Rate Of Recurrent Stenosis Research Articles

More reassuring safety data regarding paclitaxel-eluting technologies in lower extremity revascularization

Paclitaxel-eluting technologies (PET), drug-coated balloons (DCB), and drug-eluting stents may be associated with decreased rates of recurrent stenosis and repeat revascularization.1 A recent study-level meta-analysis of 28 randomized controlled trials (RCTs) comparing PET vs plain-old balloon angioplasty (POBA) in peripheral arterial disease concluded that PET were associated with an increased risk of late mortality.1,2 The analysis suffers from several flaws.

Comprehensive comparison of carotid endarterectomy primary closure and patch angioplasty: A single-institution experience.

Background: Carotid endarterectomy (CEA) is an effective intervention for the treatment of high-grade carotid stenosis. Technical preferences exist in the operative steps including the use patch for arteriotomy closure. The goals of this study are to compare the rate of postoperative complications and the rate of recurrent stenosis between patients undergoing primary versus patch closure during CEA.Methods: Retrospective chart review was conducted for patients who underwent CEA at single institution. Vascular surgeons mainly performed patch closure technique while neurosurgeons used primary closure. Patients’ baseline characteristics as well as intraprocedural data, periprocedural complications, and postprocedural follow-up outcomes were captured.Results: Seven hundred and thirteen charts were included for review with mean age of 70.5 years (SD = 10.4) and males representing 64.2% of the cohort. About 49% of patients underwent primary closure while 364 (51%) patients underwent patch closure. Severe stenosis was more prevalent in patients receiving patch closure (94.5% vs. 89.4%; P = 0.013). The incidence of overall complications did not differ between the two procedures (odds ratio = 1.23, 95% confidence intervals = 0.82–1.85; P = 0.353) with the most common complications being neck hematoma, strokes, and TIA. Doppler ultrasound imaging at 6 months postoperative follow-up showed evidence of recurrent stenosis in 15.7% of the primary closure patients compared to 16% in patch closure cohort.Conclusion: Both primary closure and patch closure techniques seem to have similar risk profiles and are equally robust techniques to utilize for CEA procedures.

A single-centre, retrospective analysis of mortality over 80 months comparing paclitaxel-coated balloon versus standard balloon angioplasty in the treatment of dysfunctional arteriovenous access.

Percutaneous transluminal angioplasty (PTA) is a standard treatment for arteriovenous fistula (AVF) stenosis to preserve haemodialysis vascular access, promoting improved dialysis adequacy and better outcomes for those dependent on renal replacement therapy. Drug coated balloons (DCB) may help reduce the rate of neointimal hyperplasia and recurrent stenosis, but their use in femoropopliteal angioplasty has been associated with increased mortality at 2 and 5 year follow-up. This study aims to address the long-term safety of PTA for AVF stenosis with clinical correlation to participant co-morbidity and mortality. All patients undergoing PTA for AVF stenosis at a single centre between 2013 and 2017 were identified and grouped according to the use of DCB versus standard balloon angioplasty. All data was anonymised and correlated to verify independent predictors of mortality. 481 (400 standard balloon; 81 DCB) procedures were performed in 313 patients (250 standard balloon; 63 DCB). Follow-up at 80 months did not show any difference in mortality (p = 0.546). Multivariate analysis identified time on dialysis (p < 0.001), age (p = 0.001) and Charlson comorbidity index (p = 0.02) as independent predictors of mortality. In this study, mortality was not associated with the use of DCBs, but was related to established factors of dialysis longevity, age and comorbidity.

Carotid endarterectomy with saphenous vein patch angioplasty: a single-center experience.

