Effectiveness of a purified type I collagen matrix plus the antimicrobial polyhexamethylene biguanide for use in cutaneous wounds: analysis of a population of three combined registries.

INTRODUCTION: Chronic wounds represent a significant burden to the health care system and patients. OBJECTIVE: This study determined the effectiveness of a wound scaffold comprised of PCMP for use in nonhealing, cutaneous wounds; this study analyzes pooled data from the population of 3 combined registries. MATERIALS AND METHODS: A total of 3 combined registry populations were pooled from a single-center study of 41 patients, a single-center study of 86 patients, and the RESPOND Registry of 307 patients treated at 28 centers. All 434 patients received PCMP and were followed for up to 48 weeks. Male and female patients 18 years or older with wounds between 0.2 cm2 and 200 cm2 were included. RESULTS: In total, there were 95 VLUs, 78 DFUs, 90 PIs, 73 PSWs, and 98 wounds of other etiologies analyzed. The mean baseline area, depth, and volume of all 434 wounds was 15.1 cm2, 4.9 mm, and 7.2 cm3, respectively. K-M median time to wound closure for all wounds was 19 weeks. At weeks 20, 24, 28, and 48, the frequency of wound closure for all wounds was 51%, 56%, 62%, and 72%, respectively. The median time to closure by wound type was 22 weeks for VLUs, 24 weeks for DFUs, 23 weeks for PIs, 12 weeks for PSWs, and 14 weeks for other wounds. The proportion of wounds closed were 72% (VLUs), 52% (DFUs), 63% (PIs), 95% (PSWs), and 67% (other etiologies). CONCLUSIONS: This 434-patient PCMP cohort analysis showed 72% wound closure and median time to wound closure of 19 weeks. PCMP demonstrated effectiveness for use in multiple wound types.

Treatment of arteriovenous access pseudoaneurysms using ultrasound guided balloon assisted thrombin injection: Two cases and systematic review of the literature.

BACKGROUND: Arteriovenous fistula pseudoaneurysm (AVF-PSA) is a common complication, usually caused during dialysis cannulation, which traditionally has been treated with open and less frequently endovascular techniques. Thrombin injection, although established in the treatment of arterial pseudoaneurysms, has barely been used in the treatment of AVF-PSA, due to concerns for AVF thrombosis or proximal embolization. METHODS: A systematic review was performed according to the PRISMA 2020 guidelines. PubMed and Cochrane Central databases were reviewed and all clinical reports on AVF-PSA balloon assisted percutaneous thrombin injection through July 2022 were included. The electronic search yielded five case reports. Due to between-study differences and small sample size, the findings were summarized from each report, but the results were not pooled. Additionally, we present our own experience on two patients with AVF-PSA that were treated with balloon assisted percutaneous thrombin injection. RESULTS: A total of five case reports (no of patients: 7, including ours) were included for review. Most of the patients were male (n = 6) and the mean age was 65.9 years. The average size of the PSA was 1.6 cm. In all cases a balloon was inflated to prevent thrombin and thrombotic material intrusion into the fistula lumen, prior to thrombin injection. In one patient n-butyl cyanoacrylate and Lipiodol were used, due to thrombin non availability. Recurrence was reported in only one patient, and average follow-up is 16 months. CONCLUSIONS: Thrombin injection with concomitant balloon inflation seems to be a safe and effective treatment for arteriovenous fistula pseudoaneurysms. Future studies should be aimed at evaluating the long-term outcomes of such minimally invasive techniques.

Geniculate Artery Endovascular Embolization Post-Total Knee Arthroplasty for Hemarthrosis Treatment: A Systematic Review of the Literature.

