VASCULAR DISEASE MANAGEMENT
May 2014, Vol. 11, No. 5
Vena Cava Filters: Too Often, Too Many or Just Right?
Vishesh Kumar, MD, David P. Slovut, MD, PhD
From Massachusetts General Hospital, Boston, Massachusetts, and Montefiore Medical Center, New York, New York.
Venous thromboembolism (VTE) comprising of both deep vein thrombosis (DVT) and pulmonary embolism (PE) is a common disease in the general population. The mainstay of the treatment for the most patients is anticoagulation. However, for patients that fail anticoagulation, or are unable to receive anticoagulation because of a contraindication or increased risk of bleeding, inferior vena cava filters (IVCF) offer an attractive alternative for prevention of PE. Although beneficial in some patients, the utilization of IVCF has skyrocketed despite limited level I evidence. Much of this increase occurred after the introduction of optional (or retrievable) IVCF. Owing to low retrieval rates, so-called “optional” filters frequently become permanent, which may add to the morbidity associated with their routine use. In this review, we discuss various types of filters, their main indications, evidence behind their use and the patterns of utilization.
Popliteal Entrapment Syndrome in Two Siblings: Coincidence or Inheritance?
Elias Kfoury, MD, Dipankar Mukherjee, MD, Homayoun Hashemi, MD
From Inova Fairfax Hospital, Fairfax, Virginia.
A 17-year-old white male presented with left lower extremity claudication and was found to have left popliteal artery entrapment syndrome. The patient underwent revascularization with interposition graft and had an uneventful recovery. One year later his 17-year-old sibling presented with an identical clinical picture of right popliteal entrapment syndrome with chronic occlusion of right popliteal artery requiring bypass surgery with interposition graft. The patient had an uneventful postoperative course. The question arises at this point: can the occurrence of this rare condition in siblings be a pure coincidence or due to inherited genetic factors. To our knowledge this is the third reported familial related popliteal entrapment syndrome in literature.
A Study of Left Renal Artery Pseudoaneurysm With Multiple Fractures of Stent
Ash Jain, MD, Lamiya Sheikh, MD
From the Washington Hospital Healthcare System, Fremont, California.
Percutaneous renal angioplasty with stenting is the predominant method of intervention for atherosclerotic renal artery stenosis. We present the relatively rare complication of formation of pseudoaneurysm after stent fracture in the case of a 74-year-old male with flash pulmonary edema and severe hypertension associated with renal artery stenosis and stenting, followed by formation of a large pseudoaneurysm in his left renal artery. We discuss management of such patients. We recommend that clinicians perform follow-up imaging on patients undergoing renal artery angioplasty for restenosis of renal artery stent to rule out the possibility of stent fracture and pseudoaneurysm formation.
Three-Year Global ENGAGE Registry Data: An Interview With Dittmar Böckler, MD, PhD
From the University Hospital of Heidelberg, Heidelberg, Germany.
* Articles are subject to change at the editor’s discretion.