When performing a conventional CEA it is recommended the use of patch angioplasty (PA), since previous meta-analyses have shown PA to be superior to primary closure (PRC) in terms of stroke and restenosis rates. Different materials patches can be employed although none of them has been proved to be superior. Although autologous veins are potentially more resistant to immediate thrombosis as well as infection, cons may be represented by patch rupture and late dilatation. Aim of this study is to evaluate immediate and long-term results of CEA with saphenous vein patch angioplasty (SVPA) in a single-center experience. A retrospective study was performed analyzing all patients undergoing CEA with SVPA at our institution from January 2012 to March 2020. CEA was performed in symptomatic patients with 50-99% carotid stenosis degree or asymptomatic patients with 70-99% stenosis degree. Exclusion criteria were critical limb ischemia, varicose disease, unavailability of saphenous veins, vein diameter <3.5 mm. All CEAs were performed under general anesthesia with routine shunting. Primary endpoints were perioperative stroke, death, carotid thrombosis and hematoma requiring surgery rates. Secondary endpoints included the rate of recurrent stenosis >70%, patch aneurysm/rupture/infection at follow-up. Overall, 488 interventions were performed on 461 patients. Most patients were male (77.8%) with a mean age of 71.2±8.3 years. Thirty-day mortality and stroke rates were 0.4% and 1.2% respectively. Carotid thrombosis occurred in five patients (1%). Five patients (1%) developed a surgical site hematoma requiring surgical drainage. At a mean follow-up of 34.4±25.8 months 12 restenoses (2.5%) were detected. Five-year freedom from restenosis rate was 96.7%. Restenosis at follow-up was more frequent in patients who had contralateral carotid stenosis (P=0.019). Two patients (0.4%) developed carotid patch aneurysmal degeneration at a mean follow-up of 78.7 months. No infection nor patch disruption were detected. CEA with SVPA resulted safe and effective in terms of early and late results. The perioperative complications rates we recorded were quite similar to those reported by other larger reviews and meta-analyses.

The Rare Occurrence of Reoperation After Cervical Laminoplasty: A 14-Year Retrospective Review of Reoperative Rates at a Single Institution.

Retrospective cohort study. To determine the rate of recurrent or adjacent-level stenosis requiring reoperation after single-door cervical laminoplasty for spondylotic myelopathy at our institution. Adjacent-level stenosis requiring reoperation is a commonly evaluated condition for anterior or posterior arthrodesis, however, there are few studies that evaluate adjacent-level stenosis in the case of cervical laminoplasty. Retrospective review of adults undergoing cervical laminoplasty for spondylotic myelopathy between January 2005 and May 2018 at our institution. Demographics, symptom duration, stenotic levels, preoperative and postoperative Medical Research Council motor, American Spinal Injury Association, modified Japanese Orthopaedic Association scores, and Nurick grade were obtained. Postoperative data included presence of C5 palsy, infection rate, alleviation or persistence of symptoms, and rate of recurrent or adjacent-level stenosis. A total of 102 patients underwent cervical laminoplasty; mean age was 56.7 years (±12.96). Most were men (n=76, 74.5%), with myelopathy (n=64, 63.4%), C4 (n=94, 93.1%), and C5 (n=92, 91.1%) cervical stenosis; mean symptom duration was 55 days (7 d to 2.8 y). Average follow-up was 6.4 months (±3.4). After surgery, there was statistically significant improvement in Nurick grade (3.1±2.2 vs. 2.7±2.4, P=0.002) and modified Japanese Orthopaedic Association score (11.4±3.7 vs. 13.9±3.6, P<0.001); American Spinal Injury Association scores also improved (P<0.001). Rate of postoperative C5 palsy was 7.8% (n=8); postoperative infection rate was 1.96% (n=2). Reoperation rate was 4.9% (n=5); reoperation for recurrent or adjacent-level stenosis was 1.96% (n=2). Recurrent or adjacent-level stenosis requiring reoperation after cervical laminoplasty is rare. Longitudinal studies are needed to verify correlation between motion preservation and incidence of adjacent or recurrent stenosis. Level III-treatment benefits: nonrandomized controlled cohort/follow-up study.

