Hugh G. Beebe

Classification and Grading of Chronic Venous Disease in the Lower Limbs-A Consensus Statement-

Classification and grading of chronic venous disease in the lower limbs : A consensus statement

Concern about safety of carotid angioplasty.

Stroke risk reduction for the large majority of patients with high-grade carotid stenosis is presently best accomplished by carotid endarterectomy. When properly applied according to clearly identified standards and guidelines, this treatment is effective, safe, and durable.1 2 The results of recent large randomized trials demonstrate conclusively not only the effectiveness of surgical therapy for symptomatic and asymptomatic patients in reducing stroke incidence but also the importance of careful studies in providing definitive information.3 4 With this background of hard-won experience, we view with concern the application of catheter-based angioplasty techniques to carotid artery bifurcation and internal carotid artery disease. Reports of such techniques can be found in small published series characterized by lack of complete descriptive information and absent …

Endograft Planning without Preoperative Arteriography: A Clinical Feasibility Study:

Purpose: To investigate an alternative method of preprocedural planning for aortic endografting based solely on spiral computed tomography (CT) with 3-dimensional (3D) reconstruction without preoperative arteriography. Methods: From August 1997 to April 1998, 25 consecutive patients with abdominal aortic aneurysms (AAA) were evaluated for endovascular repair by spiral CT scans (2-mm slice thickness) and computerized 3D model construction. No additional imaging for planning was performed. The aortoiliac dimensions, thrombus load, calcification, and vessel tortuosity were measured and evaluated from the 3D model of the aortoiliac segment. These data were used for selecting the patients; the configuration, diameter, and length of the endograft; and the attachment sites for deployment. Results: Primary procedural success was 92% (23/25). All endografts were deployed as planned, and there were no conversions to open repair. Six patients required adjunctive procedures for delivery system access or for iliac aneurysm exclusion, as predicted by the 3D model. Mean procedural time was 91 minutes (range 24 to 273). Two (8%) type II (side branch) endoleaks both sealed spontaneously within 1 month. No graft-related complications or death occurred, for a 30-day technical success rate of 100%. Conclusions: This computerized 3D model provided accurate data for preoperative evaluation of the aortoiliac segment for endovascular AAA repair. Satisfactory technical outcomes for aortic endografts can be achieved without the use of preprocedural invasive imaging.

Imaging Modalities for Aortic Endografting

One of the most fundamental and influential differences between conventional surgery and endovascular grafting for aortic aneurysm is the central role of imaging in every aspect of management. This review summarizes five imaging techniques for aortic endografting: intravascular ultrasound, contrast angiography, conventional computed tomography (CT), spiral CT with image processing, and magnetic resonance angiography (MRA). External ultrasound and intravascular ultrasound have important relevance to endovascular aortic surgery. Artifacts of arteriography include magnification, thrombus effect, foreshortening of tortuosity, loss of luminal detail, parallax error, and projection errors. Conventional CT scans have artifacts and difficulties also. Diameter measurement by CT suffers from methodology errors and observer variability. If conventional CT and angiography are used for endovascular aortic graft planning, both should be obtained since neither alone provides sufficient data. The use of spiral CT scanning and computerized image processing has clearly aided the preoperative definition of aneurysm morphology both in terms of dimensional accuracy and by adding diagnostic information. MRA is capable of producing three-dimensional images, axial sections, and longitudinal projections in any plane. It can detect blood flow without contrast medium, but gadolinium enhances MRA by avoiding the “signal dropout” artifact. Technology exists to provide new forms of imaging for endovascular surgery that combines three-dimensional models with on-line image data in a process called “data fusion.” This may offer improved ease and accuracy for conducting endovascular procedures in the future.

Cost comparison of aortic aneurysm endograft exclusion versus open surgical repair.

BACKGROUND Shrinking health care resources impose a requirement to evaluate new technology for cost as well as clinical effectiveness. We studied an initial clinical experience with endograft treatment (EAG) of abdominal aortic aneurysm (AAA) at the beginning of an endovascular program in comparison with open surgical repair (OSR), which had been in use for decades. METHODS From March 1997 to April 1998, the utilization of hospital resources, actual cost, clinical descriptors, and treatment outcomes were recorded for two contemporaneous groups, each having 16 consecutive patients with AAA, treated with either EAG or OSR. Subjects were not randomized; EAG treatment was based on predetermined exclusion/inclusion criteria. Statistical comparison was by either Fishers exact test or the Wilcoxon rank sum test. RESULTS There were no differences between OSR and EAG in age, gender, AAA size, smoking status, diabetes, ischemic heart disease, history of coronary artery bypass grafts, previous vascular surgery, or other comorbidity. There were no deaths in either group. Patients treated by EAG procedure had significantly lower length of hospital stay, length of stay in intensive care unit, time in operating room, and cost of operating room without graft (P <0.05). Cost of operating room with graft was less in OSR group (P <0.001). In-hospital imaging costs specific to the EAG procedure were

Aortic Aneurysm Morphology for Planning Endovascular Aortic Grafts: Limitations of Conventional Imaging Methods:

1,370.45 +/-

Carotid arterial ultrasound scan imaging: A direct approach to stenosis measurement

66.92 (range

Popliteal vein entrapment presenting as deep venous thrombosis and chronic venous insufficiency

911.58 to

Intermittent claudication : Effective medical management of a common circulatory problem

1,826.76). Total costs were not significantly different between the OSR and EAG,

Effects of cilostazol on resting ankle pressures and exercise-induced ischemia in patients with intermittent claudication

12,714.19 +/-