PURPOSE: To provide an updated systematic review on the use of geniculate artery embolization (GAE) in the management of recurrent hemarthrosis post-total knee arthroplasty (TKA). MATERIALS AND METHODS: A systematic literature review was conducted, and all clinical reports in the English language from inception to July 2022 were identified. References were manually reviewed to identify additional studies. Demographics, procedural techniques, post-procedural complications, and follow-up data were extracted and analyzed using STATA 14.1. RESULTS: A total of 20 studies (9 case reports, 11 case series; n= 214) were included for review. In all cases, patients underwent coil embolization of one or more geniculate arteries. Procedure success was reported in 94.8% (n=203/214) of cases without perioperative adverse events. Improvement of symptoms was seen in 72.6% (n=119/164) of cases, with 30.7% (n=58/189) of cases requiring repeat embolization. Recurrent hemarthrosis occurred in 22.2% (n=22/99) of cases over a mean follow-up of 48 months. CONCLUSION: GAE appears to be a safe and effective treatment for recurrent hemarthrosis following TKA. Future studies in the form of randomized controlled trials should be conducted to further evaluate such embolization techniques and compare outcomes between GAE and standard techniques. CLINICAL IMPACT: Conservative management of post total knee arthroplasty (TKA) hemarthrosis is successful in only one third of cases. Geniculate artery embolization (GAE) has recently gained attention due to its minimally invasive nature compared to open or arthroscopic synovectomy promising faster rehabilitation, decreased infection rates and less additional surgeries. The purpose of this article was to summarize current literature, provide an updated review on the use of GAE in the management of recurrent hemarthrosis post-TKA and describe immediate and long-term outcomes in an effort to help optimize current treatment algorithms.

Endovascular Repair of Popliteal Artery Injury Post-total Knee Arthroplasty is Safe and Effective: A Case Report and Systematic Review of the Literature.

BACKGROUND: Popliteal artery pseudoaneurysms are a rare but serious complication following total knee arthroplasty that have been traditionally managed with open surgical repair. Endovascular stenting, while relatively new, offers a promising alternative that is less invasive and may reduce the risk of perioperative complications. METHODS: A systematic literature review was conducted, and all clinical reports in the English language from inception to July 2022 were identified. References were manually reviewed to identify additional studies. Demographics, procedural techniques, postprocedural complications, and followup data were extracted and analyzed using STATA 14.1. Additionally, we present a case of a patient with a popliteal pseudoaneurysm treated with a covered endovascular stent. RESULTS: A total of 14 studies (12 case reports, 2 case series; n = 17) were included for review. In all cases, a stent-graft was placed across the popliteal artery lesion. In 5 out of 11 cases, popliteal artery thrombus was present and treated with adjacent modalities (i.e., mechanical thrombectomy, balloon angioplasty, etc.). Procedure success was reported in all cases without perioperative adverse events. Stents remained patent over a median followup of 32 weeks (interquartile range: 36). In all but one case, the patients experienced immediate symptom relief and had an uneventful recovery. For our case, at the 12-month followup the patient was asymptomatic, and ultrasound demonstrated vessel patency. CONCLUSIONS: Endovascular stenting is a safe and effective treatment for popliteal pseudoaneurysms. Future studies should be aimed at evaluating the long-term outcomes of such minimally invasive techniques.

A Prospective Noninterventional Study of Type I Collagen Matrix Plus Polyhexamethylene Biguanide Antimicrobial for the Treatment of Venous Leg Ulcers: A Secondary Analysis.

BACKGROUND: The RESPOND registry study was the first prospective noninterventional study evaluating the real-world effectiveness of a native type 1 collagen matrix plus polyhexamethylene biguanide antimicrobial (PCMP) barrier in nonhealing wounds. PURPOSE: The objective of this secondary analysis was to describe the effects of PCMP in the subgroup of patients with venous leg ulcers (VLUs) in the RESPOND registry. METHODS: RESPOND was a 28-site, prospective, noninterventional study for up to 32 weeks. All patients (N = 307) in RESPOND received PCMP. Eligibility criteria included patients being 18 years of age and older and having cutaneous wounds, not including third-degree burns. Kaplan-Meier methods analyzed the frequency and median time to wound closure. RESULTS: For the cohort of PCMP-treated VLUs (n = 67), the mean baseline wound area was 20.07 cm2 and mean wound duration was 89 days. Wound closure frequencies were 33%, 42%, 45%, 53%, and 73% at weeks 8, 12, 16, 24, and 32, respectively. The median time to closure was 22 weeks. Incidences of achieving >60% reduction in baseline area and depth were 78% and 70%, respectively, with 87% showing a reduction of >75% in volume. CONCLUSION: PCMP appears to be a valuable adjunct for treating venous leg ulcers.

