Search

Purpose: Carotid revascularization can be associated with modifications of the vascular geometry, which may lead to complications. The changes on the vessel angulation before and after a carotid WallStent (WS) implantation are compared against 2 new dual-layer devices, CGuard (CG) and RoadSaver (RS)., Materials and Methods: The study prospectively recruited 217 consecutive patients (112 GC, 73 WS, and 32 RS, respectively). Angiography projections were explored and the one having a higher arterial angle was selected as a basal view. After stent implantation, a stent control angiography was performed selecting the projection having the maximal angle. The same procedure is followed in all the 3 stent types to guarantee comparable conditions. The angulation changes on the stented segments were quantified from both angiographies. The statistical analysis quantitatively compared the pre-and post-angles for the 3 stent types. The results are qualitatively illustrated using boxplots. Finally, the relation between pre- and post-angles measurements is analyzed using linear regression., Results: For CG, no statistical difference in the axial vessel geometry between the basal and postprocedural angles was found. For WS and RS, statistical difference was found between pre- and post-angles. The regression analysis shows that CG induces lower changes from the original curvature with respect to WS and RS., Conclusion: Based on our results, CG determines minor changes over the basal morphology than WS and RS stents. Hence, CG respects better the native vessel anatomy than the other stents.Level of Evidence: Level 4, Case Series.

Purpose: To illustrate the use of a mechanical thromboaspiration device originally designed for clot retrieval in acute stroke in the treatment of acute distal embolism occurring during percutaneous revascularization of the femoropopliteal and below-the-knee arterial segments., Technique: The Penumbra system was adapted for aspiration of thrombus in the distal foot arteries as a standalone device. The 2 over-the-wire, tapered lumen catheters have long working lengths (139 cm for the 4MAX to 153 cm for the 3MAX) that allow advancement below the ankle even with a retrograde contralateral approach. Once the occluded arterial segment is reached, the catheters are connected to the dedicated pump for continuous vacuum aspiration. The use of the device is illustrated in 3 diabetic patients (1 woman and 2 men; ages 88, 70, and 73 years, respectively) undergoing limb salvage procedures who experienced distal embolization that would have seriously jeopardized the foot circulation. The lumens of the occluded arteries were restored without complication., Conclusion: While further evaluation in a larger cohort of patients is needed, this initial experience using the Penumbra system in the peripheral vasculature suggests that this is a rapid, effective approach to address intraprocedural foot embolization and avoid possible grave clinical sequelae., (© The Author(s) 2015.)

Purpose: To describe the use of an Amplatzer Vascular Plug to facilitate endovascular aneurysm repair (EVAR) in a renal transplantation recipient with contained rupture of an abdominal aortic aneurysm (AAA)., Case Report: A 52-year-old man with a history of kidney transplantation and a 4-cm AAA was referred to our hospital with severe abdominal pain. Imaging showed the contained AAA rupture measuring 8 cm, with 2 blisters at the proximal short neck and narrow calcified iliac arteries. The blisters were the probable sites of rupture, and the cranial one was 4 mm below the superior mesenteric artery, precluding conventional EVAR. The Amplatzer Vascular Plug was used to occlude the blister and remodel the proximal neck so that a low-profile Ovation prosthesis could be passed through the narrow calcified iliac artery without damaging the transplanted renal artery anastomosed to the external iliac artery., Conclusion: The unconventional use of the Amplatzer Vascular Plug for neck remodeling made EVAR possible in this case.

Purpose: To describe a technique to recanalize occluded superficial femoral artery (SFA) stents without inflow or outflow in patients with proximal SFA obstruction., Technique: After a failed attempt to engage an occluded stent through an antegrade femoral approach, a distal retrograde puncture of the proximal part of the stent was performed. After subintimal rendezvous with a catheter advanced from the antegrade access, in-stent angioplasty can be performed to recanalize the stent and SFA., Conclusion: Direct retrograde puncture of an occluded stent may be considered an approach to recanalization in patients with stent occlusion and no inflow or outflow.

The syndrome of plethora without splenomegaly, leukocytosis, or thrombocytosis was described by Gaisböck in 1905. It was reevaluated in 25 patients through the study of numerous hematologic and biochemical parameters. Statistically significant findings included mild obesity; elevation of blood pressure (especially diastolic); decrease in plasma volume with relative increase in red cell count, hemoglobin, hematocrit, viscosity of blood, elevation of plasma proteins, serum cholesterol, triglycerides, uric acid, and plasma renin; and increased excretion of urinary sodium. The reduction in plasma volume seemed related to the elevation of the diastolic blood pressure, and favorable through temporary therapeutic results were produced by some antihypertensive agents. The elevation of serum cholesterol, triglycerides, and uric acid, the increased blood viscosity, and the elevated plasma renin were reminescent of the biochemical changes observed in some instances of hypertension and atherosclerotic disease. They may explain why patients with the Gaisböck's syndrome belong to the high risk group of hypertensive individuals who often develop cardiovascular complications. While its long-term effects remain to be evaluated, treatment with nondiuretic antihypertensive drugs may help reduce the incidence of these complications.