Atypical iliac vein compression in patients with symptomatic May-Thurner syndrome.

PURPOSE: We aimed to investigate the incidence, etiology, treatment, and clinical course of atypical iliac vein compressions (AIVCs) among patients with May-Thurner syndrome (MTS). METHODS: A total of 173 patients who presented with MTS were retrospectively analyzed at a single center. Computed tomographic venography (CTV) was used to diagnose MTS. An AIVC was defined as the compression of the left common iliac vein (LCIV) by structures other than the right common iliac artery (RCIA) or the compression of other venous structures in the pelvic cavity instead of the LCIV. The patients with AIVC were categorized into the LCIV compression group (category A) and non-LCIV compression group (category B). RESULTS: Ten patients with AIVC were identified (5.8%; male/female, 5/5), five in category A and five in category B. The median age of patients was 76 years (range, 51-94 years), and the median follow-up duration was 388 days (range, 12-4694 days). In category A, the LCIVs were compressed by the left common iliac artery (LCIA) (n=2), uterine leiomyoma (n=1), LCIA aneurysm (n=1), and RCIA aneurysm (n=1). In category B, the right common iliac veins were compressed by the RCIA (n=4) and L5 osteophyte (n=1). Endovascular treatment, including balloon angioplasty and stent placement, was performed in six patients, three from each group. Three patients underwent conservative treatment due to their advanced age and comorbidities. Endovascular aneurysm repair was performed in one patient with RCIA aneurysm. Follow-up images were available for six patients, and all of them had patent venous flow. CONCLUSION: The AIVC had an incidence of 5.8% (10/173) among symptomatic MTS patients and wide spectrum of etiologies. Pathogenesis-tailored endovascular treatments are safe and effective.

Effect of Fluvastatin on Cardiovascular Complications in Kidney Transplant Patients: A Systemic Review and Meta-analysis.

BACKGROUND: Hyperlipidemia and cardiovascular disease are risk factors for long-term renal transplant dysfunction. However, no meta-analyses of randomized controlled trials have investigated the effects of statin treatment on graft function in renal transplant recipients. The aim of the present study was to evaluate the effects of statin use on renal transplant patients using a meta-analysis approach. METHODS: We conducted a systematic review and meta-analysis using random effects modeling. We searched the following databases for all studies published through to June 15, 2018: Cochrane Central Register, OVID MEDLINE, Embase, and PubMed. We reviewed all relevant reviews, registered trials, and relevant conference proceedings to compare clinical outcomes and survival between fluvastatin recipients and controls. RESULTS: Five trials with a total of 3725 patients were included. Glomerular filtration rates, graft loss, tacrolimus level, antibody-mediated rejection, T cell-mediated rejection, proteinuria, fungal infection (candida), and patient survival rates did not differ between the fluvastatin and control groups. However, major adverse cardiovascular events were 1.547 times more common in the control group than in the fluvastatin group (P = .001). CONCLUSIONS: Fluvastatin use was associated with a reduction in major adverse cardiac events among kidney transplant patients.

Risk Factors of Amputation in Lower Extremity Trauma with Combined Femoropopliteal Arterial Injury.

PURPOSE: The clinical characteristics and results of femoropopliteal artery injury (FPAI) remain unclear. In this study, we evaluated the outcomes and risk factors of limb loss in patients treated for FPAI. MATERIALS AND METHODS: We retrospectively reviewed data from a database of patients who underwent revascularization for an FPAI at a single institution between January 2013 and December 2017. We reviewed and analyzed the characteristics, postoperative results, and factors that influence amputation rates. RESULTS: Twenty-four femoropopliteal arterial reconstructions in 24 patients were included in this study. Among the patients were 20 (83.3%) male with a first-quartile age of 28 years and a third-quartile age of 45 years (range, 15-68 years). The mean injury severity score (ISS) was 16 (range, 4-55), and 5 patients (20.8%) had ISSs of >20 points. The mean mangled extremity severity score (MESS) was 3.8 (range, 1-11), and 8 patients (33.3%) had MESSs of >5 points. In terms of arterial reconstruction methods, autogenous saphenous vein grafting, vein patching, and primary closure were performed in 9 patients (37.5%), 4 patients (16.7%), and 11 patients (45.8%), respectively. Despite arterial reconstruction, 5 patients (20.8%) underwent above-knee amputation. ISSs of >20, MESSs of >7, and orthopedic fixation were statistically significant factors associated with amputation. CONCLUSION: In cases of FPAI with ISSs of >20, MESSs of >7, and orthopedic fixation, amputations should be considered. We were also careful to attempt limb salvage in such cases.