Acute superior mesenteric artery thrombosis seven days after discharge for novel coronavirus pneumonia.

Since the emergence of novel coronavirus pneumonia (NCP), a number of reports have pointed out an increased coagulation activity in these patients mostly during acute phase of the disease. We are reporting a case of acute superior mesenteric thrombosis in a 55-year-old man with NCP 1 week after hospital discharge. He returned to the emergency department 7 days later with severe acute abdominal pain and found to have superior mesenteric artery thrombosis. He subsequently underwent emergent exploratory laparotomy, superior mesenteric artery thrombectomy, and bowel resection. Acute arterial thrombosis may occur in the posthospitalization period in patients with NCP.

Efficacy of the Application of a Purified Native Collagen With Embedded Antimicrobial Barrier Followed by a Placental Allograft on a Diverse Group of Nonhealing Wounds of Various Etiologies.

INTRODUCTION: Invoked by the presence of biofilm, upregulation of tissue-destroying proteases is the hallmark of continuous inflammation in nonhealing wounds. Preventing biofilm re-formation and quenching protease activity in the wound bed, followed by providing regenerative factors to the area may aid in triggering a wound healing trajectory. OBJECTIVE: In this case series, the author evaluated a multimodal approach in patients with wounds that did not respond to conventional therapy. These patients were initially treated with purified native cross-linked extracellular matrix (ECM) with polyhexamethylene biguanide (PHMB) antimicrobial barrier (PCMP) followed by placental allografts MATERIALS AND METHODS: Wounds underwent once-weekly debridements, followed by application of PCMP and subsequent applications of hypothermically stored amniotic membrane (HSAM) and/or dehydrated amnion/chorion membrane (dACM) placental allografts. RESULTS: Sixteen wounds were included in the study, but 1 patient died before healing rates were calculated. Of the remaining 15 wounds, 13 (86.67%) closed at or before week 12, with the remaining 2 wounds achieving complete wound closure by week 17. A subgroup analysis of larger wounds (> 25 cm2) also was conducted. Of the 16 wounds, 6 (37.5%) were present for 8.5 weeks; these wounds ranged in size from 31 cm2 to 78 cm2, with mean baseline area (standard deviation) of 43.5 cm2 (15.99) and median baseline area of 42 cm2. Of the 5 larger wounds, 3 (60%) closed before 12 weeks. All wounds achieved complete wound closure by week 17 following application of PCMP and subsequent application of HSAM or dACM. CONCLUSIONS: Applications of PCMP to nonhealing wounds, followed by application of dACM or HSAM placental allograft, in conjunction with the standard of care provided at the author's institution, resulted in satisfactory wound closure rates in a diverse group of wounds in a patient group with multiple comorbidities.

Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis.

BACKGROUND: Coronary artery disease requiring coronary artery bypass graft (CABG) frequently coexists with critical carotid stenosis. The most optimized strategy for treating concomitant carotid and coronary artery disease remains debatable. OBJECTIVE: The aim of this meta-analysis was to compare synchronous CAS and CABG versus staged CAS and CABG for patients with concomitant coronary artery disease and carotid artery stenosis in terms of peri-operative (30-day) and long-term clinical outcomes. METHODS: This study was performed according to the PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane database until December 2019. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess heterogeneity. RESULTS: Four studies comprising 357 patients were included in this meta-analysis. Patients who were treated with the synchronous approach had a statistically significant higher risk for peri-operative stoke (OR: 3.71; 95% CI: 1.00-13.69; I2 = 0%) compared tο the staged group. Peri-operative mortality (OR: 4.50; 95% CI: 0.88-23.01; I2 = 0%), myocardial infarction (MI) (OR: 1.54; 95% CI: 0.18- 13.09; I2 = 0%), postoperative bleeding (OR: 0.27;95% CI: 0.02-3.12; I2 = 0%), transient ischemic attacks (TIA) (OR: 0.60; 95% CI: 0.04- 9.20; I2 = 0.0%), acute kidney injury (AKI) (OR: 0.34; 95% CI: 0.03-4.03; I2 = 0.0%) and atrial fibrillation rates (OR:0.27; 95% CI: 0.02-3.12; I2 = 0.0%) were similar between the two groups. Synchronous CAS-CABG and staged CAS followed by CABG were associated with similar rates of late mortality (OR: 3.75; 95% CI: 0.50-27.94; I2 = 0.0%), MI (OR: 0.33; 95% CI: 0.01-12.03; I2 = 0.0%) and stroke (OR:3.58; 95% CI:0.84-15.20; I2 = 0.0%) after a mean follow-up of 47 months. CONCLUSION: The simultaneous approach was associated with an increased risk of 30-day stroke compared to staged CAS and CABG. However, no statistically significant difference was found in long-term results of mortality, MI and stroke between the two approaches. Future studies are warranted to validate our results.