P1337ENDOVASCULAR REVISION OF ARTERIOVENOUS ANASTOMOSIS BY DOUBLE GUIDE TECHNIQUE

Abstract Background and Aims Juxta-anastomotic stenosis is the most frequent complication of arteriovenous fistula (AVF) for haemodialysis (HD). Treatment options are surgical bypass by creating a more proximal anastomosis or endovascular treatment by angioplasty. The available literature data show equal outcomes in term of secondary patency, but a significantly higher rate of recurrent stenosis for endovascular treatment (0.5 procedure/AVF/year). We describe the results of endovascular treatment by “double guide technique” (DGT) as to Turmel Rodrigues original description, in a series of patients referred to our centre. Method We describe all consecutive patients treated by DGT in the first semester of 2018 because of a de novo occurring juxta-anastomotic stenosis of the arteriovenous fistula for haemodialysis. The procedure was carried out as described by Turmell Rodrigues. In short: by means of a single retrograde access through the outflow vein by a 6 french valved introducer, two guide wire are navigated into both proximal and distal artery. Two consecutive dilatation of the anastomosis area are then performed including first the juxta-anastomotic vein at 6 to 7 mm (mean 6.7mm, ds 0.55), followed by the juxta-anastomotic artery at 4mm (mean 4.1mm, ds 0.33), as show in figures. Follow up was carried out at 1, 3, 6 12 month by clinical examination and ultrasound examination. Prospectively collected data was analyzed retrospectively. Results 25 patients were treated during the first 6 month of 2018 by a single operator. Patients data (mean): age 71years, HD vintage 31month, AVF vintage 31month. AVF distribution were: distal radio-cephalic 32%, proximal radio-cephalic 52%, distal ulnar-basilic 8%, humero-basilic 8%. Mean preoperative AVF blood flow - as measured by duplex ultrasound (US) - was 540ml/min. 32% of AVF have preoperative blood flow &amp;gt;600ml/min but a critical stenosis (&amp;lt;1.9mm of diameter). Mean juxta-anastomotic vein and juxta-anastomotic artery ballon diameter were 6.7mm (ds 0.55) and 4.1mm (ds 0.33) respectively. Overall mean blood flow at 12 month was 830ml/min. During follow up 3 patients required endovascular treatment of some new occurring stenosis, 3 patients were lost to follow up at 12 month, 1 patient died from unrelated reasons. In 52% of patients any other revision was required, while 32% required 1 further angioplasty, 4% 2 further angioplasty and 4% 4 further angioplasty of the target lesion during the following 12 month (recurrence rate: 0.28 procedure/patients/year). Assisted functional patency at 12month was 95%. Conclusion Endovascular treatment of juxta-anastomotic AVF stenosis by the DGT performed quite satisfactorily in our series and showed a low recurrence on the target lesion compared to data from literature. At 12 month the average AVF blood flow was below 1000ml/min. The technical advantage of the DGT consist in the single, small caliber percutaneous access, needed to complete the procedure. A larger series would confirm how this refinement of the technique compares with the improved results we preliminary observed.

Local anesthetic with sedation is a viable alternative to general anesthesia for lumbar spinal decompressions: A retrospective cohort feasibility study and short-term analysis of outcomes

Background: An increasing focus on value-based care in spine surgery has prompted interest in alternative anesthetics. Avoidance of general anesthesia (GA) has gained support due to reductions in postoperative symptoms. Little has been published on local anesthesia with sedation techniques. Methods: A retrospective chart review was performed to compare outcomes of lumbar decompression using local anesthesia with light intravenous sedative (LIS) and lumbar decompression using general anesthesia. Outcomes reported were 90-day adverse events, reoperations, and narcotic use. Results: A total of 65 patients who underwent lumbar decompression were identified. Patients receiving LIS were older and had more comorbidities compared with those receiving GA. Rates of peripheral vascular disease and peptic ulcer disease were higher in patients receiving LIS (P=0.004 and 0.012, respectively). The overall rate of postoperative adverse events was 30% lower in patients with LIS. There were no aborted procedures in the LIS cohort. Rates of reoperation trended towards being lower in LIS (14.3%) versus the GA group (37.8%). There was no difference in postoperative narcotic use (LIS 17.9%, GA 24.3%, P=0.530). After adjusting for age, gender, body mass index, Charlson Comorbidity Index, and peripheral vascular disease, the rate of adverse events remained lower in the LIS group (odds ratio: 0.166 [95% CI: 0.037, 0.617], P=0.011), and the trends towards lower rates of recurrent stenosis (P=0.082) and reoperation (P=0.082) remained. There was still no difference in the rate of postoperative narcotic use beyond the first follow-up (P=0.542). Conclusions: Lumbar spinal decompressions are commonly performed surgeries, and they are increasingly being performed in outpatient settings. We conclude that LIS is a safe alternative to GA. Further work is needed to identify cost savings in LIS spine surgery and define patient characteristics that identify appropriate candidates. Level of Evidence: Level III.

