Volume 2 - Issue 4 - July/August 2005
Feature »
Inaccurate Ultrasound Assessment of Internal Carotid Disease in Patients with Carotid Artery Disease and Aortic Valve Stenosis C
Introduction
The association of internal carotid artery disease (ICAD) with aortic valve stenosis (AVS) constitutes a very high-risk clinical occurrence of which surgical management is still unclear, because the rate of death and stroke for combined suergry is 3%.1 Carotid stenting before or after cardiac surgery may be a valuable option in such high-risk patients. An accurate diagnosis of any significant carotid artery stenosis is of paramount importance for a proper combined or staged surgical or endovascular repair, and for immediate results after cardiac valve surgery.
Feature »
Perforation of External Carotid Artery Branch Arteries during Endoluminal Carotid Revascularization Procedures: Consequences and
Introduction
Over 12,000 carotid angioplasty and stenting (CAS) procedures have been performed worldwide.1 More than 130,000 carotid endarterectomies (CEA) are performed annually in the United States.2 The FDA has already approved CAS with distal protection for high-risk patients. With the emerging data from ongoing trials demonstrating at least clinical equipoise with CEA, it is only a matter of time before CAS becomes the procedure of choice for patients with atherosclerotic carotid artery disease.3,4 A wealth of experience in overcoming the technical
Feature »
First Clinical Application of Absorbable Metal Stents in the Treatment of Critical Limb Ischemia: 12-month results
Introduction
Peripheral stents aim to support revascularization procedures of intravascular stenoses by mechanically preventing vessel recoil and counteracting pathophysiologic processes of luminal re-narrowing triggered by procedural injury of the vessel wall. Despite improvements in stenting techniques and concomitant medication, repeated intervention due to target lesion restenosis is necessary on a significant percentage of patients. The permanent presence of an artificial implant plays a prominent role in the discussion of mechanisms causing in-stent restenosis. Permanent metallic
Feature »
“Magic” Bioabsorbable Metal Stents: The Role of the “Houdini stent” in the disappearance of CLI
In 1892, Ehrich Weiss (aka Harry Houdini) with his brother, and later his beloved wife, Bess, burst upon the vaudeville scene by performing the first of over 11,000 performances of their famous disappearing act “Metamorphosis.” Harry was tied up, shackled with irons and locks, and put in a locked trunk in full view of the audience. A small curtain was placed over the trunk by Bess, who immediately stepped out behind one side of the curtain while Harry stepped from the other side. The curtain was immediately raised and the trunk opened, only to find Bess tied and locked within the trunk, al
Editor's Corner »
Stent-Graft Repair of Thoracic Aortic Diseases: A New Frontier in Endovascular Therapy
The FDA announced approval of the first thoracic endograft device (Gore TAG) on March 23, 2005. It signaled the true beginning of a new era in endovascular therapy, and the unmistakable 'message' that thoracic aortic surgery is about to be transformed in a dramatic and irreversible fashion.
Thoracic aortic diseases, such as aneurysms, dissection, and others, share in common several important features - a relatively high incidence and high lethal potential, among others! Open surgical repair has been the acknowledged standard of care for decades, but it is far from ideal because of continuin
Feature »
Percutaneous Closure of the Inadvertent Subclavian Artery Puncture During Central Venous Catheterization
Introduction
We report the use of an Angio-Seal™ Vascular Closure Device (St. Jude Medical, Minnetonka, MN) to close the arterial puncture site of the left subclavian artery (LSA) during inadvertent central line placement.
History
A 56-year-old male presented with a history of severe peripheral vascular disease (PVD) and non-healing ulcer of the right foot and toes. He underwent a right femoral-to-posterior tibial bypass graft. During the preparation for intubation, a 7 Fr triple-lumen catheter was inadvertently placed in the left subclavian artery at the infraclavicular l
Feature »
Endovascular Treatment of Symptomatic Radiation-Induced Vasculitis of the Left Vertebral and Left Subclavian Arteries
Introduction
Radiation-induced vasculitis (RIV) is a well-documented complication in patients with a history of previous head and neck or mediastinal radiation. Cardiac valves and ostial location lesions of the epicardial coronary arteries are the more common sites of injury.1 However, areas distant to the heart have also been shown to undergo changes after radiation-induced therapy. These areas are not limited to but include the carotid, vertebral and less commonly, the subclavian arteries. Treatment of RIV has included percutaneous intervention, surgical and medical therap
Feature »
Treatment of Iatrogenic Renal Artery Perforation with a Covered Stent and Subsequent Rheolytic Thrombectomy
Introduction
Iatrogenic renal artery perforation is a rare, but well-described complication of percutaneous renal artery intervention.1-3 Treatment has traditionally involved surgical intervention including renal artery reconstruction, bypass grafting, and even nephrectomy.4,5 More recently, several non-surgical techniques have been described, including balloon tamponade, custom-made stent graft deployment, and use of an autologous vein-covered stent.6,7 The JoStent® (JoMed, Rancho Cordova, California) has been approved by the FDA under humanitarian d
