Ann Vasc Surg Research Articles

On Ten-Year Epidemiological Review of In-Hospital Patients With Marfan Syndrome

On Ten-Year Epidemiological Review of In-Hospital Patients With Marfan Syndrome

Quality Improvement Guidelines for the Treatment of Lower Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal

Suresh Vedantham, MD, Akhilesh K. Sista, MD, Seth J. Klein, MD, Lina Nayak, MD, Mahmood K. Razavi, MD, Sanjeeva P. Kalva, MD, Wael E. Saad, MD, Sean R. Dariushnia, MD, Drew M. Caplin, MD, Christine P. Chao, MD, Suvranu Ganguli, MD, T. Gregory Walker, MD, and Boris Nikolic, MD, MBA, for the Society of Interventional Radiology and Cardiovascular and Interventional Radiological Society of Europe Standards of Practice Committees

Management of traumatic brachial artery injuries: A report on 49 patients

BACKGROUND AND OBJECTIVE:The brachial artery is the most frequently injured artery in the upper extremity due to its vulnerability. The purpose of our study was to review our experience with brachial artery injuries over a 9-year period, describing the type of injury, surgical procedures, complications, and associated injuries.PATIENTS AND METHODS:Forty-nine patients with brachial artery injury underwent surgical repair procedures at our hospital, from the beginning of May 1999 to the end of June 2008. The brachial artery injuries were diagnosed by physical examination and Doppler ultrasonography. Depending on the mode of presentation, patients were either taken immediately to the operating room for bleeding control and vascular repair or were assessed by preoperative duplex ultrasonography.RESULTS:This study group consisted of 43 males and 6 females, ranging in age from 6 to 65 years with a mean (SD) age of 27.9 (6.7) years. The mechanism of trauma was penetrating in 45 patients and blunt in the remaining 4 patients. Stab injury was the most frequent form of penetrating trauma (24 of 45). Treatment included primary arterial repair in 5 cases, end-to-end anastomosis in 28 cases, interposition vein graft in 15 cases, and interposition-ringed polytetrafluoroethylene graft in 1 case. Associated injuries were common and included venous injury (14), bone fracture (5), and peripheral nerve injury (11). Fifteen patients developed postoperative complications. One patient underwent an above-elbow amputation.CONCLUSIONS:Prompt and appropriate management of the brachial artery injuries, attention to associated injuries, and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage.

Comments on “The relation between Helicobacter pylori infection and cardiac syndrome X: A preliminary study", Assadi M, et al.

[1] Garcia Garcia C, Casanovas N, Recasens L, Miranda F, Bruguera J. Spontaneous coronary artery dissection in ergotamine abuse. Int J Cardiol 2007;118:410–1. [2] Shimony A, Romem A, Horowitz S, Boehm R, Horowitz J. Acute coronary syndrome associated with myocardial bridging due to ergotamine treatment for migraine. Int J Cardiol 2006;113:e7–8. [3] Schiff PL. Ergot and its alkaloids. Am J Pharm Educ 2006;70:98. [4] Tfelt-Hansen P, Saxena PR, Dahlof C, et al. Ergotamine in the acute treatment ofmigraine: a review andEuropean consensus. Brain 2000;123: 9–18. [5] Molkara AM, Abou-Zamzam Jr AM, Teruya TH, Bianchi C, Killeen JD. Chronic ergot toxicity presenting with bilateral external iliac artery dissection and lower extremity rest pain. Ann Vasc Surg 2006;20: 803–8. [6] De Costa C. St Anthony's fire and living ligatures: a short history of ergometrine. Lancet 2002;359:1768–70. [7] Demeke T, Kidane Y, Wuhib E. Ergotism—a report on an epidemic, 1977–78. Ethiop Med J 1979;17:107–13. [8] Voyvodic F, Hayward M. Case report: upper extremity ischaemia secondary to ergotamine poisoning. Clin Radiol 1996;51:589–91. [9] Setola V, Hufeisen SJ, Grande-Allen KJ, et al. 3,4-methylenedioxymethamphetamine (MDMA, “Ecstasy”) induces fenfluramine-like proliferative actions on human cardiac valvular interstitial cells in vitro. Mol Pharmacol 2003;63:1223–9. [10] Baldwin ZK, Ceraldi CC. Ergotism associated with HIV antiviral protease inhibitor therapy. J Vasc Surg 2003;37:676–8. [11] Delafuente JC. Understanding and preventing drug interactions in elderly patients. Crit Rev Oncol Hematol 2003;48:133–43. [12] Zhou SF, Zhou ZW, Li CG, et al. Identification of drugs that interact with herbs in drug development. Drug Discov Today 2007;12:664–73. [13] EisenbergDM,KesslerRC, FosterC,NorlockFE,CalkinsDR,Delbanco TL. Unconventional medicine in theUnited States. Prevalence, costs, and patterns of use. N Engl J Med 1993;328:246–52. [14] Shapiro LE, Shear NH. Drug interactions: proteins, pumps, and P-450s. J Am Acad Dermatol 2002;47:467–84. [15] Coats AJ. Ethical authorship and publishing. Int J Cardiol 2009;131: 149–50.