Type I collagen matrix plus polyhexamethylene biguanide antimicrobial for the treatment of cutaneous wounds.

Aim: Determine the effectiveness of purified native type I collagen matrix plus polyhexamethylene biguanide antimicrobial (PCMP) on cutaneous wounds. Materials & methods: A prospective cohort study of 307 patients (67 venous leg ulcers, 62 diabetic foot ulcers, 45 pressure ulcers, 54 post-surgical wounds and 79 other wounds) was conducted. Results: Cox wound closure for PCMP was 73% at week 32. The median time to wound closure was 17 weeks (Kaplan-Meier). The incidence of PCMP-treated wounds showing >60% reductions in areas, depths and volumes were 81, 71 and 85%, respectively. Conclusion: PCMP demonstrated clinically meaningful benefits to patients with various types of cutaneous wounds. Clinical Trial registration number: NCT03286452.

Endovascular Treatment of Persistent Sciatic Artery Aneurysms With Primary Stenting: A Systematic Review of the Literature.

Persistent sciatic artery (PSA) is an embryologic remnant of the internal iliac artery, and when is present, it undergoes aneurysmal degeneration in up to 60% of the cases. Endovascular repair is an increasingly utilized treatment strategy for PSA aneurysms (PSAAs). The objective was to demonstrate the safety and efficacy of the endovascular repair in patients with PSAA and to identify potential risk factors for loss of patency or limb loss. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and eligible studies were identified through search of the PubMed, Scopus, and Cochrane Central databases. Fifteen case reports, comprising 15 patients overall, were included. The median age of the patients was 68 years old (mean age 66 ± 13.4 years) with half of the reported patients being women. Most patients presented with progressive limb claudication, complaining about an enlarging palpable pulsatile buttock mass. The onset of symptoms was sudden in 78% of the reported cases. Additionally, the distal pulses on PSAA side were diminished or absent in 91% of the patients. Acute limb ischemia was the primary diagnosis in 75% of the cases. All patients underwent endovascular repair of the PSAA with a covered stent. Procedural outcomes were favorable in all patients demonstrating no symptoms recurrence, aneurysmal regression, or total obliteration evaluated by angiographic studies (computed tomography angiography [CTA] and angiogram). Periprocedural imaging evaluation was determined either with CTA or duplex ultrasound (DUS). Periprocedural complications included only 1 endoleak with distal dissection. This endoleak was identified after stent deployment and dissection distal to the aneurysm. Mean follow-up (with CTA and/or DUS) was 22 months, with all patients being asymptomatic with no recurrence of symptom. The endovascular treatment of PSAA with covered stent is safe and effective. Persistent sciatic artery aneurysms is associated with high procedural success, low periprocedural compilations, and favorable mid-term follow-up.

Synchronous Carotid Endarterectomy and Coronary Artery Bypass Graft versus Staged Carotid Artery Stenting and Coronary Artery Bypass Graft for Patients with Concomitant Severe Coronary and Carotid Stenosis: A Systematic Review and Meta-analysis.

