Review of the Use of Ionizing Radiation in Endovascular Aneurysm Repair.

Endovascular repair for aortic aneurysm (EVAR) is rapidly increasing in popularity. The nature of this intervention requires significant exposure to ionizing radiation both during the procedure and for postoperative surveillance, generally in the form of computed tomography. Here the authors review the literature for radiation exposure during EVAR, both for the patient and the physician.

64-section CT angiography in patients with critical limb ischaemia and severe claudication: comparison with digital subtractive angiography.

AIM: To assess the utility of 64 section multidetector computed tomography (MDCT) lower-limb angiography in the evaluation of patients with critical limb ischaemia (CLI) or severe intermittent claudication (IC) in grading disease before endovascular treatment. MATERIALS AND METHODS: Forty-one consecutive patients with CLI or severe IC were assessed using 64 section MDCT angiography. The MDCT examinations were compared with subsequent intra-arterial digital subtraction angiography (IADSA) examinations performed at the time of endovascular intervention. The MDCT and IADSA examinations were independently scrutinized by readers blinded to the results of the other imaging method. RESULTS: For arterial segments with haemodynamically significant disease (stenosis ≥50%), the overall sensitivity, specificity, and accuracy of MDCT in patients with severe claudication and CLI was 99% (95% CI: 98-100%), 98% (95% CI: 97-100%) and 98% (95% CI: 97-99%), respectively. The positive predictive value (PPV) was 97% and the negative predictive value (NPV) was 99%. CONCLUSIONS: MDCT angiography is a useful tool in the assessment of patients with severe claudication and CLI and can be reliably used to grade disease severity and plan treatment.

Operative repair of an incidentally diagnosed giant hepatic artery aneurysm.

Hepatic Artery Aneurysms (HAA) are rare vascular lesions which are associated with significant morbidity and mortality in the event of rupture. Early diagnosis and expedient management are therefore important to optimise outcome. Here we report a case of a giant Hepatic Artery Aneurysms (HAA) found incidentally on Computerised Tomography, successfully managed without complication by elective surgical repair.

Endovenous laser ablation for the treatment of recurrent varicose vein disease--a single centre experience.

INTRODUCTION: Varicose vein surgery for recurrent disease can result from inadequate primary surgery. Redo open surgery is more difficult to perform than primary surgery and can be associated with a higher incidence of neurovascular injury and infection. In this study we evaluate EVLA, a percutaneous technique that uses intra-operative duplex ultrasound as an option for the treatment of recurrent varicose veins. MATERIALS AND METHODS: Data prospectively collected on patients who had EVLA for varicose veins were obtained from our dedicated vascular registry. From November 2004 to December 2008 we performed 586 EVLA procedures, 77 procedures were for recurrent varicose veins. RESULTS: The mean age was 52 +/- 12.77 years, range 28-80; and 48 (62%) were female. 64 (83%) cases were for recurrent LSV disease, 13 (17%) cases for recurrent SSV disease and all patients had LSV or SSV incompetence confirmed on preoperative duplex assessment. Median duration since primary surgery was 60 months (range 2-360). Mean length of vein treated was LSV--36 cm +/- 14.5 (6-73) and SSV--14.5 cm +/- 7.35 (5-24); mean energy delivered was LSV 3102J +/- 1053 (150-4656) and SSV--693J +/- 396 (135-1216). 17 patients had bilateral EVLA for recurrent disease at the same setting with one patient having bilateral procedures under local anaesthetic. There was an incidence of pulmonary embolism 10 days post EVLA and two patients required further phlebectomies post EVLA for residual varices that were present pre-operatively. Median follow-up was 18 months (range 1-38), with no clinical recurrence and no recannalisation of the treated LSV or SSV on duplex ultrasound. CONCLUSIONS: In our experience EVLA can be safely performed for recurrent varicose vein disease. In our experience Redo EVLA is not more difficult than primary EVLA to perform.

Endovenous laser ablation for superficial venous insufficiency.

BACKGROUND: Endovenous laser ablation (EVLA) is a new minimally invasive alternative to conventional surgery for superficial venous insufficiency and varicose veins, where laser energy is used to ablate the incompetent veins. DISCUSSION: Endovenous laser ablation avoids the need for surgical incisions, and the complications of surgical exploration of the groin or popliteal fossa, and stripping. The procedure is commonly performed under local anaesthesia, with immediate mobilisation and rapid return to normal activity. Severe varicosity of tributaries may require adjunctive procedures such as microphlebectomy or sclerotherapy. CONCLUSION: Early outcomes and cosmesis are superior, and long-term data is accumulating that recurrence of EVLA rates may be lower.

Tips for successful endovenous laser ablation.

BACKGROUND: Endovenous laser ablation (EVLA) is increasingly used as an alternative to open surgery for superficial venous incompetence. EVLA is a new technique and the success may vary with surgeons. The authors have summarised few practical tips for improving the success rates of surgeons who are lacking experience in this area. METHOD: This article contains various tips for EVLA practising surgeons and trainees is based upon recent literature and the authors experience. DISCUSSION: The success rate of EVLA can be improved by understanding the principles of EVLA and by repeated practice and follow ups.

5-years of endovenous laser ablation (EVLA) for the treatment of varicose veins--a prospective study.

