Volume 5 - Issue 3 - May/June 2008
Clinical Review »
Long-Term Safety and Economic Impact of Drug-Eluting Stents
Drug-eluting stents (DES) were designed to prevent neointimal proliferation via the controlled release of antiproliferative agents. Two such DES have been approved for use in the United States. The sirolimus-eluting Cypher stent (SES, Cordis Corporation, Miami Lakes, Florida) and paclitaxel-eluting TAXUS stent (PES, Boston Scientific Corporation, Natick, Massachusetts) were approved for use after randomized controlled clinical trials demonstrated their superiority over bare-metal stents (BMS) at reducing restenosis rates and the need for repeat revascularization. Months afte
Clinical Review »
Re-establishing Macro Vascular Flow and Wound Healing: Beyond the Vascular Intervention
Introduction
Since approximately 70% of wounds treated at outpatient wound centers in the United States are lower extremity venous ulcerations, we will use a leg ulcer as case study for the purposes of this article. A 65-year-old Caucasian female presents to the wound center with a 10 x 8 cm wound just above the medial malleoli. The wound has been present for 2 years and is slowly increasing in size. The skin surrounding the wound is hyperpigmented and the soft tissue is firm on palpation. The ankle circumference is 16 cm, while the mid-calf circumference is 3
Clinical Review »
A New Treatment Option for Treating Peripheral Vascular Stenosis: Orbital Atherectomy
Introduction
Peripheral artery disease (PAD) is a manifestation of atherosclerosis that results in compromised functional capacity and an impaired quality of life for the affected individual.1,2 There are many risk factors for PAD, including diabetes mellitus, current or past smoking history, age greater than 50 years, high blood pressure, obesity, hyperlipidemia, and a family history of heart disease or stroke.3 Classic symptoms affecting the lower extremities include pain with exercise (intermittent claudication) or, in extreme cases, rest pain,
Clinical Decision Making »
Acute Inflow Stenosis — A Rare Cause of Sudden AV Fistula Failure in an ESRD Patient
Background
The arteriovenous (AV) fistula is regarded as the vascular access of choice for hemodialysis (HD) because of its superior patency and low complication rates. Even so, this type of vascular access can result in severe complications, among them, thrombosis of the shunt. This complication usually results from stenotic lesions in the venous outflow system. Inflow arterial obstruction is not an uncommon complication of the AV fistulas, but also most often starts in the venous system and extends into the juxta-anastomotic artery. A true inflow stenosis results from
Clinical Decision Making »
Percutaneous Management of Takayasu Arteritis Presenting with Subclavian Steal Syndrome
Introduction
Takayasu arteritis is a rare, chronic vasculitis of unknown etiology that predominantly affects young Asian women. The chronic inflammation causes progressive transmural fibrosis of the large arteries, primarily the aorta and its major branches. Most patients present with a constellation of systemic complaints that include fatigue, weight loss, and low-grade fever. However, it is rare for patients to initially present with vascular symptoms, as a hemodynamically significant stenosis is a late manifestation. We present a case of Takayasu arteritis that prese
Case Study »
Endovascular Repair of Abdominal Aortic Aneurysm Revealed by Reversible Segmental Colonic Ischemia
Introduction
The natural history of undetected abdominal aortic aneurysms (AAA) includes ischemic complications that may affect peripheral limb or organ circulation. Distal embolization or thrombosis is the usual pathological process related to either migration of cholesterolic particles, or extension of wall thrombosis from the aneurysm sac. In that circumstance, ischemic colitis remains an uncommon primary mode of revelation for aneurysm occurring when patency of the inferior mesenteric artery (IMA) is suddenly affected.1 We report a successful endovascular treatme
Editor's Corner »
Stent-Graft Technologies 2008: AAA Conquered
More than half of all abdominal aortic aneurysm (AAA) repairs performed in the U.S. today are being done endovascularly. In other words, stent-graft intervention has already replaced the old open-surgery standard. Undeniably, this represents a very important and amazing development involving a therapy that is less than 20 years old from primordial inception (1990)… and less than 10 years after the initial FDA approvals (late September 1999).
AAA is an important disease process, affecting an estimated 2 million people in the United States alone. Ruptured AAA rank