Iatrogenic Iliofemoral Vein Dissection: A Rare Complication of Femoral Artery Puncture.

Iatrogenic iliac vein dissection secondary to femoral artery puncture is a rare complication that has not yet been documented. A 55-year-old woman presented to our institution with acute right iliofemoral thrombosis 2 weeks after transfemoral cerebral angiography. She was previously healthy and was not taking any medication. Right iliofemoral vein dissection was diagnosed by computed tomography angiography and confirmed by conventional venography. The patient was treated endovascularly with stent insertion, and the venous outflow was patent on the 6-month follow-up computed tomography angiogram.

Contralateral Deep Vein Thrombosis after Iliac Vein Stent Placement in Patients with May-Thurner Syndrome.

PURPOSE: To investigate the incidence and potential causes of contralateral deep vein thrombosis (DVT) after common iliac vein (CIV) stent placement in patients with May-Thurner syndrome (MTS). MATERIALS AND METHODS: Data of 111 patients (women: 73%) who had CIV stent implantation for symptomatic MTS at a single center were retrospectively analyzed. Mean patient age was 63.1 ± 15.2 years. Median follow-up was 36 months (range, 1-142 months). Stent location was determined by venogram and classified as extended to the inferior vena cava (IVC), covered the confluence, or confined to the iliac vein. Potential causes of contralateral DVT were presumed based on venographic findings. The relationship between stent location and contralateral DVT was analyzed. RESULTS: Ten patients (9%, men/women: 4/6) exhibited contralateral DVT at a median timing of 40 months (range, 6-98 months). Median age was 69 years (range, 42-85 years). Median follow-up was 73.5 months (range, 20-134 months). Potential causes were venous intimal hyperplasia (VIH) (n = 7), "jailing" (n = 2), and indeterminate (n = 1). All patients with VIH had previous CIV stents overextended to the IVC. Overextension of CIV stent was associated with contralateral DVT (P < .001). The primary patency rate of the contralateral CIV stent was 70% at 20 months. CONCLUSIONS: Contralateral DVT after CIV stent implantation has a relatively high incidence and often occurs late during follow-up. Overextension of the CIV stent to the IVC is associated with development of contralateral DVT, and VIH should be considered a potential cause.

Thoracic Endovascular Repair for Acute Traumatic Transection of the Descending Thoracic Aorta and Postendovascular Remodeling Change.

BACKGROUND: The recently developed thoracic endovascular repair (TEVAR) technique seems to offer a good alternative for treating acute traumatic transection of the thoracic aorta (TTA). We reviewed our experience of TEVAR in cases of acute traumatic transection and analyzed the subsequent remodeling changes. METHODS: The medical records of 17 patients who underwent TEVAR for TTA were reviewed. The trauma mechanisms, anatomical characteristics of the transected aortas, technical details of TEVAR, and postprocedural results were reviewed. RESULTS: The overall mean injury severity score was 53 ± 12. On three-dimensional computed tomography (CT), the mean distance of transection from the left subclavian artery was 14 ± 9 (0-31) mm. Fifteen patients presented an aortic pseudoaneurysm and two patients had impending rupture. TEVAR was performed emergently under general endotracheal induction. Technical success was achieved and complete pseudoaneurysm sealing was confirmed with aortography in all 17 patients. Two patients (12%) died of hypovolemic shock and hyperkalemia; however, no late death or stent-related complication occurred during the 45 ± 32 (6-102) months of follow-up. During a mean CT follow-up of 35 months, the mean aortic diameter increased by 2 (0-5) mm and pseudoaneurysm lesions completely disappeared in all patients. CONCLUSIONS: TEVAR resulted in good early survival in patients with TTA. No late or stent graft-related event was encountered up to a maximum of 9 years after surgery. We recommend that patients with grade III or higher TTA should undergo emergency surgery. Moreover, we consider that long-term follow-up and blood pressure management are essential when the proximal aortic diameter is found to increase slightly after TEVAR on follow-up CT.