PURPOSE: This prospective study evaluates the results of Endovenous laser ablation (EVLA) for the treatment of varicose veins. METHODS: Data were prospectively collected for all patients undergoing EVLA for varicose veins in our unit including clinical outcomes (CEAP classification) and post-operative duplex. RESULTS: 624 EVLA procedures were performed from April 2004 to February 2009. There were 527 LSV EVLA cases, 449 of which were for the above-knee segment only. There were 94 SSV EVLA cases and 3 patients needed LSV EVLA on the same leg at the same time. 84% were done under general anesthetic including 126 patients who underwent bilateral procedures at the same session. There were no intra-operative complications, and a 1% incidence of thrombophlebitis, and <1% incidence of neuropraxia. During a median follow-up of 20 months (Range 2-51) there was no clinical or duplex evidence of recurrence and no recannalisation of the treated vein. CONCLUSIONS: Our 5-year experience suggests that EVLA is a safe and effective alternative to conventional surgery for the treatment of varicose veins. Bilateral procedures were well tolerated by patients even under local anaesthesia.

Endovenous laser ablation for short saphenous vein incompetence.

Conventional surgery for short saphenous vein (SSV) incompetence has a high incidence of recurrence and is associated with neurovascular injury. The aim of this study was to evaluate the safety and efficacy of endovenous laser ablation (EVLA) as an alternative to open surgery for SSV incompetence. Data were prospectively collected for all patients undergoing EVLA for SSV disease in our unit, including clinical outcomes and postoperative duplex. There were 368 EVLA procedures performed from April 2004 through December 2007, of which 66 (18%) were for SSV incompetence. Six (9%) SSV procedures were for recurrent disease after conventional surgery. Forty (61%) procedures were performed under local anesthesia, including four patients who underwent bilateral procedures at the same session. There were no intraoperative complications, and there was no evidence of neurovascular injury. During a median follow-up of 14 months (interquartile range 6-24) there was no clinical or duplex evidence of recurrence and no recanalization of the SSV. Our early results suggest that EVLA is a safe alternative to conventional surgery for the treatment of SSV incompetence in patients with C2-C4 disease. Bilateral procedures have been performed under local anesthesia.

Surveillance of patients post-endovascular aneurysm repair.

Endovascular aneurysm repair (EVAR) is increasingly being employed as an alternative to open surgical repair for patients with abdominal aortic aneurysms. The surveillance of patients post-EVAR has traditionally been carried out with regular computed tomographic scans which have in part been responsible for the high costs associated with this procedure. Duplex has been proposed as an alternative, but researchers have so far been unable to devise a standardised protocol for this surveillance. This review aims to provide a clear understanding of currently employed imaging modalities and discuss future surveillance possibilities for this patient group.

11-year experience with anatomical and extra-anatomical repair of mycotic aortic aneurysms.

BACKGROUND: We have reviewed our management, of both ruptured and non-ruptured, abdominal and thoraco-abdominal mycotic aneurysms in order to determine the safety and efficacy of in situ and extra-anatomical prosthetic repairs. METHODS: Data regarding presenting symptoms, investigations, operative techniques and outcome, were collected on patients treated at a singe centre over 11 years. RESULTS: There were 11 men and four women, with a median age of 70 years (range, 24-79). All but one patient were symptomatic and six had a contained leak on admission. In six patients no organisms were identified in either blood or tissue cultures. Pre-operative CT identified; four infra-renal, four juxta-renal, three (Crawford thoraco-abdominal) type IV, three type III and one type II, aortic aneurysms. Thirteen were repaired with in situ prostheses and two required axillo-femoral prosthetic grafts. There were four early deaths. All surviving patients have been followed-up for a median duration of 38 months (range 1/2-112 months). There were two late deaths at 3 months (juxta-renal) and at 2 years (type III), the latter relating to graft infection. CONCLUSIONS: In the absence of uncontrolled sepsis, repair of mycotic aortic aneurysms using prosthetic grafts can achieve durable results.

Sialyl Lewis(x) hybridized complement receptor type 1 moderates acid aspiration injury.

The potentially enhanced anti-inflammatory effects of the sialyl Lewis(x) (sLe(x))-decorated version of soluble complement receptor type 1 (sCR1) in moderating acid aspiration injury are examined. HCl was instilled in tracheostomy tubes placed in mice, and extravasation of (125)I-labeled albumin in bronchoalveolar lavage (BAL) fluid was used to calculate the vascular permeability index (PI). Neutrophil counts in BAL fluid and immunohistochemistry were performed. PI was moderated by 82% after treatment with sCR1sLe(x) compared with 54% in sCR1-untreated mice (P < 0.05). Respective reductions in PI in mice treated 0.5 and 1 h after acid aspiration with sCR1sLe(x) of 70 and 57% were greater than the decreases in PI of 45 and 38% observed in respective sCR1-treated groups (P < 0.05). BAL fluid neutrophil counts in sCR1sLe(x)-treated mice were significantly less than those in sCR1-treated animals, which were similar to those in untreated mice. Immunohistochemistry stained for sCR1 only on the pulmonary vascular endothelium of sCR1sLe(x)- but not sCR1-treated mice. In conclusion, sCR1sLe(x) moderates permeability by antagonizing complement activation and neutrophil adhesion. Delayed complement and neutrophil antagonism significantly reduces injury.