VASCULAR DISEASE MANAGEMENT
December 2014, Vol. 11, No. 12
Treatment of Angioseal-Related Femoral Artery Occlusion Using TurboHawk Directional Atherectomy
Anvar Babaev, MD1; David W. Lee, MD2; Anna Kurayev, MD2; Heather Yang, MD2
From 1New York University School of Medicine and 2New York University Division of Cardiology, New York, New York.
Objective: We describe a novel approach for the endovascular treatment of femoral artery occlusion as a result of Angioseal closure device deployment. Background: Angioseal is the most commonly used vascular closure device following percutaneous coronary and peripheral catheterizations worldwide. A rare complication of Angioseal deployment is occlusion of the femoral artery leading to limb ischemia and requiring revascularization. Given its unique ability to cut both plaque and the Angioseal device at operator-directed planes, TurboHawk can be a fast and effective approach to treat Angioseal-associated femoral artery occlusions. Case Series: We report four cases of Angioseal-associated femoral artery occlusions that occurred between three hours and twelve days after catheterization. These patients were successfully treated with TurboHawk directional atherectomy followed by balloon angioplasty with no complications. During a mean follow-up period of 12.1 ± 8.6 months, patients remained claudication free with no evidence of obstructive arterial disease of the treated limb on imaging studies. Conclusion: The use of directional atherectomy followed by balloon angioplasty is a quick, safe, and effective endovascular approach to treating Angioseal-associated femoral artery occlusions. It is associated with a high success rate, no complications, and good midterm outcomes.
Trends in the Incidence of Carotid Body Tumors in the USA from 1998-2011
Anahita Dua, MD1; Tanner C. Spees, MD1; Francisco C Hernandez, MD2; Anthony A. Igbadumhe, MD3; Mohammed Algodi, MD4; Sapan S. Desai, MD5
From 1Medical College of Wisconsin, 2University of Carabobo School of Medicine, 3Ambrose Alli University College of Medicine, 4Montefiore Medical Center, and 5Duke University Medical Center
Objective: The aim of this study was to characterize national trends in CBTs in the U.S by year, incidence, patient demographics, and hospital covariates. Methods: This was a retrospective cross-sectional analysis of hospital discharge data from 1998-2011 using the Health Care Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database. Patients with benign CBT identified (ICD-9 227.5) were included and demographics, clinical covariates and hospital inpatient charges were reported. Results: There were 684 cases of carotid body tumor in the USA, with an overall incidence of one case per every one million people in 2011. The mean age of patients diagnosed with carotid body tumor was 53.8 +/- 17.9, 60.4% were female (60.4%) and the mean length of stay was 3.3 +/- 3.9 days. Total hospital costs were approximately $9,763 per patient. The incidence of CBT has increased by 57% since 1998 (P<0.001). Average age, gender, and length of stay have not appreciably changed since 1998. 66.2% (452/683) underwent surgical management of the carotid body (ICD-9 39.8) of which 0.7% experienced a stroke. Conclusion: The incidence of CBT has increased by 37% since 1998 (P<0.001). In the USA, the incidence is 1/1,000,000 people. Less than 1% experience stroke as a complication of management.
May-Thurner Syndrome Resulting in Paradoxical Embolism
Jon C. George, MD; Frank Amico, MD; Harit Desai, MD; Vincent Varghese, MD
From Deborah Heart and Lung Center, Browns Mills, New Jersey.
A 53-year old female with a past medical history of hypertension, hyperlipidemia, asthma, and prior transient ischemic attack (TIA), presented after an embolic cerebrovascular accident (CVA) requiring the use of thrombolytic therapy. The patient underwent a tranesophageal echocardiogram that detected a 12 mm patent foramen ovale (PFO). Given her dramatic clinical presentation and prior TIA, a decision was made to treat the patient’s PFO with percutaneous closure for secondary stroke prevention.
* Articles are subject to change at the editor’s discretion.