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1.
Ann Vasc Surg ; 31: 208.e1-4, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26631771

ABSTRACT

Aortoiliac occlusive disease coincident with a congenital ectopic pelvic kidney is a rare occurrence. Traditionally, the treatment has been open aortobifemoral repair with reimplantation of the renal artery. We present a patient with Trans-Atlantic Inter-Society Consensus (TASC) D bilateral aortoiliac occlusive disease, an ectopic pelvic kidney, and prohibitive medical comorbidities. We describe a totally endovascular repair using a chronic total occlusion crossing device, a luminal re-entry device, and balloon-mounted covered stents to revascularize the lower extremities and the ectopic pelvic kidney. We discuss various aspects of this endovascular approach as the incidence of patients with TASC D lesions and prohibitive comorbidities continue to rise.


Subject(s)
Aortic Diseases/surgery , Arterial Occlusive Diseases/surgery , Choristoma/complications , Endovascular Procedures , Iliac Artery/surgery , Kidney , Plastic Surgery Procedures , Aortic Diseases/complications , Aortic Diseases/diagnosis , Aortography/methods , Arterial Occlusive Diseases/complications , Arterial Occlusive Diseases/diagnosis , Choristoma/diagnosis , Endovascular Procedures/instrumentation , Female , Humans , Iliac Artery/diagnostic imaging , Middle Aged , Plastic Surgery Procedures/instrumentation , Stents , Tomography, X-Ray Computed , Treatment Outcome
2.
Ann Vasc Surg ; 29(5): 1021.e9-1021.e12, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25770382

ABSTRACT

Abdominal aortic aneurysm complicated by a horseshoe kidney (HSK, fused kidney) represents a unique challenge for repair. Renal arteries arising from the aneurysmal aorta can further complicate intervention. Reports exist describing the repair of these complex anatomies using fenestrated endografts, hybrid open repairs (debranching), and open aneurysmorrhaphy with preservation of renal circulation. We describe an extra-anatomic, fully endovascular repair of an abdominal aortic aneurysm with a HSK partially supplied by a renal artery arising from the aneurysm. We successfully applied aortouni-iliac endografting, femorofemoral bypass, and retrograde renal artery perfusion via the contralateral femoral artery to exclude the abdominal aortic aneurysm and preserve circulation to the HSK.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/methods , Endovascular Procedures/methods , Fused Kidney/complications , Aged, 80 and over , Angiography , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnosis , Humans , Imaging, Three-Dimensional , Male , Radiography, Abdominal , Tomography, X-Ray Computed
3.
J Vasc Surg ; 60(4): 1085-91, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25124360

ABSTRACT

Peripheral arterial disease (PAD) is well recognized as a marker for systemic atherosclerosis. Platelets play an essential role in all stages of the disease, contributing to both thrombosis and the development of atherosclerosis. Medication regimens to optimize outcomes in both patients who are to undergo revascularization and those who will be managed without interventional therapy must address antiplatelet therapy. Given the common cardiovascular and cerebrovascular comorbidities in patients with PAD, antiplatelet therapy has the potential to decrease thromboembolic events in addition to improving patency after interventions. This clinical update reviews the current literature and recommendations for antiplatelet therapy in patients with PAD.


Subject(s)
Perioperative Care/methods , Peripheral Arterial Disease/drug therapy , Peripheral Arterial Disease/surgery , Platelet Aggregation Inhibitors/therapeutic use , Vascular Surgical Procedures , Humans
5.
J Heart Lung Transplant ; 24(9): 1289-96, 2005 Sep.
Article in English | MEDLINE | ID: mdl-16143247

ABSTRACT

BACKGROUND: Studies have associated anti-HLA antibodies detected by panel-reactive antibody (PRA) with increased risk for rejection and transplant coronary artery disease (TCAD) in adults, but the role of PRAs in monitoring immunologic status after pediatric cardiac transplantation has not been described. METHODS: We reviewed post-transplant PRAs in 96 pediatric heart recipients. PRAs were performed concurrently with endomyocardial biopsy and if rejection was suspected. The presence of anti-HLA IgG antibodies was defined as >10% reactivity. Pre-transplant variables, including age, race, gender, pre-transplant PRAs and presence of a mechanical assist device, were correlated with post-transplant PRAs. Outcome variables included rejection history, TCAD incidence and survival. RESULTS: The mean age of patients was 9.0 +/- 6.8 years. A mean of 8.1 +/- 5.3 PRAs were measured over a follow-up period of 4.8 +/- 2.7 years. There was a mean of 0.55 +/- 0.71 rejection events per patient-year, and TCAD was detected in 19 (22%) patients. Nineteen patients (20%) had anti-HLA Class I antibodies and 37 (39%) had Class II antibodies detected after transplant. There was no association between Class I antibodies and survival, TCAD or rejection. Class II antibodies were associated with worse survival and a decreased time-free of TCAD. Class II antibodies were also associated with rejection at the time of measurement (sensitivity 17%, specificity 94%) and for the ensuing 3 months (sensitivity 12%, specificity 94%). CONCLUSIONS: Class II anti-HLA antibodies correlate with worse patient outcomes and rejection episodes after pediatric cardiac transplant. A low sensitivity precludes use as a sole diagnostic tool, but post-transplant PRAs may be an important adjunct in a multi-faceted algorithm to assess immunologic status.


Subject(s)
Antibodies/blood , Graft Rejection/immunology , Graft Survival/immunology , HLA Antigens/immunology , Heart Transplantation/immunology , Adolescent , Adult , Child , Child, Preschool , Female , Histocompatibility Testing , Humans , Infant , Male , Treatment Outcome
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