P138. Local anesthetic and sedation works as well as general anesthesia for lumbar spinal decompressions: a short-term analysis of outcomes

BACKGROUND CONTEXT An increasing focus on value-based care in elective spine surgery has prompted interest in alternative modalities of surgical intervention. Avoidance of general anesthesia (GA) is one modality that has recently gained support due to reductions in postoperative symptoms related to general anesthetics. Some patients with operative spine pathology cannot tolerate a GA due to comorbidities or other issues that preclude RA or GA. Our goal was to determine the complication rate of lumbar spinal decompression under local anesthesia with IV sedation (LIS) compared to patients decompressed under general anesthesia. PURPOSE Our goal was to determine the complication rate of lumbar spinal decompression under local anesthesia with IV sedation (LIS) compared to patients decompressed under general anesthesia. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients were selected from a single surgeon's case series of lumbar decompression performed with local and sedation only and comapred to the same cases perfmed with GA at approximately the same date. OUTCOME MEASURES Outcomes reported are 90-day complications (wound complication, DVT, PE, dural tear, UTI, urinary retention, neurologic injury or recurrent stenosis) and reoperations, and postoperative narcotic use. METHODS Retrospective chart review of lumbar decompressions with at least 90-day follow up from a single surgeon was performed to evaluate patient outcomes with local anesthetic and sedation only versus GA. Outcomes reported are 90-day complications (wound complication, DVT, PE, dural tear, UTI, urinary retention, neurologic injury or recurrent stenosis) and reoperations, and postoperative narcotic use. Univariate differences between groups were assessed with chi-squared and Fisher's exact tests for categorical variables and independent samples t-tests for continuous variables. Multivariable logistic regression analyses adjusted for age, sex, body mass index (BMI), and Charlson Comorbidity Index (CCI), and any additional factors with p RESULTS A total of 65 lumbar decompression patients were identified (73.9% female, age 75.4±10.8 years): 28 local and 37 GA. The local cohort is the entire group of patients that have undergone the procedure in the past 10 years from the lead surgeon's practice. The GA patients were selected randomly for comparison. LIS patients were older (p =0.004) and more comorbid (CCI p =0.012) than those having GA. Rates of PVD and PUD were higher in local patients (p =0.004 and 0.012, respectively). Despite this, the overall rate of postoperative complications was more than 30% lower in LIS vs GA patients (local =25.0%, GA = 56.8%, p =0.013), in part due to a trend toward lower rates of recurrent stenosis in local patients (p =0.073). Rates of reoperation trended toward being lower in local (14.3%) versus GA (37.8%) patients (p =0.050). There was no difference in postoperative narcotics (local 17.9%, GA 24.3%, p =0.530). After adjusting for age, sex, BMI, CCI, and PVD, the rate of complications was still lower in the LIS group (odds ratio: 0.166 (95% CI: 0.037, 0.617), p =0.011), and the trends toward lower rates of recurrent stenosis (p =0.082) and reoperation (p =0.082) remained. There was still no difference in the rate of postoperative narcotics (p=0.5416) after adjustment. CONCLUSIONS Lumbar spinal decompressions are a commonly performed surgery and there is an increasing trend toward these being performed in the outpatient setting. The use of local anesthetic and sedation for anesthesia may have significant benefits, but there is a paucity of data analyzing spine surgery done in this manner. We analyzed the results of a single surgeon's series of lumbar spinal decompression with LIS and conclude this is a safe alternative to decompressions under general anesthesia. Further work is needed to better identity specific cost savings in LIS spine surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Reoperation Rate After Microsurgical Uni- or Bilateral Laminotomy for Lumbar Spinal Stenosis With and Without Low-grade Spondylolisthesis: What do Preoperative Radiographic Parameters Tell Us?

