{"title":"Endovascular iliac branch devices for iliac aneurysms.","authors":"Gustavo S Oderich, Roy K Greenberg","doi":"10.1177/1531003511408344","DOIUrl":"https://doi.org/10.1177/1531003511408344","url":null,"abstract":"<p><p>The evolution of endovascular techniques has increased the proportion of patients with abdominal aortic aneurysms suitable for treatment with endovascular aneurysm repair (EVAR). Developments in fenestrated and branched technology provide an endovascular solution to incorporate the visceral branches and iliac arteries into the repair, expanding the indications of EVAR. Iliac branch devices (IBDs) allow preservation of flow into one or both internal iliac arteries in patients with ectatic or aneurysmal iliac arteries. The technique has been performed with high technical success rates and no added morbidity and mortality as compared with standard EVAR, potentially decreasing pelvic ischemic complications associated with hypogastric exclusion. This article summarizes the state of the art on IBD design, procedure planning, implantation, and clinical results.</p>","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 3","pages":"166-72"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511408344","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30050013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Results and challenges for the endovascular repair of aortic arch aneurysms.","authors":"Christos Lioupis, Cherrie Z Abraham","doi":"10.1177/1531003511413608","DOIUrl":"https://doi.org/10.1177/1531003511413608","url":null,"abstract":"<p><p>Endovascular aortic arch reconstruction provides an attractive alternative to treat aortic arch disease in high-risk patients who would otherwise be unsuitable for open repair. Success with multibranched stent grafts in the thoracoabdominal aorta along with recent advances in design such as the precurved inner nitinol cannula have simplified the endovascular reconstruction of aortic arch aneurysms with multibranched stent grafts. These devices allow for greater flexibility in conforming to difficult anatomy and preserving important side branches. During the first surgical stage, a left carotid -subclavian bypass or left subclavian artery transposition is performed. The second stage is the endovascular procedure. The device is inserted through a transfemoral approach, and crossing of the aortic valve with the device is necessary. The stent graft is deployed during brief periods of rapid pacing. Bridging from the branches to the innominate and left common carotid arteries requires a suitable covered stent. In the case of a large-diameter innominate artery, a custom-made bridging limb has to be used to ensure that adequate length and size are available. Direct flow to the innominate and left common carotid arteries do not cease for any significant time during the procedure. Initial experience with mean follow up more than 6 months is encouraging. The method is not suitable for patients with extensive atheromatous involvement of the aortic arch. Careful preoperative planning (preoperative imaging, device construction, and access issues), high endovascular skills, and appropriate imaging equipment are imperative for a successful result. Long-term follow-up is necessary to evaluate the efficacy and safety of these new devices.</p>","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 3","pages":"202-13"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511413608","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30059647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Moritz S Bischoff, Gabriele Di Luozzo, Eva B Griepp, Randall B Griepp
{"title":"Spinal cord preservation in thoracoabdominal aneurysm repair.","authors":"Moritz S Bischoff, Gabriele Di Luozzo, Eva B Griepp, Randall B Griepp","doi":"10.1177/1531003511400622","DOIUrl":"https://doi.org/10.1177/1531003511400622","url":null,"abstract":"<p><p>Spinal cord injury (SCI) stands as one of the most dreadful complications of thoracoabdominal aneurysm repair. Despite the less invasive nature and recent technical advancements of endovascular aortic repair, SCI still remains a significant danger in endovascular approaches. However, as our understanding of the collateral network of spinal cord vasculature has grown, it has become evident that the incidence of paraplegia and paraparesis in conjunction with endovascular procedures can be minimized through the use of many of the same strategies that have proven successful in reducing SCI associated with open surgical repair. This article highlights important aspects of spinal cord protection, which have been derived from the authors' clinical and experimental experience.</p>","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 3","pages":"214-22"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511400622","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29824922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Standardized off-the-shelf components for multibranched endovascular repair of thoracoabdominal aortic aneurysms.","authors":"Tim Chuter, Roy K Greenberg","doi":"10.1177/1531003511430397","DOIUrl":"https://doi.org/10.1177/1531003511430397","url":null,"abstract":"<p><p>Endovascular techniques have been slow to assume a primary role in the management of thoracoabdominal aortic aneurysms (TAAAs) because of the high cost of multiple components, regulatory challenges, manufacturing delays, and the complexity of multibranched stent graft insertion. Standardized off-the-shelf stent grafts have the potential to lower all these barriers to the widespread application of multibranched endovascular technology. Despite the desire for a single design to accommodate all variations of thoracoabdominal aneurysms, different approaches are likely required for patients with extensive aneurysmal disease compared with disease that is more localized to the infradiaphragmatic region or that which does not extend below the renals. This article summarizes the basic concepts and stent graft designs for repair of TAAA using off-the-shelf fenestrated and branched endografts.