Kiattisak Hongku

Endovenous radiofrequency thermal ablation and ultrasound-guided foam sclerotherapy in treatment of klippel-trenaunay syndrome.

INTRODUCTION Klippel-Trenaunay syndrome is composed of port-wine stain, limb hypertrophy and varicose veins. METHODS The two patients with Klippel-Trenaunay syndrome treated by endovenous radiofrequency thermal ablation and ultrasound-guided foam sclerotherapy of the abnormal veins was conducted. RESULTS Radiofrequency thermal ablation resulted in successful occlusion of the incompetent anterior accessory great saphenous vein. Moreover, ultrasound-guided foam sclerotherapy showed complete occlusion of the residual veins. At 6 month follow-up, both patients markedly decreased leg symptoms including pain, cramping, limb swelling, and bulging of veins. CONCLUSION Radiofrequency thermal ablation combined with foam sclerotherapy is a minimally invasive procedure alternative to the standard invasive surgery and can be the option for saphenous ablation in Klippel-Trenaunay syndrome patients.

Comparison of clinical prediction scores for the diagnosis of deep vein thrombosis in unselected population of outpatients and inpatients

Objectives The aim of this research was to compare the accuracy of the modified Wells, the Wells, the Kahn, the St. André, and the Constans score for the diagnosis of deep vein thrombosis of the lower limb in unselected population of outpatients and inpatients. Method The pretest of probability score was employed in consecutive 500 outpatients and inpatients with suspicion of deep vein thrombosis. All patients were examined with compression ultrasonography. Results Deep vein thrombosis was confirmed in 26.4%. In the unselected population of outpatients and inpatients, the accuracy of the modified Wells score and the Constans score was higher than other scores. Both scores were more accurate for the outpatients. There was no accurate score for the inpatient subgroup. Conclusions The modified Wells and the Constans score appear to be useful in the unselected population of outpatients and inpatients and particularly in the outpatient subgroup.

Applicability and midterm results of branch cuff closure with vascular plug in branched endovascular repair for thoracoabdominal aortic aneurysms

Objective: This study assessed the applicability and outcomes of the closure of unused cuffs in branched endovascular aneurysm repair (b‐EVAR) of thoracoabdominal aortic aneurysm. Methods: We reviewed b‐EVAR procedures at a tertiary referral center to identify patients who underwent incomplete branching and needed closure of the unused branch cuffs. An electronic database and intraoperative and follow‐up imaging studies were reviewed to assess technical applicability and outcomes. Results: Between January 2007 and December 2015, 17 patients underwent incomplete branching during b‐EVAR. The unused branch cuff in one patient occluded spontaneously after b‐EVAR and was excluded from this analysis. The remaining 16 patients underwent 11 elective and five emergency repairs. Amplatzer Vascular Plugs (St. Jude Medical, Plymouth, Minn) were used to successfully close 17 branches: 8 targeting preoperatively occluded target vessels, 3 optional branches where fenestrations were used instead, 5 after failures of catheterization or stent bridging to target vessels, and 1 renal branch of an atrophic kidney. Four branch cuffs were extended with a peripheral covered stent before plug deployment. Sixteen branch cuffs were closed intraoperatively, and the remaining cuff was closed percutaneously at a later occasion. Perioperative death occurred in two patients. Median follow‐up duration was 19 months (interquartile range, 11‐30 months). There was no endoleak or reintervention related to the plugged cuffs. Two late deaths occurred not related to the aneurysm. Two patients required reinterventions for type III endoleaks with interval sac expansions caused by aortic stent graft component separation in tortuous thoracic segments not related to the occluded cuffs. Conclusions: Closure of the branch cuff of multibranched stent graft with Amplatzer Vascular Plug is feasible and effective. It was not associated with adverse aneurysm outcomes, and it is very useful especially when using an off‐the‐shelf device in the acute setting.