Retrospective single-center cohort study. The aim of this study was to analyze the influence of preoperative radiographic parameters on reoperation rates after microsurgical laminotomy for lumbar spinal stenosis (LSS). Decompression for symptomatic LSS has shown to be effective. However, the optimal surgical strategy remains a matter of debate, especially with underlying spondylolisthesis. Adult patients with LSS who underwent primary laminotomy without fusion between January 2012 and September 2013 at our institution were included for analysis. Disc height (in mm), facet joint (FJ) orientation (degrees), and grade of spondylolisthesis of all surgical index levels (SILs) were analyzed from preoperative magnetic resonance imaging. Patients were contacted in January 2017 by follow-up phone call (mean follow-up 49 months) regarding lumbar reoperation. A total of 161 patients (mean age 68.5 yrs, ±11.3) and 236 SILs were analyzed. Fifty-six patients (34.8%) had low-grade spondylolisthesis involving 60 SILs (25.4%). Twenty-four patients (14.9%) underwent reoperation involving 32 levels. Of latter, 23 SILs (9.7%) had recurrent stenosis (RS) and 9 (3.8%) had adjacent level stenosis. Five patients in total (3.1%) required secondary fusion; all had preexisting spondylolisthesis. SILs with spondylolisthesis had a significantly higher rate of RS requiring reoperation compared with SILs without spondylolisthesis [18.3% (11/60) vs. 6.8% (12/176), P = 0.013]. Disc height and FJ orientation showed no significant difference between patients with and without reoperation, or with and without spondylolisthesis. Decompression alone is reasonable for most patients with LSS and stable low-grade spondylolisthesis. The overall reoperation rate and need for secondary fusion were low in our series. However, patients with spondylolisthesis had a higher rate of reoperation for RS after laminotomy without fusion. This must be taken into account for preoperative risk-benefit analysis, tailored surgical decision making and patient counseling. 4.

Minimally Invasive Aortobiilliofemoral Endarterectomy for Aortoiliac Occlusive Disease Is a Compelling Alternative to Bypass.

Aortobifemoral bypass is a time-honored, durable surgery allowing restoration of lower extremity blood. However, the potential for significant complications exists, impacting mortality, morbidity, and quality of life. Minimally invasive aortobiiliofemoral endarterectomy offers an alternative to prosthetic bypass and its associated complications. Here, we present a case series using remote endarterectomy for aortoiliac occlusive disease. Nine patients with aortoiliac occlusive disease were treated at a single institution, by a single surgeon, with direct and remote endarterectomy combination. Standard femoral access approach was used. A limited longitudinal distal aorta arteriotomy into the right common iliac artery to the hypogastric bifurcation was made. Then, an open thromboendarterectomy was performed. Circumferential common femoral endarterectomies were performed bilaterally and the plaque transected, allowing manually controlled Vollmar ring passage proximally to the iliac bifurcation on the right and the aortic bifurcation on the left. Aortoiliac arteriotomy was closed, followed by the femoral arteriotomies. Morbidity, secondary interventions, recurrent stenosis (adjacent segment velocity ratios ≥2), ankle-brachial index (ABI), and patency rates were tracked postoperatively for 6 years. Kaplan-Meier life-table analysis was used to determine patency rates per the criteria of SVS and ISCS. The average age was 59.1 years (54-87 years), and 88% were male. Comorbidities included hypertension (75%), former/current smokers (100%), and prior PAD surgical intervention (38%). Revascularization of 100% was achieved, with average ABI improving from 0.42 preoperatively to 0.92 postoperatively (0.91 at 8-month follow-up). Six-year patency rate was 100% without reintervention. Incidence of myocardial infarction, stroke, death, amputation, intestinal ischemia, sexual dysfunction, and aneurysmal degeneration was zero after 6 years of follow-up. Minimally invasive aortobiiliofemoral endarterectomy is a viable alternative to aortobifemoral bypass for the treatment of aortoiliac occlusive disease, allowing reestablishment of normal anatomic anatomy while avoiding the use of prosthetic material. Patency rates in this series was 100% at 6 years, with minimal postoperative complications or morbidity.