</p>","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 3","pages":"195-201"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511430397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30354657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Endovascular repair of type II and type III thoracoabdominal aneurysms.","authors":"Tara M Mastracci, Matthew J Eagleton","doi":"10.1177/1531003511412083","DOIUrl":"https://doi.org/10.1177/1531003511412083","url":null,"abstract":"<p><p>Thoracoabdominal aortic aneurysms (TAAA) remain a challenging problem to manage. Operative care for patients afflicted with this devastating problem is associated with significant risks, including renal failure and paraplegia. Several techniques have been developed to help limit the risk for these complications, yet they still remain some of the greatest hurdles associated with these procedures. Endovascular technology is rapidly advancing and may provide an alternate approach to patients with TAAA. Endograft treatment of TAAA is possible with the use of fenestrated and/or branched aortic endografts. Although still early in its evolution, we are beginning to understand some of the risks and benefits of this approach to complex aortic disease. Fenestrated and branched aortic endografting may provide an option that has lower risk to patients. Spinal cord ischemia, however, still remains a critical problem in patients who require treatment of a significant portion of their aorta. In addition, renal failure is also still observed. The mechanisms leading to the development of these complications following endograft repair, however, may not be the same as observed with open TAAA repair. This review will highlight some of our current understandings of endovascular repair of thoracoabdominal aortic aneurysms.</p>","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 3","pages":"178-85"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511412083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30051139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Iatrogenic injury from vascular access and endovascular procedures.","authors":"Britt H Tonnessen","doi":"10.1177/1531003511409057","DOIUrl":"https://doi.org/10.1177/1531003511409057","url":null,"abstract":"<p><p>Endovascular procedures inevitably result in iatrogenic injury in a small percentage of patients. Appropriate choice of access site, careful technique, and selective use of closure devices may reduce the incidence of these complications. The vascular interventionalist should be able to recognize and manage various access site complications, such as pseudoaneurysm, arteriovenous fistula, and retroperitoneal hematoma. Procedural complications such as arterial dissection can often be repaired with endovascular techniques. Newer techniques such as totally percutaneous endovascular aneurysm repair have special considerations to minimize the risk of hemorrhage or limb ischemia. The purpose of this review is to define the more common endovascular complications, their diagnosis, and management.</p>","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"128-35"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511409057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30198892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Commentary on \"Iatrogenic injury from vascular access and endovascular procedures\".","authors":"Karl A Illig","doi":"10.1177/1531003511408331","DOIUrl":"https://doi.org/10.1177/1531003511408331","url":null,"abstract":"","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"136-7"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511408331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30050964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advances in resuscitation in the setting of vascular injury.","authors":"Charles J Fox, Jonathan N Bowman","doi":"10.1177/1531003511400627","DOIUrl":"https://doi.org/10.1177/1531003511400627","url":null,"abstract":"<p><p>Damage control surgery with the principles of expeditious control of hemorrhage and contamination, followed by predominant crystalloid resuscitation in the intensive care unit has saved the lives of many severely injured trauma patients. Unfortunately, crystalloid resuscitation has too often led to worsening of coagulopathy in the setting of vascular injury. The recent conflicts in Iraq and Afghanistan have created injured patients with severe vascular injury and massive soft tissue destruction creating early and profound coagulopathy associated with high rates of mortality. An alternative strategy, known as damage control resuscitation, with the principal resuscitation of a 1:1 ratio of packed red blood cells and fresh frozen plasma has been developed during these conflicts. This method is associated with decreased mortality and improved limb salvage in military and civilian trauma patients.</p>","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"112-6"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511400627","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29822823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Commentary on \"The ischemic threshold of the extremity\".","authors":"Michael T Watkins","doi":"10.1177/1531003511408335","DOIUrl":"https://doi.org/10.1177/1531003511408335","url":null,"abstract":"","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"88-9"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511408335","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30050960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Commentary on \"Vascular injuries in the young\".","authors":"M Margaret Knudson","doi":"10.1177/1531003511408333","DOIUrl":"https://doi.org/10.1177/1531003511408333","url":null,"abstract":"","PeriodicalId":87201,"journal":{"name":"Perspectives in vascular surgery and endovascular therapy","volume":"23 2","pages":"111"},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1531003511408333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30050961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}