Statins Suppress the Development of Aneurysms: Fact or Fiction?

HomeStrokeVol. 39, No. 8Statins Suppress the Development of Aneurysms: Fact or Fiction? Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBStatins Suppress the Development of Aneurysms: Fact or Fiction? Kosmas I. Paraskevas, MD, FASA Kosmas I. ParaskevasKosmas I. Paraskevas Department of Vascular Surgery, “Red Cross” Hospital, Athens, Greece, Honorary Clinical Research Fellow, Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), Royal Free Hospital, London, UK Search for more papers by this author Originally published3 Jul 2008https://doi.org/10.1161/STROKEAHA.107.521070Stroke. 2008;39:e134Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: July 3, 2008: Previous Version 1 To the Editor:A recent study on rats demonstrated that statins may suppress the development of cerebral aneurysms.1 Similar results were reported in 2 independent experimental studies investigating the effects of statin therapy on abdominal aortic aneurysms.2,3 Compared with placebo, treatment with simvastatin reduced both the overall extent of aortic dilatation, as well as the incidence of abdominal aortic aneurysm development.2,3So far, the beneficial effects of statins on abdominal aortic aneurysm progression in humans have only been supported in 2 observational studies including 1304 and 1505 patients, respectively; regarding cerebral aneurysms, there is no similar report up-to-date.Verification of the positive results from animal studies in randomized controlled trials on humans holds implications for the medical management of both abdominal aortic6 and cerebral1 aneurysms.DisclosuresNone.1 Aoki T, Kataoka H, Ishibashi R, Nozaki K, Hashimoto N. Simvastatin suppresses the progression of experimentally induced cerebral aneurysms in rats. Stroke. 2008; 39: 1276–1285.LinkGoogle Scholar2 Kalyanasundaram A, Elmore JR, Manazer JR, Golden A, Franklin DP, Galt SW, Zakhary EM, Carey DJ. Simvastatin suppresses experimental aortic aneurysm expansion. J Vasc Surg. 2006; 43: 117–124.CrossrefMedlineGoogle Scholar3 Steinmetz EF, Buckley C, Shames ML, Ennis TL, Vanvickle-Chavez SJ, Mao D, Goeddel LA, Hawkins CJ, Thompson RW. Treatment with simvastatin suppresses the development of abdominal aortic aneurysms in normal and hypercholesterolemic mice. Ann Vasc Surg. 2005; 24: 92–101.Google Scholar4 Sukhija R, Aronow WS, Sandhu R, Kakar P, Babu S. Mortality and size of abdominal aortic aneurysm at long-term follow-up of patients not treated surgically and treated with and without statins. Am J Cardiol. 1996; 97: 279–280.Google Scholar5 Schouten O, van Laanen JH, Boersma E, Vidakovic R, Feringa HH, Dunkelgrun M, Bax JJ, Koning J, van Urk H, Poldermans D. Statins are associated with a reduced infrarenal abdominal aortic aneurysm growth. Eur J Vasc Endovasc Surg. 2006; 32: 21–26.CrossrefMedlineGoogle Scholar6 Paraskevas KI, Liapis CD, Hamilton G, Mikhailidis DP. Are statins an option in the management of abdominal aortic aneurysms? Vasc Endovascular Surg. 2008; 42: 128–134.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Paraskevas K (2009) Regarding “The benefit of statins in non-cardiac vascular surgery patients”, Journal of Vascular Surgery, 10.1016/j.jvs.2009.02.213, 49:6, (1636), Online publication date: 1-Jun-2009. August 2008Vol 39, Issue 8 Advertisement Article InformationMetrics https://doi.org/10.1161/STROKEAHA.107.521070PMID: 18599806 Originally publishedJuly 3, 2008 PDF download Advertisement