Impact of routine completion angiography on outcome after carotid endarterectomy

ObjectiveThe objective of this study was to analyze the impact of completion digital subtraction angiography (cDSA) after carotid endarterectomy (CEA) on technical and early clinical results. MethodsThis retrospective study included consecutive patients undergoing CEA from January 2011 to January 2015. Routine cDSA was performed in all patients. Study end points were the incidence of pathologic findings on completion angiography necessitating intraoperative revision, type of revision, periprocedural stroke rate, mortality, morbidity, and recurrent stenosis rate during follow-up (median, 5 months; range, 0-39 months). ResultsThere were 827 procedures performed in 770 patients (male, 72.5%; median age, 70.6 years) with extracranial internal carotid artery (ICA) stenosis (asymptomatic, 57.3%); 426 patients underwent conventional endarterectomy (cCEA) with patch angioplasty (51.6%), 393 patients (47.5%) received an eversion technique (eCEA), and 8 patients (1%) underwent other revascularization. Immediate surgical revision based on angiographic findings after CEA was performed in 6.9% (57/827) of cases. Reasons for revision of the ICA were mural thrombus in 7.0% (4/57), dissections in 7.0% (4/57), residual stenosis in 8.7% (5/57), and intimal flaps of ICA in 1.8% (1/57). In six cases, combined pathologic changes of the ICA and external carotid artery led to revision. Thirty-five revisions (4.2%) were performed for isolated pathologic angiographic findings of the external carotid artery; in two cases, revision was performed for residual stenosis of the common carotid artery. There was no significant difference regarding the frequency of revision between surgical techniques (cCEA, 56.4%; eCEA, 63.6%; P = .76). However, mural thrombus as a reason for revision was more common in the cCEA group; plaque residues were more common in the eCEA group. Periprocedural (30-day) stroke rate was 0.5% (4/827); six additional patients suffered transient ischemic attack (0.7%). The mortality rate within 30 days was 0.1% (1/827); 30-day morbidity was 4.2% (35/827). The rate of recurrent stenosis (>50%) during follow-up was 0.8%. There was no significant correlation between pathologic findings on cDSA with consecutive revision and perioperative stroke rate, recurrent stenosis rate, mortality, or morbidity. ConclusionsIn this study, cDSA after CEA detected findings leading to immediate intraoperative surgical revision in a relevant proportion of cases. Therefore, cDSA represents a reasonable quality control without being associated with significantly prolonged operating times. Whether cDSA reduces perioperative stroke rate, procedure-related mortality, morbidity, or incidence of early recurrent stenosis cannot be proven with the current study design.

A Matched Case-Control Study on Early and Late Results of Carotid Endarterectomy Performed in Young Patients.

The aim of the study was to describe the perioperative and long-term results of carotid endarterectomy (CEA) in patients aged 60 or less and compare them to patients of more advanced age in a retrospective single-centre case-control study. From January 1996 to December 2014, 5893 consecutive CEAs were performed in our institution. Data concerning these interventions were prospectively inserted in a dedicated database. A retrospective analysis of that database was performed and 457 interventions performed in patients aged 60 or less were found (group 1). The control group was represented by 457 interventions selected from the remaining 5436 by a one-to-one coarsened exact matching on the basis of all the baseline demographic and clinical covariates significantly different in the two groups (group 2). The two groups were compared in terms of intraoperative technical features and perioperative (<30days) results of interventions (transient ischaemic attack-TIA, stroke and death rates) with χ 2 test. Follow-up data were analysed by life-table analysis (Kaplan-Meier test) in terms of survival, stroke-free and neurological symptom-free survival, freedom from severe restenosis and occlusion and freedom from reintervention, and the results in the two groups were compared by means of log rank test. There were no differences between the two groups in terms of clinical presentation and of degree of carotid stenosis on operated side. Anaesthesiological and surgical details were also similar between the two groups. Thirty-day stroke and death rate was 0.6% in both groups (p=0.9). Follow-up was available for 877 patients (96% of the study group) with a mean duration of 50months. Estimated 10-year survival rates were 85% in group 1 (SE 0.03) and 76% in group 2 (SE 0.04, p=0.003, log rank 8.9). At the same time interval, stroke-free survival was also significantly better in group 1 (85%, SE 0.035) than in group 2 (72.5%, SE 0.03; p=0.002, log rank 10.1). The corresponding figures in terms of any neurological symptom-free survival were 82.8% in group 1 (SE 0.04) and 70.3% in group 2 (SE 0.04, p=0.002, log rank 9.7). Estimated freedom from severe restenosis and occlusion was 76.5% in group 1 (SE 0.04) and 88.5% in group 2 (SE 0.035, p=0.001, log rank 11.9). Disease recurrence was symptomatic in six cases, three in each group. Estimated freedom from reintervention rates at 10years was 87% in group 1 (SE 0.035) and 91.5% in group 2 (SE 0.03; p=0.2, log rank 1.1). CEA in patents aged 60 or less is safe and provides significantly better long-term results than those obtained in patients over 60 in terms of survival and stroke-free survival. Younger patients appear to have higher rates of recurrent carotid stenosis compared to the older cohort; however, these rarely require a secondary intervention.

