Carotid Bypass Using Gore Hybrid Vascular Graft for In-stent Restenosis after Carotid Stenting.

In-stent restenosis (ISR) is the most common long-term complication following carotid artery stenting (CAS), affecting 3.5% to 21% of patients after a mean follow-up of 18 months in published reports. Until now, the optimal management for ISR after CAS is still not clear, and different endovascular treatments along with various surgical options have been proposed. Moreover, surgical treatment for ISR in a previously operated patient of ipsilateral endarterectomy is a technically demanding procedure. In this report, we describe a case of severe carotid recurrent ISR, which occurred after CAS for postendarterectomy restenosis, that was successfully treated, in a straightforward way, with a carotid bypass using a Gore® Hybrid Vascular Graft.

"Two is better than one": a composite graft made of two different vascular prostheses for urgent hemodialysis access in a troublesome case.

BACKGROUND: Multiple failed hemodialysis access and poor vascular anatomy can jeopardize an end-stage renal disease patient's survival, frequently leading to the urgent need for rapid and durable new vascular access. In these circumstances, the extensive use of central venous catheters (CVC) can led to serious complications, such as infection, thrombosis, and often vessel scarring with obstruction of the central veins. More recently, new self-sealing prosthetic grafts may be cannulated within a few days after implantation, avoiding the need for extensive CVC. However, similar to all synthetic arteriovenous grafts (AVG), the new grafts are prone to rapid and aggressive venous neointimal hyperplasia (VNH), which is responsible for outflow stenosis and access thrombosis. Endoluminal sutureless anastomosis has been demonstrated to have better hemodynamics at the venous outflow with a supposed reduction of VNH, thus potentially improving graft patency. METHODS: We report a case of a successful creation of a composite prosthetic access in a patient with severe comorbidities and nearly complete exhaustion of all vascular sites and with the need for immediate access for hemodialysis. Two relatively novel vascular expanded polytetrafluoroethylene prostheses were used jointly in this patient for a brachial-axillary AVG to allow early cannulation and with the aim of being less vulnerable to outflow stenosis. A multilayer self-sealing graft and a graft with a nitinol reinforced section, which permits endoluminal sutureless anastomosis, were sewed together to create a unique prosthesis with both features. RESULTS: The composite graft was cannulated 48 hr after implantation and continued to function well at 10 months of follow-up without signs of venous stenosis. CONCLUSIONS: This simple technique allows the creation of a customized composite graft with self-sealing properties and improved hemodynamics at the venous outflow.

[Thread-passer for laparoscopic use. Preliminary results with a prototype]. / Passafilo a uso laparoscopico: risultati preliminari di un prototipo.

The Authors present their prototype of a thread-passer for laparoscopic use, devised, designed and produced by them. The prototype was made at the Politecnico di Torino, Department of Mechanical Engineering. This tool consists of a rod measuring 12 mm in diameter, with a curved dove-tailed slotted end to lodge and pass the surgical thread. A 5-mm diameter operative canal passes through the instrument to permit the passage of a dissector to grasp the thread. The Authors used the instrument during three cholecystectomies and three appendectomies. The aim is to pass the thread around an anatomical structure without any loose ends, using only one port to favour surgical manoeuvres and avoiding the use of much more expensive devices.