Volume 1 - Issue 1 - Sept/Oct 2004
CME »
Percutaneous Mechanical Thrombectomy Combined with Thrombolysis for the Treatment of Deep Venous Thromboses
Background
Multiple sequellae may occur after deep venous thrombosis (DVT), including acute limb symptoms such as swelling and pain, valvular damage and reflux leading to chronic symptoms, and, the most serious, pulmonary embolism and death. Venous thromboembolic disease, including both DVT and pulmonary embolism, is an under-diagnosed medical problem that results in high rates of significant patient morbidity and mortality. Conventional therapy consists of anticoagulation with heparin and warfarin in the setting of an acute DVT, which prophylaxes against clot propagation and pulmonary
Editor's Corner »
Welcome to Vascular Disease Management
It is with a sense of pride and excitement that I set out to write the first Editor’s Letter for the inaugural issue of Vascular Disease Management (VDM). This is a truly unique publication that was designed with the multi-disciplinary nature of today’s vascular team in mind. It intends to become a readily available source of practically important information and a forum for the dissemination of current opinions and changing standards in this rapidly evolving field.
Unlike many of the established peer-review journals, VDM incorporates a unique format which places great em
Feature »
Intracranial Middle Cerebral Artery Percutaneous Intervention Using a Drug-Eluting Stent
INTRODUCTION
Intracranial angioplasty and stenting are increasingly being used to treat patients with recurrent cerebral ischemia due to intracranial atherosclerosis, which is a cause of 8-10% of all ischemic strokes. Since there are no commercially available stents designed specifically for the cerebral vasculature, all such procedures have utilized conventional coronary stenting systems. However, the incidence of stent restenosis in the intracranial circulation can be up to 40%.1 Since the FDA approval of the Cypher™ sirolimus-eluting stent (Cordis Corporation, Miami, Fl
Feature »
Bivalirudin in Peripheral Vascular Interventions: A Single Center Experience
This article is reprinted with permission from the Journal of Invasive Cardiology 2003;15:401-404.
Unfractionated heparin (UFH) is the current antithrombotic agent utilized during peripheral angioplasty procedures (PTA). UFH has an unpredictable anticoagulation response, is an indirect thrombin inhibitor, does not inhibit bound thrombin and activates platelets.1 We have recently reported our procedural complications rate (9.2%) during PTA with the use of UFH as a primary anticoagulant.2 Our experience was in concordance with multiple published reports showing a
Feature »
Update: Bivalirudin in Peripheral Vascular Intervention
Percutaneous peripheral vascular procedures have increased exponentially over the past 10 years. Anderson et al.1 reported a 979% growth in peripheral vascular interventions since 1995, with a simultaneous drop in the number of surgical vascular procedures. Despite the sharp rise in peripheral vascular interventions (PVI), complication rates have continued to be significant and, in fact, limb loss has trended upwards.1
There are many potential predictors of complications in PVI. These predictors potentially include the state of the limb (rest ischemia versus claudica
Feature »
Multidetector Computerized Tomography for the Evaluation of Crebrovascular Disease: A Case Study
The patient is a 59-year-old hypertensive, diabetic, white male ex-smoker with a history of CABG in 1994. In 1997, he underwent insertion of a pacemaker for bradycardia. In 1999, he presented with hoarseness and was diagnosed with squamous cell laryngeal cancer by biopsy. He underwent laryngeal irradiation from 3/99 to 5/99 and required insertion of a PEG tube relating to his irradiation. He stopped smoking at that time. He did well until 5/03, at which time he complained of some worsening dysphonia, dizziness and diplopia. Workup at that time revealed hypothyroidism that was successfully trea
News »
Boston Scientific Announces FDA Clearance for FilterWire EZ™ Embolic Protection System
Next-generation system cleared for SVG treatment in the U.S.
Boston Scientific Corporation has received 510(k) clearance from the U.S. Food and Drug Administration to market its FilterWire EZ Embolic Protection System to treat saphenous vein graft (SVG) disease. The Company plans to launch the product in the United States immediately. Boston Scientific launched the product in Europe and other international markets in September 2003.
The FilterWire EZ System is a low-profile embolic filter mounted on a guide wire and is designed to reduce complications during balloon angioplasty an
Feature »
Excimer Laser-Assisted Angioplasty in Severe Infrapopliteal Disease and CLI: The CIS "LACI Equivalent" Experience
Critical limb ischemia (CLI) has only recently been characterized in the clinical literature; therefore knowledge of the clinical impact of CLI is still rudimentary at best. The TransAtlantic Inter-Societal Consensus (TASC) committee and document on the management of peripheral arterial occlusive disease (PAOD) have recently attempted to unify and clarify CLI with the following recommendations:1
1. Recommendation 73: Clinical definition of critical limb ischemia:
The term critical limb ischemia should be used for all patients with chronic ischemic rest pain, ulcers, or ga
Interview »
Purcutaneous Intraspinal Navigation (PIN)
What is PIN?
PIN stands for percutaneous intraspinal navigation. Just as we’ve been using the arteries as a conduit to navigate the vascular system for a long time, we also believe it may be possible to use the space surrounding the brain and spinal cord — the so-called sub-arachnoid space — to navigate in and around the brain and spinal cord. We've known for a long time that you can access that space by putting a needle in the back. Currently, people visualize the spinal cord via myelograms and also perform lumbar punctures to draw some of the spinal fluid. Another way that peop
Discussion Forum »
Percutaneous revascularization for SFA/popliteal arterial disease: how and when will endovascular techniques and devices become
In our experience, the “when” occurred in the late 1990’s for the CLI subset of SFA/popliteal disease (in our experience, 40-50% of CLI patients will have SFA/popliteal involved and 30-40% in LACI trial) and the “when” began a year or so ago for the truly lifestyle-limiting claudicatant who has failed aggressive “medical intervention.” In each subset, endovascular SFA/popliteal therapy (ESPT) has become more truly competitive with the evolution of improved endovascular tools. Long ago, I became lucky enough to be able to wear both the surgeon’s and interventionalist’
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