Evaluation of Delayed Endoleak Compared with Early Endoleak after Endovascular Aneurysm Repair.

PURPOSE: To identify prevalence and evaluate outcomes of delayed endoleak (DEL) compared with early endoleak (EEL) after endovascular aortic aneurysm repair (EVAR). MATERIALS AND METHODS: Data of 164 patients who underwent elective EVAR at a single center were retrospectively analyzed. DEL was defined as any type of endoleak that was first detected ≥ 12 months after EVAR. Patients who had < 1 year of follow-up were excluded. Endoleak was classified into a more aggressive category if a patient had > 1 type of endoleak. Analysis included 81 patients (82.7% male). Mean age was 73.1 years ± 9.3. Median follow-up duration was 43 months (range, 12-135 months). RESULTS: Endoleak was present in 32 patients (39.5%), including 21 EEL (25.9%) and 11 DEL (13.6%). DEL consisted of 2 type I, 5 type II, 1 type III, and 3 type V (endotension). Median time to detection was 45 months (range, 15-60 months), and median follow-up duration was 62 months (range, 37-104 months). Compared with EEL, DEL had larger aneurysm diameters and higher rates of non-type II endoleak and reintervention. Type II DEL also required more reintervention procedures than type II EEL. CONCLUSIONS: DEL had a noteworthy incidence and occurred late after EVAR. It predominantly consisted of non-type II endoleak and appeared to have more reinterventions than EEL. Meticulous long-term imaging surveillance to identify and manage DEL is critical.

Usefulness of Percutaneous Puncture in Insertion of Totally Implantable Venous Access Devices in Pediatric Patients.

PURPOSE: Totally implantable venous access devices (TIVADs) are commonly used in pediatrics for the administration of chemotherapy, antibiotics, or parenteral nutrition. TIVADs can be implanted using various techniques, including surgical cutdown (SC) and percutaneous puncture (PP). Recently, percutaneous TIVAD became popular in adults, but studies comparing between PP and SC group in pediatric patients are rare. MATERIALS AND METHODS: Data were collected and analyzed retrospectively from 23 patients who underwent TIVAD at a single institution between January 2013 and December 2015. We examined the clinical characteristics, insertion techniques, and clinical outcome. We divided the patients into 2 groups and compared PP with ultrasonography and SC using the insertion technique. We compared success rate, procedural time, and the patency rate between the 2 groups. RESULTS: Eleven TIVADS were inserted using PP, and 12 TIVADs were inserted using SC. No statistically significant difference in characteristics was found between the 2 groups. The procedural time in the PP group was shorter than that in the SC group, but the difference was not statistically significant (P=0.685). During follow-up, 1 patient in the SC group had an occlusion, and 1 patient in the PP group had an infection. CONCLUSION: PP of the internal jugular vein with ultrasonography appears to be the method of choice for TIVAD insertion owing to its similar success rate in terms of implantation and complication rate to that in SC, with shorter procedural times in pediatric patients.

Long Term Outcomes of Femorofemoral Crossover Bypass Grafts.

PURPOSE: Femorofemoral crossover bypass (FCB) is a good procedure for patients with unilateral iliac artery disease. There are many articles about the results of FCB, but most of them were limited to 5 years follow-up. The purpose of our study was to analysis the results of FCB with a 10-year follow-up period. MATERIALS AND METHODS: Between January 1995 and December 2010, 133 patients were operated in Samsung Medical Center (median follow-up: 58.8 months). We retrospectively analysed patient characteristics, the preoperative treatment, the operative procedure, and material used. RESULTS: The indications for FCB were claudication in 110 and critical limb ischemia in 23 patients. Three patients were died due to myocardiac infarction, intracranial hemorrhage, and acute respiratory failure within 30 days after surgery. The one-year primary and secondary patency rates were 89% and 97%, the 5-year primary and secondary patency rates were 70% and 85%, and the 10-year primary and secondary patency rates were 31% and 67%. The 5-year and 10-year limb salvage rates were 97% and 95%, respectively. CONCLUSION: Our long term analysis suggests that FCB might be a valuable alternative treatment modality in patients with unilateral iliac artery disease.

