Volume 3 - Issue 2 - March/April 2006
Feature »
Salvage of an Occluded Renal Artery Facilitated by Targeted Renal Therapy
Case Study
D.T., a 78-year-old, black female, presented electively for a redo right renal percutaneous transluminal angioplasty (PTA) after canceling 3 weeks prior, due to the ravages of Hurricanes Katrina and Rita in Louisiana. She noted vague right back pain that she attributed to prior back surgery and muscle straining while evacuating during the hurricanes. Past medical history included diabetes, hypertension, chronic heart failure (CHF), chronic renal insufficiency (CRI) with a prior baseline serum creatinine (CR) of 1.7–1.9 mg/dl, prior bilateral renal artery (RA), celiac, s
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Management of Detached Accunet Embolic Protection Filter During Percutaneous Carotid Artery Intervention
Introduction
Carotid artery angioplasty and stenting (CAS) has gained acceptance in the past decade as an alternative strategy for management of carotid artery stenosis. The recent SAPPHIRE trial1 has shown that, in high surgical risk patients, CAS is at least as good if not superior to carotid endarterectomy. The initial concern over high thromboembolic complications has been addressed by the introduction of distal embolic protection devices (EPD). Early experience with EPD indicates that they reduce microemboli-related strokes during CAS.2 However, deployment of
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Diagnosis and Non-Surgical Management of Mesenteric Ischemia
Introduction
Mesenteric ischemia is an uncommon but serious disease. It was reported by Conner in 1933, who postulated that patients with chronic abdominal pain may have actually suffered from repeated intestinal angina.1 Mesenteric ischemia can be either acute or chronic. Acute mesenteric ischemia (AMI) is further subdivided into occlusive and nonocclusive mesenteric ischemia. Occlusive mesenteric ischemia is thrombotic or embolic in origin. Approximately 80% of cases of AMI are occlusive in etiology, with arterial emboli or thromboses in 65% of the cases. Nonocclusive mese
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Distal Vein Patch Bypass for Limb Salvage: An Option When No Vein is Available
Background
As the population ages, an increasing number of patients are in need of lower extremity revascularization. Improvements in surgical, anesthetic, and endovascular techniques provide an increasingly aggressive approach to limb salvage that can be offered to these older and often sicker patients. There is little question that the autologous saphenous vein is the ideal conduit for surgical revascularization, especially to a tibial artery. However, the lack of adequate vein can present a major challenge in the care of these patients. Because of its utility in peripheral and coron
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New Approaches for the Treatment of Superficial Venous Reflux and Symptomatic Varicose Veins
Introduction
Successful treatment of symptomatic varicose veins requires a balance between treatment of the underlying etiology and achievement of an optimal cosmetic outcome. In the overwhelming majority of cases, saphenous vein reflux is the primary problem. This superficial venous reflux must be addressed, or recurrence of the varicosities can be expected. In many cases, the varicose veins causing symptoms in the distribution of either the greater or lesser saphenous vein (GSV/LSV) do not need to be excised if the incompetent saphenous vein has been successfully ablated. Current min
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Economics of an Interrupted, Non-Penetrating Clip Anastomosis for Vascular Access Procedures
Introduction
End-stage renal disease (ESRD) is increasing in epidemic proportions worldwide. Therefore, vascular access procedures are rapidly becoming the most common surgery performed in the world.
In the United States, there are approximately 300,000 people on dialysis. This number is growing by 15% or more each year, and will consequently double this patient population in 4 to 6 years. Total annual costs are expected to exceed $28 billion by 2010.
Vascular anastomosis has evolved over a long period of time. The early vascular surgeons were hampered by their lack of medica
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Current Clinical Applications of Bivalirudin: An Overview
Clinical Pharmacology of Bivalirudin
Bivalirudin is a direct thrombin inhibitor with specific and reversible actions.1–6 It is a synthetic, 20-amino acid peptide with a molecular weight of 2180 daltons. Bivalirudin directly inhibits both circulating and bound thrombin by binding to its catalytic site and anion-binding exosite. The binding to thrombin is reversible, as the latter cleaves the bivalirudin-Arg3-Pro4 bond, resulting in recovery of the active site. Bivalirudin does not activate platelets and is not inhibited by platelet products. It produces a linear dose and co
Editor's Corner »
When "Wonderful New Technologies" Fail...
After completing a review of the article “Management of Detached Accunet…” by Chane et al., I found myself wanting to add something personal, a commentary. So I did, but it wasn’t enough. I therefore decided to reflect further upon our field’s “wonderful new technologies” and use this topic as the foundation for this month’s Editor’s Corner.
Just think about it: this is one of “the most perfect issues” for VDM readers. The use of new technologies, with a growing reliance, if not dependence, on innovative devices, is at the very center of who we have all become
