as a function of the severity of HTN.

Obesity is common in patients presenting with vascular diseases and has been associated with increased perioperative complications with open surgical procedures, but the effect of body mass index (BMI) on endovascular procedures is uncertain. This study was to determine the effect of BMI on hospital course and 30-day mortality and morbidity on patients undergoing endovascular surgical procedures.

Recent data show no differences in survival to 2 years when chronic (2 to 52 weeks from symptom onset) uncomplicated type B aortic dissection is treated medically or with thoracic endovascular repair (TEVR). The high rate of late aneurysmal degeneration, however, coupled with the high mortality and paralysis rate of this entity, is critical to include in any analysis of the relative effectiveness of these two treatments.

One of the most important determinants for successful endovascular repair of abdominal aortic aneurysms (EVAR) is adequate infrarenal aortic neck length. We reviewed our experience with EVAR in patients with short (<15 m) infrarenal necks focusing on the incidence, treatment, and midterm outcome of proximal attachment site endoleaks.

Endovascular repair of intact abdominal aortic aneurysms (EVAR) has been shown to decrease morbidity and resource utilization compared with open repair (open). However, the utility of EVAR for the repair of ruptured abdominal aortic aneurysms (RAAA) remains unknown. This study used the Medicare database to evaluate trends in RAAA volume and compared outcomes of open and EVAR repair of RAAA in contemporary practice.

Giant-cell arteritis is one of the most common vasculitic disorders that a vascular surgeon encounters during daily practice. According to American College of Rheumatology guidelines, the diagnosis can be established on clinical findings without the need of a pathologic specimen. We examined the current experience of vascular surgery service performing temporal artery biopsies.

Stenosis at the pulmonary artery (PA) anastomosis after lung transplantation is a rare complication that has poor prognosis even after surgical correction. We present the first case of PA anastomotic stenosis that was successfully treated with the assistance of a remote robotic catheter navigation system (Hansen Sensei system) because of failure of conventional interventional techniques.

Aortic endograft collapse is a rare complication described predominately in thoracic aortic endografts. Factors predisposing to graft collapse include excessive oversizing, tight aortic arch diameter, and poor wall apposition of the graft resulting in a “bird's beak” phenomenon. Here we report an interesting case of a collapsed abdominal aortic endograft repaired using endovascular techniques.

Thoracic endovascular aortic repair (TEVAR) of descending thoracic aortic aneurysms has been frequently performed since the release of commercially available endografts. TEVAR is an attractive option for the treatment of complex aortic disease and maintains a relatively low reintervention rate. This case series describes three patients who developed proximal fixation aneurysms that were discovered with meticulous postoperative endograft surveillance and were successfully repaired with a secondary endovascular intervention.

Inadvertent arterial puncture is a complication of placement of central catheters; this can lead to arterial occlusion, embolism, pseudoaneurysm formation, vessel laceration, or dissection. To prevent the occurrence of these complications, the central catheter has to be removed, but direct pressure is not an adequate option in the subclavian artery. The management of this complication does not have a standard accepted treatment.

During an endovascular aneurysm repair (EVAR), dissection occurred in the bilateral common and external iliac arteries, resulting in acute bilateral hypogastric artery occlusion. Attempts were made to re-establish flow to the left internal iliac artery through a retrograde ipsilateral approach, without success. A left brachial approach was used to gain access to the left internal iliac artery. Kissing angioplasty and subsequent stent placement with two self-expanding stents was performed, raising the iliac bifurcation to the level of the stent graft in the common iliac artery to salvage the internal iliac artery. The patient postoperatively developed right lower extremity weakness and paresthesia, despite a normal ABI >0.7, which raised the question of spinal cord-related injury from pelvic malperfusion and suggested that if both stenosis were not treated, this could have resulted in significant morbidity.