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Recanalization of Occluded Iliac Artery Allowing Abdominal Aortic Aneurysm Stent Graft
Introduction
This case presents a patient scheduled to receive a femorofemoral bypass graft in conjunction with aortomonoiliac endograft. Initially, the patient was to undergo an endovascular stent graft repair for his abdominal aortic aneurysm and occluded iliac artery; however, the decision was made to recanalize the long segment occlusion and convert him to a standard bifurcated endograft. Significant literature has been published concerning monoiliac stent grafts, but there have been no reported cases of recanalizing a chronic total occlusion of the iliac with subsequent bi-limb st
Automated Contrast Injection and Targeted Renal Therapy: Strategies to Prevent Contrast-Induced Nephropathy and Treat Renal Insu
It is currently estimated that in the United States there are 15–18 million patients with peripheral arterial disease (PAD), and 18–20 million with diabetes mellitus (DM).1,2 These incidences are increasing, along with the number of PAD patients revascularized with percutaneous peripheral interventions (PPI).2,3 Several factors are likely to increase the number of PPIs performed yearly and therefore, patient contrast exposure. The rapid adoption of multidetector computed tomography angiography (MDCTA) as a noninvasive modality in PAD diagnosis, treatment and follow-up
Management of Detached Accunet Embolic Protection Filter During Percutaneous Carotid Artery Intervention
Introduction
Carotid artery angioplasty and stenting (CAS) has gained acceptance in the past decade as an alternative strategy for management of carotid artery stenosis. The recent SAPPHIRE trial1 has shown that, in high surgical risk patients, CAS is at least as good if not superior to carotid endarterectomy. The initial concern over high thromboembolic complications has been addressed by the introduction of distal embolic protection devices (EPD). Early experience with EPD indicates that they reduce microemboli-related strokes during CAS.2 However, deployment of
Technical Considerations for Renal Artery Stenting
Renal artery stenosis is the most common secondary cause of hypertension (HTN). It affects 5% of the 50 million people with HTN in the United States. Renovascular disease leads to malignant HTN in 10–45% of patients. In patients older than 50 years, it is responsible for 5–15% of the renal failure population, and 10–20% of the end-stage renal disease population. The prevalence of RAS, greater than 60%, has been reported to be 6.8% in patients older than 65 years of age.1
Percutaneous transluminal renal angioplasty (PTRA) was introduced as an alternative to surgery by Grue
Effects of Global Renal Artery Stenting on Chronic Renal Failure
Introduction
The natural history of atherosclerotic renal artery stenosis is characterized by progression, causing hypertension and chronic renal failure (RF). Up to 21% of patients with renal stenosis reducing luminal diameter by more than 60% progress to occlusion within 2 years. Renal stenosis is responsible for renal failure in 15% of adult patients who begin dialysis each year.1–3
Renal angioplasty4 with renal artery stenting (RAS)5–8 has become the procedure of choice in the treatment of stenosis. The technical success and low complication
Distal Vein Patch Bypass for Limb Salvage: An Option When No Vein is Available
Background
As the population ages, an increasing number of patients are in need of lower extremity revascularization. Improvements in surgical, anesthetic, and endovascular techniques provide an increasingly aggressive approach to limb salvage that can be offered to these older and often sicker patients. There is little question that the autologous saphenous vein is the ideal conduit for surgical revascularization, especially to a tibial artery. However, the lack of adequate vein can present a major challenge in the care of these patients. Because of its utility in peripheral and coron
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Frank J. Criado, MD, FACS, FSVM
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CME Showcase
"Diabetic Peripheral Neuropathy"
Upcoming Accredited Webcast Release Date: December 22, 2008 Expiration Date: December 22, 2009 This activity is supported by an educational grant from PamLabs. To register for this Webcast, visit www.naccme.com/program/n-558/ |
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Commentary: In-Stent Restenosis in the Renal Arteries: The Role of Brachytherapy
Stenting of the renal artery is now the procedure of choice in treating obstructive atherosclerotic renal artery disease. Unfortunately, restenosis remains the Achilles’ tendon of this percutaneous therapy, and ranges from 15–25%.1 Several predictors of restenosis following stenting of the renal arteries have been suggested, including small vessel size1,2 (typically < 4.5 mm), length of stented segment,2 time to evaluate for restenosis,1,3 smoking,1 the use of gold-coated stents3 and bilateral renal artery disease.3
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