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Heparin-induced thrombocytopenia is an unusual but major problem during peripheral vascular surgery. The direct thrombin inhibitors provide an alternative to heparin but experience with bivalirudin during peripheral vascular procedures is limited. In this case report, bivalirudin was used to successfully achieve and maintain anticoagulation during femoral and tibial thromboembolectomy, as well as in the post-operative period until anticoagulation with warfarin could be achieved. To our knowledge, this is only the second case report of the intraoperative use — and first case report of peri-operative use — of bivalirudin during peripheral vascular revascularization. Advantages of various direct thrombin inhibitors, a modified dosing schedule for bivalirudin, and experience with monitoring parameters are described.

Spontaneous coronary artery dissection (SCD) is an uncommon clinical condition. It usually appears in healthy young women during peripartum period. Here, we present a case of SCD that occurred during treadmill exercise testing and disappeared spontaneously one day after.

Objective: To evaluate the safety and feasibility of optimizing platelet inhibition and thrombin inhibition anticoagulation during peripheral vascular interventions (PVI) for patients with critical limb ischemia (CLI). Background: Glycoprotein (GP) IIb/IIIa inhibition combined with direct thrombin inhibition (DTI) with bivalirudin (Angiomax, The Medicines Company, Cambridge, Massachusetts) has shown decreased bleeding and ischemic complications in percutaneous coronary interventions (PCI). PCI benefits potentially applicable to CLI treatment include improved efficacy in diabetes, small complex vessels, microembolism reduction, and clinical outcomes. PVI cases have higher complications, more frequent reinterventions, and poorer outcomes than PCI. In CLI, a high incidence of diabetes, renal insufficiency, platelet dysfunction, hypercoagulability, inflammation, diffuse disease, and thrombus make DTI and eptifibatide (Integrilin, Millennium Pharmaceuticals, Inc., Camb

The optimal anticoagulation regimen during percutaneous peripheral intervention (PPI) for chronic limb ischemia (CLI) is unknown. Although unfractionated heparin has been widely utilized, the feasibility of other anticoagulants in CLI patients has been infrequently reported. We retrospectively reviewed 65 consecutive patients with CLI treated percutaneously by 3 interventionalists at our institution. All patients were within the Rutherford-Baker classifications IV and V. Patients received unfractionated heparin (UFH) (with 3 patients receiving adjunctive GP IIb/IIIa inhibition) (n = 17), enoxaparin (with 2 patients receiving adjunctive GP IIb/IIIa inhibition) (n = 22) or bivalirudin (with 8 patients receiving adjunctive GP IIb/IIIa inhibition and 3 patients receiving adjunctive fibrinolytic therapy plus GP IIb/IIIa inhibition) (n = 26). Clopidogrel was administered prior to the procedure in 73.4%, 76.2% and 62.5% of the patients in the UFH, enoxaparin and bivalirudin groups, respect

Purpose: To assess outcomes of percutaneous infrainguinal endovascular interventions as the initial therapeutic modality in patients with critical limb ischemia (CLI). Materials and Methods: We performed a retrospective review of 33 consecutive interventions in 29 patients over a period of 24 months at a single center. Mean follow-up was 11.4 months. Technical success was defined as the ability to obtain in-line arterial flow into the foot with less than a 20% residual stenosis using percutaneous techniques. Limb salvage was defined as the ability to avoid major level amputation (below or above knee). Follow-up included clinical examination and noninvasive vascular evaluation by color-flow duplex ultrasound. Results: Thirty-three limbs were treated for disabling claudication (n = 2), rest pain (n = 10) or ulceration/gangrene (n = 21). All patients were male. Technical success was achieved in 31 limbs (93.9%). Intra-procedural complications included clinically