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We are pleased that you are interested in our report on the endoconduit.1Peterson B.G. Matsumura J.S. Internal endoconduit: an innovative technique to address unfavorable iliac artery anatomy encountered during thoracic endovascular aortic repair.J Vasc Surg. 2008; 47: 441-445Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar In the two subsequent cases mentioned in the case report, the hypogastric arteries were patent, as they have been in two out of three cases utilizing the endoconduit since submission of the original manuscript. We understand your concern regarding back-bleeding from a patent hypogastric artery using the endoconduit technique, but in our experience, the endoconduit alone seems to prevent back-bleeding; and therefore, we do not consider a patent hypogastric artery to be an absolute contraindication to using an endoconduit. Similar findings have been reported in the literature when one considers the absence of type II endoleak with hypogastric artery orifice coverage without coil embolization during the endovascular management of aortoiliac aneurysms.2Tefera G. Turnipseed W.D. Carr S.C. Pulfer K.A. Hoch J.R. Acher C.W. Is coil embolization of hypogastric artery necessary during endovascular treatment of aortoiliac aneurysms?.Ann Vasc Surg. 2004; 18: 143-146Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar In our cases, the controlled ruptures have seemed to take place in the mid-external iliac artery. However, if the area of stenosis that mandates the use of an endoconduit is adjacent to the hypogastric origin and rupture is anticipated in this area, a preemptive strategy of embolizing the hypogastric main trunk when it is patent could be useful to prevent back-bleeding. Once again, we appreciate your interest in our article. We hope that this technique helps you and others address unfavorable iliac anatomy during aortic endovascular procedures, and we agree that larger series are needed to draw definitive conclusions regarding the safety of this technique. Regarding “Internal endoconduit: An innovative technique to address unfavorable iliac artery anatomy encountered during thoracic endovascular aortic repair”Journal of Vascular SurgeryVol. 48Issue 1PreviewWe read with great interest the article of Peterson and Matsumura1 concerning an innovative technique to deal with unfavorable iliac artery anatomy during thoracic endovascular aortic repair (TEVAR). This technique allows for the safe passage of large-profile delivery sheaths during TEVAR by means of the deployment of an iliac stent graft, followed by angioplasty and controlled rupture of the iliac artery. We have found this technique extremely ingenious and simple, although we agree with the authors that a larger series needs to be examined before any conclusions can be made about the safety of this technique. Full-Text PDF Open Archive

Infected splenic artery aneurysm with associated splenic abscess formation secondary to bacterial endocarditis: Case report and review of the literature

Infected aneurysms are rare and may present with rupture or sepsis. Surgical treatment is often required to prevent catastrophic sequelae. Bacterial endocarditis is one of the classic causes of infected aneurysm. We present a case of a 6.1-cm infected splenic artery aneurysm secondary to endocarditis. Surgical treatment consisted of aortic and mitral valve replacements, splenic artery aneurysm resection, and splenectomy. We reviewed five other reported infected splenic artery aneurysms in which documented ruptured had occurred in three patients. Because the rate of rupture in these patients appears to be quite high, infected splenic artery aneurysms require prompt treatment.

Guidelines for the treatment of arterial insufficiency ulcers

1. Co-chaired panel 2. University of Utah, Salt Lake City, UT 3. University of Texas, San Antonio, TX 4. Sinai Hospital/Johns Hopkins Medical Institutions, Baltimore, MD 5. GKT School of Medicine, King’s College, London, UK 6. University of Texas Health Science Center at Houston, TX 7. Sequoia Hospital, Redwood City, CA 8. Maricopa Medical Center, Phoenix, AZ 9. Tufts-New England Medical Center, Boston, MA 10. Southampton University Hospitals Trust NHS, Southampton, UK 11. Penrose–St. Francis Health Services, Colorado Springs, CO 12. Beverly Surgical Associates, Beverly, MA 13. Saint Francis Memorial Hospital, San Francisco, CA 14. Northbay Center for Wound Care, Vacaville, CA, and 15. University of California, San Francisco, CA

Highlights of the Recent Literature on Abdominal Aortic Aneurysm Research

Significant advances have been made since January 2004 when Annals of Vascular Surgery published an Editor's Commentary entitled “Are There Genes for Aneurysms in the Blueprint of The Human Genome?” 1 Kuivaniemi H Are there genes for aneurysms in the blue-print of the human genome?. Ann Vasc Surg. 2004; 18: 2-3 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Here, we highlight some of the most interesting results obtained using genetic, genomic, and proteomic approaches to study abdominal aortic aneurysms (AAAs). We selected these studies (Table I) from over 100 published articles.