Functional and morphological evolution of remnant pancreas after resection for pancreatic adenocarcinoma.

Functional and morphological evolution of remnant pancreas after resection for pancreatic adenocarcinoma is investigated.The medical records of 45 patients who had undergone radical resection for pancreatic adenocarcinoma from March 2010 to September 2013 were reviewed retrospectively. There were 34 patients in the pancreaticoduodenectomy (PD) group and 10 patients in the distal pancreatectomy (DP) group. One patient received total pancreatectomy. The endocrine function was measured using the glucose tolerance index (GTI), which was derived by dividing daily maximum serum glucose fluctuation by daily minimum glucose. Remnant pancreas volume (RPV) was estimated by considering pancreas body and tail as a column, and head as an ellipsoid, respectively. The pancreatic atrophic index (PAI) was defined as the ratio of pancreatic duct width to total pancreas width. Representative indices of each patient were compared before and after resection up to 2 years postoperatively.The area under receiver operating characteristic curve of GTI for diagnosing DM was 0.823 (95% confidence interval, 0.699-0.948, P < .001). Overall, GTI increased on postoperative day 1 (POD#1, mean ±â€Šstandard deviation, 1.79 ±â€Š1.40 vs preoperative, 1.02 ±â€Š1.41; P = .001), and then decreased by day 7 (0.89 ±â€Š1.16 vs POD#1, P < .001). In the PD group, the GTI on POD#14 became lower than preoperative (0.51 ±â€Š0.38 vs 0.96 ±â€Š1.37; P = .03). PAI in the PD group was significantly lower at 1 month postoperatively (0.22 ±â€Š0.12 vs preoperative, 0.38 ±â€Š0.18; P < .001). In the PD group, RPV was significantly lower at 1 month postoperatively (25.3 ±â€Š18.3 cm vs preoperative, 32.4 ±â€Š20.1 cm; P = .02), due to the resolution of pancreatic duct dilatation. RPV of the DP group showed no significant change. GTI was negatively related to RPV preoperatively (r = -0.317, P = .04), but this correlation disappeared postoperatively (r = -0.044, P = .62).Pancreatic endocrine functional deterioration in pancreatic adenocarcinoma patients may in part be due to pancreatic duct obstruction and dilatation caused by the tumor. After resection, this proportion of endocrine insufficiency is corrected.

Spontaneous dissections of multiple visceral arteries: an extremely rare case.

Spontaneous dissections of visceral arteries without aortic involvement are very rare. The etiologies of these entities are unclear and their clinical managements remain controversial. We report a case of spontaneous multiple dissections affecting 4 visceral arteries including the superior mesenteric artery, the celiac artery and the bilateral renal arteries. The patient was managed conservatively and endovascularly. The clinical manifestation markedly improved and laboratory tests returned to normal limits within 1 week. The regular follow-up suggested a good clinical and radiological outcome until 84 months.

Outcomes of endovascular treatment for TASC C and D aorto-iliac lesions.

BACKGROUND/OBJECTIVE: The aim of this study was to evaluate the technical success rates, primary patency, and complications for TASC C and D aorto-iliac lesions treated by endovascular procedures. Additionally, the influence of the access site and the clinical outcomes were analyzed. METHODS: Between 2008 and 2014, data from 39 patients with 45 chronic iliac artery stenosis and/or occlusion who were treated with endovascular treatment were retrospectively reviewed. RESULTS: The procedure time was longer for TASC D lesions than for TASC C lesions (163 ± 82 min vs. 105 ± 34 min; p = 0.002), where there was the more common use of brachial and femoral approach simultaneously. There were two perioperative deaths associated with TASC D lesions caused by one iliac artery rupture and one postoperative hospital-acquired pneumonia. The total perioperative complication rate was higher in the TASC D lesions than in TASC C lesions [five (18.5%) vs. zero; p = 0.073]. The corresponding 2-year primary patency rates were 94.9% in TASC C lesions and 88.4% in TASC D lesions. The simultaneous brachial and femoral approach took the longest procedure time (226 ± 157 min). CONCLUSION: This study demonstrated that the outcomes of endovascular treatment for TASC C and D aorto-iliac lesions were acceptable, with better technical success in TASC C lesions than in TASC D lesions. Furthermore, the 2-year patency rate for both TASC C and TASC D lesions was acceptable. Additionally, brachial access was useful for complex anatomy, but the failure rate was high.