Results of Carotid Endarterectomy Using Bovine Pericardium Patch Closure, with a Review of Pertinent Literature

Patch closure after carotid endarterectomy lowers risk of recurrent stenosis and perioperative neurologic events. Although vein patches have theoretic benefits, few differences between vein and nonautologous patches have been noted. Bovine pericardium has been increasingly used in carotid surgery over the last 15 years, with favorable reports. This study reviews a large carotid surgery series using this patch. Data were gathered on 464 consecutive carotid operations using the bovine pericardium patch; all complications were analyzed and pertinent literature review was performed. Of 464 procedures, 218 (47%) were performed for symptomatic disease. Total perioperative ipsilateral stroke rate was 0.65 per cent. A low rate of postoperative bleeding was noted. Recurrence of >70 per cent stenosis was 1.6 per cent at follow-up of 26 months in 410 patients. Handling was subjectively described as excellent. Literature review comprising 3239 carotid operations revealed low risks of stroke, bleeding requiring intervention, or high rates of recurrent stenosis. Bovine pericardium patch angioplasty has low perioperative and late complications and good handling characteristics, making it an acceptable choice for use in carotid surgery.

Canalplasty for Exostoses With Maximal Skin Preservation With Temporoparietal Fascia Grafting and Use of Bone Wax for Skin Flap Protection: A Retrospective Case Series.

External auditory canal exostoses are benign, bony overgrowths that arise in patients who experience chronic cold water exposure. While considerable advancement has been made in canalplasty techniques in recent decades, many patients continue to experience prolonged healing periods and recurrent stenosis following surgery. To perform a retrospective outcomes analysis of our experience with a skin-preserving canalplasty technique with temporoparietal fascia grafting and use of bone wax for skin flap protection. Retrospective review. Thirty-four patients (41 ears) underwent canalplasty from 2008 to 2014 at a tertiary referral center. Primary outcome measures included rates of prolonged healing and restenosis, need for revision surgery, and audiometric results. Rates of intraoperative and postoperative complications were also tabulated. No patient experienced recurrent stenosis or required a revision surgery within the follow-up period. All but one patient (97%) achieved complete healing within 8 weeks. Minimal intraoperative complications were found. Statistically significant improvements in air pure tone averages and air-bone gaps were achieved. The proposed technique is a safe and effective method of canalplasty for exostoses that imparts accelerated wound healing and minimizes the rate of recurrent stenosis.

Risk of recurrent or refractory strictures and outcome of endoscopic dilation for radiation-induced esophageal strictures

Radiation therapy for head, neck, and esophageal cancer can result in esophageal strictures that may be difficult to manage. Radiation-induced esophageal strictures often require repeat dilation to obtain relief of dysphagia. This study aimed to determine the long-term clinical success and rates of recurrent and refractory stenosis in patients with radiation-induced strictures undergoing dilation. Retrospective cohort study of patients with radiation-induced strictures who underwent endoscopic dilation by a single provider from October 2007-October 2012. Outcomes measured included long-term clinical efficacy, interval between sessions, number of dilations, and proportion of radiation strictures that were recurrent or refractory. Risk factors for refractory strictures were assessed. 63 patients underwent 303 dilations. All presented with a stricture >30 days after last radiation session. Clinical success to target diameter was achieved in 52 patients (83%). A mean of 3.3 (±2.6) dilations over a median period of 4 weeks was needed to achieve initial patency. Recurrence occurred in 17 (33%) at a median of 22 weeks. Twenty-seven strictures (43%) were refractory to dilation therapy. Fluoroscopy during dilation (OR 22.88; 95% CI 3.19-164.07), severe esophageal stenosis (lumen <9 mm) (OR 10.51; 95% CI 1.94-56.88), and proximal location with prior malignancy extrinsic to the lumen (OR 6.96; 95% CI 1.33-36.29) were independent predictors of refractory strictures in multivariate analysis. (1) Radiation-induced strictures have a delayed onset (>30 days) from time of radiation injury. (2) Endoscopic dilation can achieve medium-term luminal remediation but the strictures have a high long-term recurrence rate of up to 33%. (3) Remediation of radiation strictures following laryngectomy can be achieved but require frequent dilations. (4) Clinical and procedural predictors may identify patients at high risk of refractory strictures. (5) The optimal strategy in highly selected refractory patients is not clear.