Migration of two venous stents into the right ventricle in a patient with May–Thurner syndrome

May–Thurner syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, possibly resulting in pain, severe edema of the left leg or in left iliofemoral deep vein thrombosis [May R, Thurner J. The cause of the predominately sinistral occurrence of thrombosis of the pelvic veins. Angiology 1957; 8: 419–427 [1].]. Corrective surgical treatment requires extensive dissection. Therefore, endovascular venous stenting is currently used in these patients [Lamont JP, Pearl GJ, Patetsios P, Warner MT, Gable DR, Garrett W, et al. Prospective evaluation of endoluminal venous stents in the treatment of the May–Thurner syndrome. Ann Vasc Surg. 2002 Jan; 16(1): 61–4. Epub 2002 Jan 17 [2].]. We present a case of migration of two iliacal vein stents into the right ventricle in a patient with May–Thurner syndrome.

Response: Combined testing of cardiac and carotid artery stenosis?

Response: Combined testing of cardiac and carotid artery stenosis?

For severe carotid stenosis found on ultrasound, further arterial evaluation prior to carotid endarterectomy is unnecessary: the argument against.

Carotid endarterectomy reduces the risk of stroke in certain patients with recently symptomatic carotid stenosis1 and to a lesser extent inpatients with severe asymptomatic stenosis.2 Screening of patients for inclusion in the randomized controlled trials (RCTs) was usually performed with Doppler ultrasound (DU), but conventional arterial angiography (CAA) was required prior to randomization in the RCTs in symptomatic stenosis1 and prior to surgery in ACAS.2 However, CAA is costly, time-consuming, and can cause stroke. A systematic review of prospective studies of the risks of CAA inpatients with cerebrovascular disease reported a 0.1% risk of death and a 1.0% risk of permanent neurological sequelae.3 More recent studies have reported lower risks in both academic centers and community hospitals,4 but many centers have already adopted a policy of operating on the basis of DU alone.5 The main advantage of DU over CAA is the absence of a procedural risk. However, it should be noted that most studies of the risk of CAA classified all strokes that occurred within 24 hours of CAA as procedural complications. Given that the risk of stroke shortly after presentation with symptomatic carotid stenosis and …

Spontaneous Rupture of the Uterine Artery in a Non-Pregnant Woman

Spontaneous rupture of the uterine artery is a rare event. Our Medline search revealed only 4 cases all of which occurred during pregnancy or puerperium. These haemorrhagic events present as acute abdomen with haemodynamic instability. In this report we describe a case of a non-pregnant woman with spontaneous rupture of the uterine artery. The aetiology of the condition is largely speculative. (excerpt)

Gadolinium-enhanced coronary angiography in patients with impaired renal function.

Gadolinium is a contrast agent used routinely for magnetic resonance imaging (MRI). It is safe, well tolerated and has shown no nephrotoxicity at the recommended doses. 1 Spinosa D. Matsumoto A. Hagspiel K. Angel J.F. Hartwell G. Gadolinium-based contrast agents in angiography and interventional radiology. AJR. 1999; 173: 1403-1409 Crossref PubMed Scopus (49) Google Scholar , 2 Hammer F.D. Malaise J. Goffette P.P. Mathurin P. Gadolinium Dimeglumine an alternative contrast agent for digital substraction angiography in patients with renal failure. Transplant Proc. 2000; 32: 432-433 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar , 3 Parodi J.C. Ferreira L.M. Gadolinium-based contrast an alternative contrast agent for endovascular interventions. Ann Vasc Surg. 2000; 14: 480-483 Abstract Full Text PDF PubMed Scopus (21) Google Scholar , 4 Spinosa D.J. Matsumoto A.H. Angle J.F. Hagspiel K.D. Leung D.A. Hartwell G.D. Gadolinium contrast agents their role in vascular and nonvascular diagnostic angiography and interventions. Tech Vasc Interv Radiol. 2001; 4: 45-52 Abstract Full Text PDF PubMed Scopus (10) Google Scholar , 5 Adding L.C. Bannenberg G.L. Gustafsson L.E. Basic experimental studies and clinical aspects of gadolinium salts and chelates. Cardiovasc Drug Rev. 2001; 19: 41-56 Crossref PubMed Scopus (106) Google Scholar Intra-arterial gadolinium has already been used to visualize small and medium size arteries. 6 Nussbaum E.S. Casey S.O. Sebring L.A. Use of gadolinium as an intraarterial contrast agent in digital substraction angiography of the cervical carotid arteries and intracranial circulation. Neurosurg. 2000; 92: 881-883 Crossref Scopus (25) Google Scholar We recently reported the use of gadolinium to perform selective intracranial angiography to visualize an aneurysm before surgical clipping. 7 Slaba S.G. El-Hajj L.F. Abboud G.A. Jebara V.A. Selective angiography of cerebral aneurysm using Gadodiamide in polycystic kidney disease with renal insufficiency. AJR. 2000; 175: 1467-1468 Crossref PubMed Scopus (14) Google Scholar The perfect tolerance of this agent encouraged us to perform the first coronary angiography that used gadolinium. 8 Sarkis A. Badaoui G. Slaba S. Moussalli A. Jebara V. Gadolinium-based coronarography in a patient with renal failure first clinical report. Cathet Cardiovasc Intervent. 2001; 54: 68-69 Crossref PubMed Scopus (19) Google Scholar The aim of this prospective report is to establish the efficacy and safety of gadolinium enhanced with low-dose nonionic contrast agents for coronary angiography in patients with impaired renal function.

