Khanjan H. Nagarsheth

A Novel Technique to Retrieve a Maldeployed Vascular Closure Device

Purpose: To report a novel technique for endovascular retrieval of a maldeployed vascular closure device, obviating the need for a femoral cutdown. Technique: To remove a 6-F Angio-Seal device that embolized to the superficial femoral artery, the contralateral common femoral artery was accessed, and an 8-F, 65-cm-long sheath was inserted just proximal to the embolus. A second semistiff 0.035-inch buddy wire was advanced past the lesion along the sheath. A 0.014-inch wire was advanced past the embolus, and a SpiderFX embolic protection device was deployed 1 cm past the embolized Angio-Seal device. The sheath was advanced so as to push the embolus into the filter. The sheath and the filter containing the Angio-Seal device were then removed. Conclusion: Endovascular retrieval of an embolized Angio-Seal device can be done using an embolic filter device, restoring arterial flow to the limb.

Gore Iliac Branch Endoprosthesis for treatment of bilateral common iliac artery aneurysms

Objective: The Gore Iliac Branch Endoprosthesis (IBE; W. L. Gore & Associates, Flagstaff, Ariz) has recently been approved by the Food and Drug Administration for treatment of common iliac artery (CIA) aneurysms. Despite early excellent results in clinical trial, none of 63 patients were treated for bilateral iliac aneurysms. The goal of this study was to examine real‐world experience using the Gore IBE for bilateral CIA aneurysms. Methods: A retrospective review of an international multicenter (16 U.S., 8 European) experience using the Gore IBE to treat bilateral CIA aneurysms was performed. Cases were limited to those occurring after Food and Drug Administration approval (February 2016) in the United States and after CE mark approval (November 2013) in Europe. Demographics of the patients, presentation, anatomic characteristics, and procedural details were captured. Results: There were 47 patients (45 men; mean age, 68 years; range, 41‐84 years) treated with bilateral Gore IBEs (27 U.S., 20 European). Six patients (12.7%) were symptomatic and 12 (25.5%) patients were treated primarily for CIA aneurysm (aorta <5.0 cm). Mean CIA diameter was 40.3 mm. Four patients had aneurysmal internal iliac arteries (IIAs). Two of these were sealed proximally at the IIA aneurysm neck and two required coil embolization of IIA branches to achieve seal in the largest first‐order branches. Technical success was achieved in 46 patients (97.9%). No type I or type III endoleaks were noted. There was no significant perioperative morbidity or mortality. IIA branch adjunctive stenting was required in four patients (one IIA distal dissection, three kinks). On follow‐up imaging available for 40 patients (85.1%; mean, 6.5 months; range, 1‐36 months), 12 type II endoleaks (30%) and no type I or type III endoleaks were detected. Two of 80 (2.5%) IIA branches imaged were occluded; one was intentionally sacrificed perioperatively. Conclusions: Preservation of bilateral IIAs in repair of bilateral CIA aneurysms can be performed safely with excellent technical success and short‐term patency rates using the Gore IBE device. Limb and branch occlusions are rare, usually are due to kinking, and can almost always be treated successfully with stenting.

Diabetes control decreases morbidity and mortality after carotid endarterectomy

Background Single‐institution studies have demonstrated a negative effect of diabetes mellitus on outcomes after carotid endarterectomy (CEA). The aim of this study was to compare patients with explicitly controlled and uncontrolled diabetes at the population level. Methods Using the National Inpatient Sample 2006–2013, we selected patients undergoing CEA. Rates of stroke, myocardial infarction (MI), and hospital mortality, as well as duration of stay and cost were compared among patients with uncontrolled diabetes (UCDM), well‐controlled diabetes (WCDM), and those without diabetes (NDM). Results We reviewed data from 614,190 patients undergoing CEA. Patients with UCDM, compared with those with WCDM and NDM, had higher rates of stroke (3.27%, 0.93%, and 0.94%, respectively; P < .0001), MI (3.35%, 1.10%, and 0.87%, respectively; P < .0001), and higher hospital mortality (1.43%, 0.25%, and 0.27%, respectively; P < .0001). On multivariate analysis, patients with UCDM compared with WCDM were more likely to develop stroke (odds ratio[OR], 1.45; 95% confidence interval [CI], 1.23–1.71), and MI (OR, 2.26; 95% CI, 1.96–2.60) and were more likely to die (OR, 2.74; 95% CI, 2.19–3.42). Patients with WCDM compared with patients without diabetes had similar likelihoods of stroke (OR, 0.96; 95% CI, 0.90–1.02) and MI (OR, 1.04; 95% CI, 0.98–1.10) but were actually less likely to die (OR, 0.85; 95% CI, 0.76–0.95). Conclusion Patients with uncontrolled diabetes had poorer outcomes after CEA than those with controlled diabetes, whose outcomes were comparable to if not better than individuals without diabetes.