BACKGROUND: Owing to the systemic nature of atherosclerosis, medium and large arteries at different sites are commonly simultaneously affected. As a result, severe coronary artery disease (CAD) requiring coronary artery bypass graft (CABG) frequently coexists with significant carotid stenosis that warrants revascularization. The aim of this study was to compare synchronous carotid endarterectomy (CEA) and CABG vs. staged carotid artery stenting (CAS) and CABG for patients with concomitant CAD and carotid artery stenosis in terms of perioperative (30-day) outcomes. METHODS: This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Eligible studies were identified through a search of PubMed, Scopus, and Cochrane until July 2018. A meta-analysis was conducted with the use of a random-effects model. The I-square statistic was used to assess heterogeneity. RESULTS: Five studies comprising 16,712 patients were included in this meta-analysis. Perioperative stroke (odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.43-1.64; I2 = 39.1%), transient ischemic attack (TIA; OR: 0.32; 95% CI: 0.04-2.67; I2 = 27.6%), and myocardial infarction (MI) rates (OR: 0.56; 95% CI: 0.08-3.85; I2 = 68.9%) were similar between the two groups. However, patients who underwent simultaneous CEA and CABG were at a statistically significant higher risk for perioperative mortality (OR: 1.80; 95% CI: 1.05-3.06; I2 = 0.0%). CONCLUSIONS: The current meta-analysis did not detect statistically significant differences in the rates of perioperative stroke, TIA, and MI between the groups. However, patients in the simultaneous CEA and CABG group had a significantly higher risk of 30-day mortality. Future randomized trials or prospective cohorts are needed to validate our results.

Synchronous versus Staged Carotid Endarterectomy and Coronary Artery Bypass Graft for Patients with Concomitant Severe Coronary and Carotid Artery Stenosis: A Systematic Review and Meta-analysis.

BACKGROUND: Due to the systemic nature of atherosclerosis, arteries at different sites are commonly simultaneously affected. As a result, severe coronary artery disease (CAD) requiring coronary artery bypass grafting (CABG) frequently coexists with significant carotid stenosis that warrants revascularization. To compare simultaneous carotid endarterectomy (CEA) and CABG versus staged CEA and CABG for patients with concomitant CAD and carotid artery stenosis in terms of perioperative outcomes. METHODS: This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A meta-analysis was conducted with the use of a random effects model. The I2 statistic was used to assess for heterogeneity. RESULTS: Eleven studies comprising 44,895 patients were included in this meta-analysis (21,710 in the synchronous group and 23,185 patients in the staged group). The synchronous CEA and CABG group had a statistically significant lower risk for myocardial infarction (MI) (odds ratio [OR] 0.15, 95% CI 0.04-0.61, I2 = 0%) and higher risk for stroke (OR 1.51, 95% CI 1.34-1.71, I2 = 0%) and death (OR 1.33, 95% CI 1.01-1.75, I2 = 47.8%). Transient ischemic attacks (TIAs) (OR 1.27, 95% CI 1.00-1.61, I2 = 0.0%), postoperative bleeding (OR 0.82, 95% CI 0.22-3.05, I2 = 0.0%), and pulmonary complications (OR 1.52, 95% CI 0.24-9.60, I2 = 67.5%) were similar between the 2 groups. CONCLUSIONS: Patients in the simultaneous CEA and CABG group had a significantly higher risk of 30-day mortality and stroke and lower risk for MI as compared to staged CEA and CABG group. The rates of TIA, postoperative bleeding, and pulmonary complications were similar between the 2 groups. Future randomized trials or prospective cohorts are needed to validate our results.

Effect of Native Type I Collagen with Polyhexamethylene Biguanide Antimicrobial on Wounds: Interim Registry Results.