Position Statement on the Use of the AnkleBrachial Index in the Evaluation of Patients with Peripheral Vascular Disease: A Consensus Statement Developed by the Standards Division of the Society of Cardiovascular & Interventional Radiology

PERIPHERAL vascular disease (PVD), also known as peripheral arterial disease, affects more than 8–10 million Americans, and its incidence is growing annually ( 1 Weitz JI Byrne J Clagett GP et al. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review. Circulation. 1996; 94: 3026-3049 Crossref PubMed Scopus (733) Google Scholar ). PVD is a risk marker for coronary disease, cerebrovascular disease, aneurysmal disease, diabetes, hypertension, and many other conditions. Patients with objectively documented PVD have a four-to six-fold increase in cardiovascular mortality rate over healthy age-matched individuals ( 2 McDaniel MD Cronenwett JL Basic data related to the natural history of intermittent claudication. Ann Vasc Surg. 1989; 3: 273-277 Abstract Full Text PDF PubMed Scopus (205) Google Scholar ). Fifty percent of people with PVD are symptomatic ( 3 McKenna M Wolfson S Kuller L The ratio of ankle and arm arterial pressure as an independent predictor of mortality. Atherosclerosis. 1991; 87: 119-128 Abstract Full Text PDF PubMed Scopus (450) Google Scholar ). One of the simplest and most useful parameters to objectively assess lower extremity arterial perfusion is the ankle-brachial index (ABI). The ABI helps to define the severity of the disease and successfully screens for hemodynamically significant disease. The Society of Cardiovascular & Interventional Radiology (SCVIR) recommends that all patients being evaluated for peripheral vascular disease should have their ABI measured.

Cerebral oximetry during carotid endarterectomy: Signal failure resulting from large frontal sinus defect

AN INTRAVASCULAR SHUNT is frequently used during carotid endarterectomy when there is concern about the adequacy of collateral cerebral perfusion. There is no consensus on the appropriate criteria for shunt use, however. The cerebral oximeter offers a potentially attractive method to objectively determine the need for a shunt and quantitatively assess its function. Changes in regional cerebrovenous oxygen saturation (rCVOS) apparently reflect changes in cerebral perfusion occurring during carotid endarterectomy. 1 Carlin RE McGraw DJ Calimlim JR et al. The use of near-infrared cerebral oximetry in awake carotid endarterectomy. J Clin Anesth. 1998; 10: 109-113 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar , 2 Samra SK Dorje P Zelenock GB et al. Cerebral oximetry in patients undergoing carotid endarterectomy under regional anesthesia. Stroke. 1996; 27: 49-55 Crossref PubMed Scopus (81) Google Scholar Declines in rCVOS also show generally good agreement with depression in spontaneous electroencephalography (EEG) activity 3 Davidovitch RI, Spire J-P, Schwartz LB, et al: Detection of intraoperative cerebral ischemia during carotid endarterectomy. Ann Vasc Surg (in press) Google Scholar and somatosensory evoked potential amplitude. 4 Cho H Nemoto EM Yonas H et al. Cerebral monitoring by oximetry and somatosensory-evoked potentials (SSEP) during carotid endarterectomy. J Neurosurg. 1998; 89: 533-538 Crossref PubMed Scopus (85) Google Scholar