Platelet count evolution as a predictor of outcome after splenectomy for immune thrombocytopenic purpura.

Splenectomy is the definitive second-line therapy for refractory immune thrombocytopenic purpura (ITP), and has a reported response rate of 50-80%. Medical attention should be reconsidered when there is no evidence of accessory spleen in refractory ITP patients after splenectomy. The purpose of this study was to determine whether platelet count evolution differs between patients with a successful or unsuccessful result after splenectomy for ITP. Archived records of 104 consecutive patients that underwent splenectomy for ITP were reviewed. Patients were divided into two groups (failures and successes) using a final follow-up platelet count of 100,000/µL as a cut-off. Platelet count evolutions in these two groups were compared using the Student's t test. Successes and failures were found to have significantly different platelet counts from two days postoperatively (P = 0.016). The area under the receiver operating characteristic curve was 0.630 (95% confidence interval, 0.518-0.741, P = 0.030), and when a cut-off value of 100,000/µL was used, sensitivity and specificity were 68.2 and 51.2%, respectively. To obtain positive and negative predictive values exceeding 50%, additional platelet counts were required at one week and one month after splenectomy. We propose a protocol for ITP follow-up after splenectomy.

Occurrences and Results of Acute Kidney Injury after Endovascular Aortic Abdominal Repair?

PURPOSE: Acute kidney injury (AKI) is an important postoperative complication that may impact mortality and morbidity. The incidence of AKI after elective endovascular aneurysm repair (EVAR) is not known well. The aim of this study is to assess the incidence of AKI after elective EVAR and examine the impact of AKI. MATERIALS AND METHODS: Data were collected and analyzed retrospectively from 78 elective EVARs for abdominal aortic aneurysm (AAA) among 102 total cases of conventional EVAR performed in Inha University Hospital from 2009 to 2015. The primary endpoint was incidence and risk factors of AKI. Secondary endpoints included drop in estimated glomerular filtration rate (eGFR) and the mortality of AKI. RESULTS: We included 78 patients (17 females, 21%; mean age, 73.9±12.5 years; mean AAA diameter, 59.3±8.9 cm), 11 (14.1%) of whom developed AKI. Within 48 hours, those with AKI experienced a decrease in eGFR from 65.5±21.2 to 51.2±19.6 mL/kg/1.73 m2, and those without AKI showed a change from 73.1±9.2 to 74.2±10.7 mL/kg/1.73 m2. There were no patients who required dialysis during follow-up (mean, 24.2±18.0 months). Development of AKI was related to operation time (odds ratio [OR], 2.024; 95% confidence interval [CI], 1.732-4.723; P<0.010) and contrast dose (OR, 3.192; 95% CI, 2.182-4.329; P<0.010). There were no differences in mortality between the 2 groups (P=0.784). CONCLUSION: The incidence of AKI after EVAR was related to operation time and contrast dose, but was not associated with medium-term mortality.

Intraoperative Vascular Surgical Consultation during Non-Vascular Surgeries in Tertiary Centers by Vascular Surgeon.

