Featured Article

Over the last 15 years, the treatment of infrarenal aortic aneurysms has dramatically changed. Today, about 50% of patients with abdominal aortic aneurysms are treated endoluminally. These patients have been treated with a variety of devices. As long-term follow-up continues, considerable evidence has accumulated regarding the prevention and treatment of endovascular graft complications, with migration and proximal attachment failure as the most serious and significant. This article reviews risk factors and strategies for the prevention and treatment of short- and long-term graft migration and proximal attachment graft failure, including appropriate patient and graft selection and accurate graft deployment.

Patients with peripheral artery disease (PAD), coronary heart disease, and diabetes mellitus have been shown conclusively to experience a 25% reduction in the rate of cardiovascular death, myocardial infarction, stroke and revascularization procedures by treatment with 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors. Despite these findings, patients with PAD are frequently undertreated with respect to HMG-CoA reductase inhibitors, compared to patients with CHD. In addition, HMG-CoA reductase inhibitors produce numerous pleiotrophic effects that may reduce the incidence of restenosis after revascularization procedures.

Endovascular surgery, like other forms of minimally invasive surgery, has developed considerably over the last decade, following the trend set by laparoscopic surgery. Level I evidence to support this surge in interventional techniques has been less convincing. This article reviews the development of stenting and endovascular surgery, drawing comparisons between outcomes following open and endovascular procedures.

Learning objectives. At the conclusion of this activity, the participant should be able to: 1) Discuss rationale for previous use of antibacterial agents in cardiovascular disease trials and the current basis of evidence supporting or refuting further effort in this area; 2) Describe the importance of endpoint selection in clinical trials in this area as it relates to powering clinical studies; 3) Identify influences in patient populations that might affect the apparent impact of antibiotic therapy; 4) Describe the basis of evidence for various pathogens for their impact on cardiovascular disease; 5) Review the potential implications of chlamydia lifecycle and characteristics of vascular infection for selection of appropriate antibacterial therapies; 6) Describe the evidence and rationale for understanding why different vascular beds (coronary, peripheral, carotid) might demonstrate different results with antibiotic therapy. Activity instructions. Successful completion

Dr. Zvonimir Krajcer is a Clinical Professor of Medicine at Baylor College of Medicine and at the University of Texas Health Science Center in Houston. He is Director of the Peripheral Vascular Disease Program at St. Luke’s Episcopal Hospital, also in Houston. Dr. Krajcer earned his medical degree from the University of Zagreb in Zagreb, Croatia. His training includes an internship at Mercy Hospital and Medical Center in Chicago, as well as an internal medicine residency at Northwestern University in Chicago. His fellowship training in cardiology was completed at Northwestern University and Baylor College of Medicine, St Luke’s Hospital in Houston. In addition to conducting extensive research in the detection and treatment if cardiovascular disease, Dr. Krajcer has pioneered a technique of non-surgical repair of abdominal aortic aneurysms with stent grafts. His special area of interest is non-surgical treatment of peripheral vascular disease with stents and stent grafts.