BACKGROUND: Biofilm can impair wound healing by maintaining an elevated, but ineffective, inflammatory state. This article describes interim results from the prospective RESPOND postmarketing registry evaluating the use of a native type 1, porcine collagen matrix with the embedded antimicrobial polyhexamethylene biguanide (PCMP) in the management of chronic wounds. METHODS: Adults ≥18 years of age with ≥1 appropriate wound were eligible for inclusion. Data that were final on January 26, 2018 were included in this analysis. At week 0, wounds were cleaned, debrided, and prepared as necessary and PCMP was applied, with a dressing to fix it in place. Patients received standard wound care plus PCMP weekly, up to 24 weeks, at the investigator's discretion. At each visit, wounds were assessed for area and quality of granulation tissue. RESULTS: Most common wound types (N = 63) were venous ulcers (28.6%), trauma and lacerations (22.2%), postsurgical open wounds (15.9%), pressure injuries (12.7%), and diabetic ulcers (9.5%). Median baseline wound area was 6.5 cm2; mean wound duration at baseline was 4 months. Of the 63 wounds, 43 (68.3%) achieved complete wound closure, 41 of 43 (95.3%) closed after PCMP treatment, and 2 of 43 (4.7%) after bridging to other modalities and surgical closure. Twelve out of 63 wounds were bridged to other modalities after PCMP treatment. Mean time to closure for PCMP wounds was 5.0 weeks. CONCLUSIONS: PCMP appears to be a useful adjunct for treating various wound types. PCMP use should be considered when managing chronic or acute wounds.

A meta-analysis of randomized trials comparing bovine pericardium and other patch materials for carotid endarterectomy.

OBJECTIVE: Patch angioplasty during carotid endarterectomy is commonly used to treat symptomatic and asymptomatic carotid artery stenosis. The objective of the present study was to compare the different patch materials that are currently available (synthetic vs venous vs bovine pericardium) in terms of short- and long-term outcomes. METHODS: This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and eligible randomized control trials were identified through a comprehensive search of PubMed, Scopus, and Cochrane Central published until September 2017. A meta-analysis was conducted with the use of a random effects model. The I2 statistic was used to assess for heterogeneity. The primary study end point was the incidence of long-term restenosis. Secondary study end points were 30-day stroke, transient ischemic attack (TIA), myocardial infarction, neck wound infection, local hematoma, carotid artery thrombosis, cranial nerve injury, long-term stroke incidence, and death. RESULTS: Eighteen studies and 3234 patients were included. The risk of 30-day stroke (relative risk [RR], 1.00; 95% confidence interval [CI], 0.45-2.19; I2 = 0%), TIA (RR, 1.14; 95% CI, 0.41-3.19; I2 = 0%), myocardial infarction (odds ratio, 0.75; 95% CI, 0.14-3.97; I2 = 0%), death (RR, 0.53; 95% CI, 0.21-1.34; I2 = 0%), wound infection (RR, 1.84; 95% CI, 0.43-7.81; I2 = 0%), carotid artery thrombosis (RR, 1.47; 95% CI, 0.44-4.97; I2 = 0%), cranial nerve palsy (RR, 1.21; 95% CI, 0.53-2.77; I2 = 0%), and long-term stroke (RR, 2.33; 95% CI, 0.76-7.10; I2 = 0%), death (RR, 1.09; 95% CI, 0.65-1.83; I2 = 0%) and restenosis of greater than 50% (RR, 0.48; 95% CI, 0.19-1.20; I2 = 0%) were similar between the synthetic vs venous patch groups. Also, no differences in terms of 30-day stroke (RR, 0.31; 95% CI, 0.02-5.16; I2 = 63.1%), TIA (RR, 0.49; 95% CI, 0.14-1.76; I2 = 0%), death (RR, 0.74; 95% CI, 0.05-10.51; I2 = 31.7%), carotid artery thrombosis (RR, 0.13; 95% CI, 0.02-1.07; I2 = 0%), and long-term restenosis of greater than 70% (RR, 0.15; 95% CI, 0.01-2.29; I2 = 70.9%) were detected between the synthetic polytetrafluoroethylene and Dacron patch groups. The comparison between the bovine pericardium vs synthetic patch did not yield any statistically significant results in terms of 30-day stroke (RR, 1.44; 95% CI, 0.19-10.79; I2 = 12.7%), TIA (RR, 1.05; 95% CI, 0.11-10.27; I2 = 0%), local neck hematoma (RR, 4.01; 95% CI, 0.46-34.85; I2 = 0%), and death (RR, 4.01; 95% CI, 0.46-34.85; I2 = 0%). CONCLUSIONS: Closure of the carotid arteriotomy with any of the studied patch materials seems to be similar in terms of short- and long-term end points. However, additional randomized trials with adequate follow-up periods are needed to compare bovine pericardium patches with other patch materials.