PURPOSE: There are many types of intraoperative consultations by vascular surgeons during non-vascular surgery. Therefore, we examined the current state of intraoperative consultations during non-vascular surgery in a single center. MATERIALS AND METHODS: From January 2014 to December 2015, we reviewed records of 40 patients (0.3%) who received an intraoperative consultation from a vascular surgeon for 10,734 non-vascular surgeries in Inha University Hospital. We examined patient characteristics, operative details, and clinical results. RESULTS: There were 40 intraoperative vascular surgical consultations relating to bleeding (n=14, 35.0%), dissection from the vessel (n=13, 32.5%), arterial occlusion (n=10, 25.0%), and retroperitoneal approach (n=3, 7.5%). The locations of surgery were lower extremity (n=10, 25.0%), kidney (n=8, 20.0%), spine (n=6, 15.0%), pelvis (n=6, 15.0%), head and neck (n=4, 10.0%), abdomen (n=4, 10.0%), and upper extremity (n=2, 5.0%). The methods of surgery included primary closure or ligation (n=17, 42.5%), end-to-end anastomosis (n=12, 30.0%), bypass (n=10, 25.0%), thrombectomy (n=4, 10.0%), retroperitoneal approach (n=3, 7.5%), and embolization (n=2, 5.0%). Postoperative treatment was performed in the intensive care unit for 13 patients (32.5%), while 3 patients (7.5%) died following surgery. CONCLUSION: Intraoperative consultation by vascular surgeons during non-vascular surgery occurred in approximately 0.3% of non-vascular surgeries. The region undergoing operation and type of surgery were variable. Therefore, it is necessary for vascular surgeons to have a comprehensive knowledge of vascular anatomy and to make rapid surgical decisions.

Evaluation of Aneurysm Neck Angle Change After Endovascular Aneurysm Repair Clinical Investigations.

PURPOSE: To evaluate the aneurysm neck angle changes and post-endovascular aneurysm repair (EVAR) complications. METHODS: We retrospectively analyzed 72 cases of elective EVAR for abdominal aortic aneurysm among 109 consecutive cases from December 2005 to April 2014. Patients were divided into angulated and non-angulated groups. The angulated group was defined as neck angulation ≥60°. Neck angle was evaluated pre- and post-EVAR during short- (within 1 month), mid- (3-6 months), and long-term (>1 year) follow-up. Aneurysm sac diameter change, aneurysm neck morphology other than angulation, endoleaks, and other post-procedural complications were also documented. RESULTS: A total of 34 patients were enrolled in the angulated group. There were no statistical differences in age, sex, follow-up duration, and aneurysm neck profile between the two groups (p > 0.05). Both groups showed statistically significant and consistent decreases in angulation during the follow-up period (p < 0.01). The angulated group revealed 22.45 % more straightening than the non-angulated group. Recoil of the Endurant device occurred in the angulated group. No statistically significant intergroup differences were observed in any endoleaks, complications, or re-intervention rates (p > 0.05). Pre-EVAR angle was the only predictor for post-procedural angle change (p < 0.001). CONCLUSION: EVAR is applicable for patients with highly angulated aneurysm neck and provides consistent neck straightening over long-term follow-up. Recoil was evident in the angulated group using the Endurant device.

Can Pre-Retrieval Computed Tomography Predict the Difficult Removal of an Implementing an Inferior Vena Cava Filter?

PURPOSE: Implementing an inferior vena cava (IVC) filter is a relatively safe procedure but potential negative long-term effects. The complications for filter retrieval have been noted. We examined filter characteristics on pre-retrieval computed tomography (CT) that were associated with complicated retrieval (CR) of IVC filters. MATERIALS AND METHODS: A retrospective review of IVC filter retrievals between January 2008 and June 2014 was performed to identify patients who had undergone a pre-retrieval CT for IVC filter retrieval. CR was defined as the use of nonstandard techniques, procedural time over 30 min, filter fractures, filter tip incorporation into the IVC wall, and retrieval failure. Pre-retrieval CT images were evaluated for tilt angle in the mediolateral and anteroposterior directions, tip embedding into the IVC wall, degree of filter strut perforation, and distance of the filter tip from the nearest renal vein. RESULTS: Of seventy-six patients, twenty-four patients (31.6%) with CRs and 56 patients (73.7%) with non-CR were evaluated for pre-retrieval CT. For IVC filter retrieval with a dwelling time of over 45 days, a tilt of over 15 degrees, the appearance of tip embedding and grade 2 perforation were associated with CR on multivariate analysis. However, for IVC filter retrievals with a dwelling time of less than 45 days, there were no factors associated with CR. CONCLUSION: Pre-retrieval CTs may be more effective for IVC filters with a dwelling time of over 45 days. Therefore, a pre-retrieval CT may be helpful in predicting CR of IVC filters with long dwelling times.