Difficult Femoral Arteriovenous Fistula in a Child

Difficult Femoral Arteriovenous Fistula in a Child

Acute traumatic rupture of the thoracic aorta: Delayed treatment with endoluminal covered stent. A report of two cases

Acute traumatic rupture of the thoracic aorta: Delayed treatment with endoluminal covered stent. A report of two cases

18.4 Complementary surgical/interventional techniques for nonresective management of “inoperable” aneurysms—A second look

Induced thrombosis (‘‘nonresective’’ therapy) of aortic aneurysms by distal arterial ligation, coil/wire embolization, and extraanatomic bypass was devalued by anecdotal reports emerging during the mid-1980s. Nevertheless, we have recently found the technique to be life-saving in occasional cases and worth revisiting. Since 1990, standard aortic aneurysm repair has been performed in 231 patients (99.1% survival), endovascular aortic aneurysm repair in 6 patients (83.3% survival), and combined surgical/interventional ‘‘nonresective’’ repair of a variety of aneurysms in 10 patients (100% survival). Mean age of the group was 67.9 years. Repair was performed for aortoiliac aneurysms (4), common iliac aneurysms (3), internal iliac aneurysms (2), and a large proximal subclavian artery pseudoaneurysm (1). Four of the patients had been explored and declared to be ‘‘inoperable’’ (retroperitoneal fibrosis) prior to transfer to the Columbia-Presbyterian Medical Center. All patients survived. Aneurysm rupture has not occurred in any patient, but one patient with a presumably thrombosed subclavian pseudoaneurysm presented 26 months postcoil-induced thrombosis with progressive aneurysm enlargement due to incomplete aneurysm thrombosis and required repair using circulatory arrest. Eight of the patients remain alive (80%) at a mean follow-up of 40.3 months (range 14-88 months). Two patients died of malignancy (30 months) and cardiac disease (15 months). It is concluded that combined surgical/interventional techniques can be life-saving in the rare instances when conventional or endovascular aneurysm repair is not advisable but that complete aneurysm thrombosis is essential and occasionally difficult to achieve. Since small proximal portions of the aneurysm may remain patent and not be visualized on magnetic resonance imaging (MRI) or computed tomography (CT) scans, contrast angiographic documentation of complete aneurysm thrombosis is essential prior to hospital discharge and close follow-up is necessary to ascertain long-term adequacy of the repair. Incomplete thrombosis is suspected as a major factor in earlier reports of aneurysm rupture after seemingly successful nonresective therapy. (Ann Vasc Surg 1998;12:248-254.)

Use of Endovascular Grafts to Treat Nonaneurysmal Arterial Disease

Soon after the first successful clinical report of endovascular grafting for the treatment of abdominal aortic aneurysms by Parodi et al. in 1991, the applications for endovascular grafting expanded to include virtually all types of arterial pathology, including occulsive disease and vascular trauma. Treating a vascular lesion from a remote access site by placing a graft within the lumen or wall of an artery is fundamental to the techniques of all endovascular grafting procedures. Although this concept seems new, it is simply a blending of preexisting technologies, that is, stents and prosthetic grafts in an effort to improve the properties of both devices and reduce their inherent limitations. Both intravascular stents and standard bypasses performed with prosthetic grafts have the best results in large-caliber arteries, such as the iliac arteries, when compared with smaller peripheral vessels, such as the superficial femoral artery. Similarly, the collected results of endovascular grafting presented in the following tables suggest greater durability for endovascular grafts in the aortoiliac circulation and in other central vessels than when these devices are used for infrainguinal arteries. The following tables (Tables I-X) summarize endovascular graft treatments for nonaneurysmal arterial disease. Since these independent series were frequently reported in a noncontrolled, nonstandardized fashion, there is uncertainty about comparative analyses of the reported outcomes. In addition, the small number of cases and limited follow-up are proof of the infancy of this field. (Ann Vasc Surg 1997;11:200-205.) From the Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, New York, NY (M.L.M., F.J.V.); First Department of Surgery, Jikei University School of Medicine, Tokyo, Japan (T.O.). Correspondence to: M.L. Marin, MD, Division of Vascular Surgery, Montefiore Medical Center, 111 East 210th Street, New York, NY 10467, USA.