Endovascular Treatment of a Complex Renal Artery Aneurysm Using Coils and the Pipeline Embolization Device in a Patient with a Solitary Kidney.

BACKGROUND: We report a case of endovascular treatment of a complex renal artery aneurysm using the Pipeline Embolization Device, a flow diverting stent which is indicated for the treatment of large and giant cerebral aneurysms. METHODS: A forty-year-old female with medically refractory hypertension and congenital agenesis of the right kidney was found to have a 2.8-cm left superior renal artery branch aneurysm. The patient was treated successfully using the Pipeline Embolization Device (Medtronic, Irvine, CA) with coil embolization of the aneurysm and of one outflow vessel. RESULTS: On 3-year follow-up, her renal function was normal, vascular imaging showed complete occlusion of the aneurysm, and physiological remodeling of the reconstructed artery and parenchymal imaging showed no evidence of renal infarction. CONCLUSION: Flow diverting stents are a valuable treatment option for visceral aneurysms with complex anatomy.

Bilateral retroesophageal course of the carotid arteries.

Many variations in the anatomy of the carotid artery are described in the literature. There are few case reports of hypoplasia or the retropharyngeal course of the internal carotid artery. We describe the unique case of a 72-year-old woman with bilateral complete retroesophageal common carotid arteries and concomitant hypoplasia of the right carotid system. Anatomical detection of such a variation is critical because the misidentification of a retroesophageal carotid artery carries the risk of potential injury during orotracheal intubation and oropharyngeal procedures.

State-of-the-art of hybrid procedures for the aortic arch: a meta-analysis.

Questions have risen regarding procedural indications, techniques, and outcomes for hybrid arch procedures. We performed a meta-analysis to benchmark this innovative approach. Studies and case reports involving hybrid aortic arch procedures listed through May 2008 were reviewed (n = 718). End points were 30-day mortality, stroke, paraplegia, and endoleak rates. A total of 15 studies with 463 patients were included in the meta-analysis. Overall 30-day mortality was 8.3%. Endoleak rate was 9.2%, stroke was 4.4%, and paraplegia was 3.9%. Treated on-pump or off-pump did not affect any of the endpoints. Results compare favorably with standard operative repair. Long-term follow-up is needed.

Ascending aortic aneurysms: asymmetrical differences in aortic cross-sectional wall motion detected by epiaortic echocardiography.

OBJECTIVE: To evaluate in vivo cross-sectional conformational changes of ascending aortic wall excursion in patients undergoing resection for aortic aneurysm with those undergoing elective coronary artery bypass grafting (CABG) using epi-aortic echocardiography. DESIGN: A prospective observational investigation. SETTING: A single tertiary care university hospital. PARTICIPANTS: Thirty-four patients undergoing elective ascending aorta resection and 23 elective CABG patients. INTERVENTION: In an open-chest model and with use of an epi-aortic echocardiographic probe, measurements of aortic wall excursion were made on the ascending aortic aneurysms. Control measurements were made on the transitional neck portions of the aneurysmal aortas (internal control) and CABG aortas (external control). MEASUREMENTS AND MAIN RESULTS: The aortic aneurysm measurements exhibited no difference (2.8%, p < 0.62) between the excursion of the anterior and posterior walls. In contrast, under similar hemodynamic conditions, the anterior wall of the aneurysm neck moved 48.2% (p < 0.0004) more than the posterior wall. Similarly, in the CABG control group, the anterior wall moved 24% (p < 0.027) more than the posterior wall. CONCLUSION: This in vivo study documented a lack of asymmetric aortic wall motion in ascending aortic aneurysms. In contrast, both the internal and external control groups (aneurysm neck and CABG) demonstrated asymmetric wall motion. The lack of asymmetric wall motion may be an important aspect of aneurysm pathophysiology and key to the development of management strategies for timing of surgical intervention.