TCT-542 Laser Atherectomy for Treatment of Femoropoliteal In-Stent Restenosis

Femoropoliteal in-stent restenosis (FP-ISR) is associated with high rates of recurrent stenosis and stent occlusion after endovascular therapy. Laser atherectomy provides neointimal debulking and possible subsequent improved patency in the treatment of FP-ISR. All cases of FP-ISR treated between

Clinical outcomes following sublaminar-trimming laminoplasty for extensive lumbar canal stenosis

Current surgical approaches for treatment of lumbar canal stenosis are often associated with relatively high rates of reoperation and recurrent stenosis. We have developed a new approach for treatment of this condition: sublaminar-trimming laminoplasty. To describe the surgical approach of sublaminar-trimming laminoplasty and to assess associated outcomes. Patients with extensive lumbar canal stenosis who received sublaminar-trimming laminoplasty from 2006 to 2008 were considered for inclusion in the study. The surgery comprised aspects of laminotomy and laminectomy. The following were assessed before surgery and 3years after surgery: leg and back pain by visual analog scale (VAS), extent of disability by Oswestry Disability Index (ODI), severity of back pain by Japanese Orthopedic Association Score for Back Pain (JOA), walking tolerance, and leg numbness. Complications were noted. A total of 49 patients were included in the study (mean age 65.6±10.6years). VAS leg and back pain, ODI, and JOA scores significantly changed from before surgery to 3years after surgery (P<0.001). Mean changes (95% confidence interval) were -6.2 (-6.7, -5.7), -4.3 (-4.8, -3.8), -21.4 (-23.4, -19.5), and 13.4 (12.1, 14.7) for leg pain, back pain, ODI, and JOA scores, respectively. Patients experienced significant improvements in walking tolerance and leg numbness (P<0.001). There were no instances of recurrent stenosis or postoperative spinal instability. Complications included intraoperative dural tear (n=2), postoperative urinary tract infection (n=2), and inadequate decompression and junctional stenosis during follow-up (both n=1). Sublaminar-trimming laminoplasty shows promise as an effective treatment for extensive lumbar canal stenosis.

Part One: For the Motion. Completion Angiography Should be Used Routinely Following Carotid Endarterectomy

Part One: For the Motion. Completion Angiography Should be Used Routinely Following Carotid Endarterectomy

The Durability of Carotid Endarterectomy

Carotid endarterectomy is a low-risk treatment for carotid occlusive disease. Recent clinical trials have suggested that carotid angioplasty may be a viable alternative. One important issue that has not been evaluated is the long-term recurrent stenosis rate after either intervention. To examine the risk of recurrent stenosis after carotid endarterectomy and to provide long-term data on the durability of carotid endarterectomy. A total of 1335 sequential patients were followed up prospectively with annual carotid ultrasonography. All patients were maintained on antiplatelet therapy, and arteriotomies were closed with a patch graft. Operations were performed under general anesthesia with electroencephalographic monitoring and selective shunting. There were no changes in surgical technique during this study. Two-thirds of the patients were men; the mean age was 70 years. Approximately 60% were symptomatic. The 90-day perioperative morbidity and mortality rate was 0.9% (0.4% stroke and 0.5% death). Five patients (0.4%) developed recurrent stenosis >70% over a mean follow-up of 15.8 years. Twelve patients (0.9%) had documentation of late stroke in the ipsilateral carotid distribution. The mean follow-up was 15.8 years. Carotid endarterectomy is an extremely safe treatment for carotid stenosis with very low perioperative complications and low rates of recurrent stenosis or late stroke. When endarterectomy is compared with angioplasty, in addition to periprocedural complications, the durability of both interventions needs to be considered, given the risks and costs of repeat interventions.

TCT-343 Paclitaxel Drug Eluting Balloon Versus Standard Angioplasty To Reduce Restenosis In Diabetic Patients With In Stent Restenosis Of The Superficial Femoral And Proximal Popliteal Artery

Plain Old Balloon Angioplasty (POBA) for In-Stent Restenosis (ISR) in the superficial femoral artery (SFA) and proximal popliteal artery (PA) has a recurrent stenosis rate of up to 70% within 12 months. Aim of the study was to test the ability to reduce this high recurrency rate with a Paclitaxel