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Vascular Disease Management - ISSN: 1553-8036 - Volume 2 - Issue 3 - May 2005 | |
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| David Nicholson, MD, Gary M. Ansel, MD, Charles F. Botti, Jr., MD, Mitchell J. Silver, MD |
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Emergency Stent-graft Repair for Thoracic Aortic Injury |
| 1Patrizio Castelli, MD, 1Roberto Caronno, MD, 1Gabriele Piffaretti, MD, 1Matteo Tozzi, MD, 1Chiara Lomazzi, MD, 2Domenico Laganà, MD, 2Gianpaolo Carrafiello, MD, 3Salvatore Cuffari, MD |
Objective. Blunt traumatic thoracic aortic disruption results in pre-hospital death in 80% to 90% of patients. Surgical repair has been the standard method throughout the past decades, but early postoperative mortality is still reported to range from 7.7–28%. More recently, an increasing number of reports have advocated endovascular treatment. We report our experience with emergency endovascular treatment of thoracic aortic disruptions treated with a commercially available stent graft. Methods. In the last three years, seven patients with a median age of 26 years (mean: 26.8 ± 9.2 years, range 18–45) with multiple system trauma after motor vehicle accidents were treated on an emergency basis for acute blunt thoracic aortic rupture. All patients presented with multiple co-existing injuries. The mean Injury Severity Score (ISS) score was 42.7 ± 29 (range, 4–75; median 50). Chest X-ray findings warranted CT-angiography scans, which revealed disruptions of the thoracic aorta, identi
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Cutting Balloon Angioplasty for the Treatment of Stenosis in Hemodialysis Arteriovenous Fistulas |
| Gianpaolo Carrafiello, MD, Domenico Laganá, MD, Monica Mangini, MD, Chiara Recaldini, MD, Domenico Lumia, MD, Andrea Giorgianni, MD, Carlo Fugazzola, MD |
Objective. To assess the effectiveness of cutting balloon angioplasty in the treatment of stenosis in hemodialysis arteriovenous fistulas (AVF). Materials and Methods. Over the past two years, we have observed 75 patients with hemodialysis AVFs. Twenty-one patients (mean age 66.4 years, range 51–81) with AVF stenosis (19 Cimino-Brescia fistulas and 2 loop grafts) were selected for cutting balloon angioplasty. In 10 cases, the cutting balloon device was used after failure of dilatation with a high-pressure balloon, while in 11 cases (9 focal stenosis and 2 restenosis), it was used as a primary approach. We utilized cutting balloons with the following diameters: 8 mm (n = 2), 6 mm (n = 10), 5 mm (n = 8) and 4 mm (n = 1). The follow-up was performed by color Doppler ultrasound (CDU) and clinical evaluation at 1, 3, 6, 12, 18 and 24 months. Results. In all patients, the post-procedure angiography demonstrated an immediate technical success. No peri-procedural complications occurred.
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Commentary:
Achieving Optimal Platelet Inhibition During Percutaneous Coronary Interventions |
| Nicholas W. Shammas, MS, MD |
From the Midwest Cardiovascular Research Foundation, Genesis Heart Institute Affiliate, Cardiovascular Medicine, PC, Davenport, Iowa. Address for correspondence: Nicolas W. Shammas, MD, FACC. Research Director, Midwest Cardiovascular Research Foundation, Genesis Heart Institute Affiliate, Cardiovascular Institute Medicine, PC, 1236 E. Rusholme, Suite 300, Davenport, Iowa 52803.
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Exclusion of a Renal Artery Aneurysm with a Viabahn Self-expanding Covered Stent |
| Jeffrey P. Schussler, MD and Kenneth B. Johnson, MD |
A 75-year-old man, with history of atherosclerotic coronary artery disease, was referred to our institution for management of a ~2 cm renal artery aneurysm. Repair was performed using a novel, self-expanding, nitinol stent which is lined with PTFE. This type of stent has had utility in repair of ruptured vessels, and several case reports have described its use in the exclusion of different types of vascular aneurysms. We describe the first case of renal artery aneurysm exclusion using a self-expanding covered stent.
Vascular Disease Management 2005;2:39-42.
Keywords: Hemobahn, nitinol, bivalirudin, IVUS, ePTFE, stent-graft
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