J.J.A.M. van den Dungen

Changing Profiles of Diagnostic and Treatment Options in Subclavian Artery Aneurysms

BACKGROUND Subclavian artery aneurysms (SAAs) are rare and may cause life- and limb-threatening complications. Therapeutic options greatly differ as do access alternatives. The aim of the study was to assess its clinical presentation, diagnostics and therapeutic options as reported in the literature. METHOD A literature search was performed of the Medline, Cochrane and EMBASE databases. All articles, published until September 2009, describing treatment of an SAA were included. RESULTS A total of 191 reports, of which 126 met the inclusion criteria, were identified and were published from June 1915 until September 2009. Of these, 394 SAAs were described in 381 patients, with a mean age of 52+/-16 years. The median diameter was 40 mm (range: 10-180 mm). The aetiology appeared to change in time towards more exogenous causes. Fifty-one percent of the SAAs presented with a pulsating mass, shoulder pain and/or non-specific chest pain. Embolisation, rupture and thrombosis were present in 16%, 9% and 6% of patients, respectively, and their incidence was related to the anatomical localisation of the SAA. Open surgery and endovascular repair had a complication rate of 26% and 28%, respectively (p=0.49). Cardiopulmonary complications were restricted to open repair. Mortality rates for open and endovascular techniques were similar (5%). The mortality rates for conventional elective and emergency procedures were 3% and 13%, respectively, and for endovascular repair 4% and 8%, respectively. CONCLUSION The profiles of diagnostic and treatment options of SAAs are changing. Although guidelines considering timing of intervention may not be conducted from available literature, intervention appears to be indicated, especially in distal SAAs, due to the risk of thrombo-embolic complications. Endovascular repair and hybrid procedures appear to be the preferred treatment modalities, due to a lower rate of cardiopulmonary complications.

Fenestrated and Branched Stent-Grafting: a 5-Years Experience

Abstract Fenestrated stent-grafts aim at treating short-necked aneurysms. As a result of customized fenestrations, patency of vital side branches such as the renal arteries and the superior mesenteric artery can be maintained, whilst positioning the graft over these aortic side branches. Over the years, the technique has been refined. Results in a few experienced centers are good, with excellent patency rates of targeted side branches. Suprarenal and thoraco-abdominal aneurysms can only be treated by endovascular means with branched grafts. This can be achieved with fenestrated grafts, but with the use of covered stents through the fenestrations, or by fully branched grafts. Both options are feasible and present with specific advantages and disadvantages. This report gives an overview of our 5-years experience with fenestrated and branched grafts, and discusses the following aspects of the technique: indications, technical principles, results, and limitations.

Randomized clinical trial of continuous sutures or non-penetrating clips for radiocephalic arteriovenous fistula

Despite several modifications to the original design, patency rates of radiocephalic arteriovenous fistulas have changed little since the first report in 1966. The use of non‐penetrating clips for vascular anastomosis on the outcome of such fistulas was studied.

Prevalence of Severe Subclinical Coronary Artery Disease on Cardiac CT and MRI in Patients with Extra-cardiac Arterial Disease

OBJECTIVE Patients with extra-cardiac arterial disease (ECAD) are at high risk of coronary artery disease (CAD). Prevalence of silent, significant CAD in patients with stenotic or aneurysmal ECAD was examined. Early detection and treatment may reduce CAD mortality in this high-risk group. MATERIALS AND METHODS ECAD patients without cardiac complaints underwent computed tomography (CT) for calcium scoring, coronary CT angiography (cCTA) if calcium score was 1,000 or under, and adenosine perfusion magnetic resonance imaging (APMR) if there was no left main stenosis. Significant CAD was defined as calcium score over 1,000, cCTA-detected coronary stenosis of at least 50% lumen diameter, and/or APMR-detected inducible myocardial ischemia. In cases of left main stenosis (or equivalent) or myocardial ischemia, patients were referred to a cardiologist. RESULTS The prevalence of significant CAD was 56.8% (95% CI 47.5 to 66.0). One-hundred and eleven patients were included. Eighty-four patients (76%) had stenotic ECAD, and 27 (24%) had aneurysmal disease. In patients with stenotic ECAD, significant coronary stenosis was present in 32 (38%) and inducible ischemia in eight (12%). Corresponding results in aneurysmal ECAD were eight (30%) and two (11%), respectively (p for difference >.05). Sixteen (19%) patients with stenotic and six (22%) with aneurysmal ECAD were referred to a cardiologist, with subsequent cardiac intervention in seven (44%) and three (50%), respectively (both p >.05). CONCLUSIONS Patients with stenotic or aneurysmal ECAD have a high prevalence of silent, significant CAD.

28 Enkel-armindex bepalen met dopplerapparaat

Het dopplereffect berust op het veranderen van de frequentie van geluid dat door stromende erytrocyten wordt teruggekaatst. Deze verschuiving van frequentie kan met een dopplerapparaat hoorbaar gemaakt worden. In het menselijke lichaam is het een ideale methode om stromende rode bloedcellen op te sporen en de bijpassende bloeddruk te meten. Arterien en venen hebben ieder een eigen flowkarakteristiek. Het doppleronderzoek hoort tot de non-invasieve, patientvriendelijke onderzoeken van de arterien.

Fenestrated Endovascular Stent-Grafts: Current Applications

Fenestrated stent-grafts are designed to treat short-neck abdominal aortic aneurysms. Thanks to customized fenestrations, patency of side branches such as the renal arteries and the superior mesenteric artery can be maintained, whilst positioning the graft across these aortic branches.