Cutaneous metastasis as an initial presentation of a non-functioning pancreatic neuroendocrine tumor.

Non-functioning pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors that account for 2% of all pancreatic malignancy. About 60% of NF-PNETs present distant metastases and usually hepatic metastases. However, cutaneous metastases are very rare. Herein, we report our experience with a 60-year-old male who visited our outpatient clinic with a mass on his left hip. An abdominal computerized tomography scan demonstrated not only a left hip mass and an enlarged left inguinal lymph node, but also a huge heterogeneous enhancing mass on the pancreas. Initially, we removed the metastatic lesions, which was a small cell neuroendocrine carcinoma with 50% of the Ki-67 index in the histopathological report. After 3 wk, we performed a total pancreatectomy and a total gastrectomy. Four weeks after the 1(st) operation, we detected a recurrence at the operative bed on his left hip, and subsequently removed the recurring mass. The patient was receiving chemotherapy based on etoposide and cisplatin treatment.

Factors affecting anatomical changes after endovascular abdominal aortic aneurysm repair.

BACKGROUND: The primary goal of endovascular aneurysm repair (EVAR) is to prevent death from aneurysm rupture. Regression of aortic sac size is believed to be a marker for success after EVAR. This study analyzes the changes in aneurysm sac size and the factors affecting sac regression after EVAR. PATIENTS AND METHODS: We retrospectively reviewed 121 patients with abdominal aortic aneurysm (AAA) who underwent elective treatment with EVAR at our institution from January 2005 to December 2011. In this study, 17 of the 121 patients were excluded due to loss during follow-up or for not having undergone a postoperative computed tomographic (CT) scan, and 3 patients were excluded due to an isolated iliac artery aneurysm. CT scans were scheduled at months 1, 6, and 12, and annually thereafter. Aneurysm size was defined by the minor axis on the largest axial cut of the aneurysm on a two-dimensional CT scan. Sac regression was defined as a reduction in the diameter of more than 5 mm. RESULTS: Sac regression was observed during follow-up in 39 of the 101 patients. There was 1 regression in 87 patients (1%) at 1 month, 18 in 62 patients at 6 months (29%), 26 regressions in 44 patients (59%) at 12 months, and 18 regressions in 34 patients (53%) at 24 months. After multivariate analysis, the absence of endoleaks was the only factor associated with sac regression (hazard ratio, 3.620; confidence interval, 1.692-7.747; p = 0.001). CONCLUSION: Sac regression over 5 mm is associated with current or previous endoleaks after EVAR. Continued surveillance is necessary in all patients after EVAR to prevent late complications.

Midterm Outcome of Femoral Artery Stenting and Factors Affecting Patency.

PURPOSE: The purpose of this study was to evaluate the early and midterm results of superficial femoral artery (SFA) stenting with self-expanding nitinol stents and to identify the factors affecting patency. MATERIALS AND METHODS: SFA stenting was performed in 165 limbs of 117 patients from January 2009 to December 2013. Patients were followed-up for the first occurrence of occlusion or stenosis based on computed tomography and duplex scan results and a decrease in ankle brachial index of >15%. RESULTS: During the follow-up period (mean, 15.3±3.2 months), no early thrombotic reocclusions occurred within 30 days, but in-stent restenosis developed in 78 limbs. The primary patency rates at 6, 12, 18, and 24 months were 78%, 66%, 42%, and 22%, respectively, and the secondary patency rates were 85%, 72%, 58%, and 58%, respectively. TASC II C or D lesions, stent length >8 cm, number of patent tibial arteries and diabetes were significantly associated with reintervention. CONCLUSION: The midterm results of stenting for SFA occlusive disease were disappointing because the primary and secondary patency rates at two years were 22% and 58%, respectively. Reintervention after SFA stenting remains a major problem, particularly in patients with diabetes mellitus or long TASC II C or D lesions.