VASCULAR DISEASE MANAGEMENT
July 2015, Vol. 12, No. 8
Case Report With Review
Infection: A Perilous Complication of a Closure Device
Ricardo Castillo, MD1; Fatemeh Malekpour, MD2
From 1Brookdale University Hospital and Medical Center, Brooklyn, New York, and 2Bronx-Lebanon Hospital Center, Bronx, New York.
ABSTRACT: The ability to achieve earlier hemostasis and comfort with percutaneous vascular closure devices (VCD) without major complications has contributed to the increase of their use. The use of VCD has been associated with different complications including access-site/femoral artery infection. We describe herein an illustrative case of a 47-year-old female patient with abnormal nuclear stress test, who developed a suture-based VCD-related infection following diagnostic coronary angiography. The patient was empirically treated with broad-spectrum antibiotics, early wound exploration, and debridement. Infection associated with percutaneous VCD placement is uncommon, but it is an extremely serious complication. Early aggressive medical and surgical interventions are required to resolve this condition.
Small Abdominal Aortic Aneurysms: Should We Wait?
George Galyfos, MD, PhD; Grigorios Voulalas, MD, PhD; Ioannis Stamatatos, MD, MSc; Stavros Kerasidis, MD, MSc; Ioannis Stefanidis, MD, MSc; Sotirios Giannakakis, MD, PhD; Georgios Kastrisios, MD; Georgios Geropapas, MD, MSc; Gerasimos Papacharalampous, MD; Chrisostomos Maltezos, MD, PhD
From the Department of Vascular Surgery, KAT General Hospital, Athens, Greece.
ABSTRACT: The proper management of small abdominal aortic aneurysms (AAAs), namely those under the threshold of 5.5 cm in diameter, has been under investigation for years. Risk of rupture for this group of AAAs is higher than the rest of the population, and specific factors have been associated with increased growth rate of small AAAs. This review aims to collect and present all available research data on the development and progress of small AAAs. Furthermore, the results of major randomized trials on proper treatment of such patients are discussed, and conclusions regarding interventional and conservative management are made.
Case Files With Dr. George
Utility of Image-Guided Atherectomy for Optimal Treatment of Ambiguous Lesions by Angiography
Jon C. George, MD; Vincent Varghese, DO
From the Deborah Heart and Lung Center, Browns Mills, New Jersey.
ABSTRACT: A 67-year-old female with lifestyle-limiting claudication affecting the left lower extremity was brought to the endovascular lab for definitive peripheral angiography. Right common femoral artery access was obtained, and selective left common femoral artery angiogram was performed. This demonstrated moderate diffuse plaque of 40% severity in the proximal to mid superficial femoral artery (SFA) with 100% occlusion of the mid vessel and reconstitution at the distal SFA via collaterals. There was 2-vessel runoff to the foot via patent posterior tibial and peroneal arteries. The Ocelot device (Avinger Inc.), an optical coherence tomography (OCT)-guided chronic total occlusion crossing device, was used to traverse the occluded segment, maintaining intraluminal position by directing the catheter away from the normal vessel layers toward the plaque. Post SFA CTO crossing angiogram demonstrated what appeared to be a dissection plane within the crossed segment.
* Articles are subject to change at the editor’s discretion.