SS28. Long-Term Survival After Endovascular Repair and Open Repair in Patients With Anatomy Outside Endovascular Repair Indications for Use Criteria

nonischemic part (proximal). After tissue processing, the cDNA was then used in reverse transcriptase polymerase chain reaction using Bio-Rads Prime PCR Probe Assays and IL-6, NOSTRIN, PROM1 and VEGFA gene expression were measured. Results: A paired t test was run for each set of data to determine whether the difference in expression levels between nonischemic (proximal) and ischemic tissues (distal) were significantly different (Fig). None of the comparisons was statistically significant. However, arterial VEGFA expression was higher in the ischemic compared with nonischemic tissues and seemed to be trending toward significance with a P value of .1. On the other hand, IL6 expression was higher in the nonischemic compared with ischemic tissues (P 1⁄4 .2). Conclusions: This study showed an increase in the VEGFA expression by the arterial MSCs in ischemic tissues which might indicate an attempt of the arterial MSCs to stimulate angiogenesis and vasculogenesis in the setting of ongoing ischemia. However, a larger sample size is needed to reach statistical significance.

SS31. TEVAR With Stent Grafts Alone or With a Composite Device Design in Patients With Acute Type B Aortic Dissection in the Setting of Malperfusion

Objectives: To evaluate long-term results of self-expanding versus balloon-expandable hypogastric stent grafts in conjunction with iliac branch devices (IBD) for aortoiliac aneurysm (AAIA) repair, in a multicenter experience (pELVIS Registry). Methods: All patients electively treated for AAIA with the Cook IBD in 9 European Centers were reviewed. Clinical and imaging data were prospectively collected locally and a multicenter database was created and interrogated. Primary outcomes were incidence of graft occlusions and reinterventions. For the purpose of this investigation, three subgroups were identified: patients receiving hypogastric balloon-expandable (BE) stent grafts; those with self-expanding (SE) grafts; and those with any stent graft plus relining with a bare metal stent (RE). Results: Between 2005 and 2017, 783 patients underwent 897 elective endovascular repair of AAIA (n 1⁄4 671, 74.8%) or isolated iliac aneurysms (n 1⁄4 226, 25.2%), with 897 Cook IBDs (n 1⁄4 114 bilateral) in nine European centers. Mean age was 71.4 years (range 45-93); and 749 (95.7%) patients were men. In 420 procedures (46.8%) BE was used, in 139 SE (15.5%), in 90 BE plus SE or undefined stent, and in 248 (27.6%) RE. At 30 days there were 4 perioperative deaths (0.5%), 10 (1.1%) technical failures, 11 (1.2%) graft thromboses, 41 (4.5%) reinterventions, and 1 (0.1%) conversion to open repair. After a mean follow-up of 32 months (range, 0-128 months), 55 IBD occlusions (6.2%) occurred. Overall primary patency, at KaplanMeier analysis, was 99.3 6 0.3 at 1 month, 97.2 6 0.6 at 12 months, 92.9 6 1.2 at 60 months, and 91.2 6 1.7 at 72 months. Primary patency was not significantly different in the BE vs SE or RE cohorts (P 1⁄4 .4; Fig 1). During follow-up, there were 149 (16.8%) reinterventions, 116 (13.1%) of which were IBD-related, including 12 (1.4%) conversions. Overall, freedom from reinterventions and conversion, estimated by Kaplan-Meier analysis, was 94.7 6 0.8 at 1 month, 86.8 6 1.2 at 12 months, 70.7 6 2.2 at 60 months, and 65.7 6 2.8 at 72 months. Reinterventions during follow-up in the 3 cohorts (Fig 2) were not significantly different (P 1⁄4 .4). Overall survival, estimated by Kaplan-Meier analysis, was 99.5 6 0.3 at 1 month, 94.8 6 0.9 at 12 months, 76.0 6 2.3 at 60 months, and 72 6 2.7 at 72 months.

Endovascular redo aortic surgery

Endovascular redo aortic operations are a challenging undertaking. Techniques for treatment date almost as far back as the original open repair itself. Risk factors for failure following aortic repair include larger abdominal aortic aneurysm necks, severe neck angulation, as well as clinical variables such as age, family history, obesity and chronic obstructive pulmonary disease. The armamentarium of endovascular treatments is vast and increasing. Aside from provisional embolization of endoleaks or deferment to open repair conversion, attention should be directed toward obtaining adequate proximal and distal sealing. This can be achieved with Palmaz stents, endoanchors, and extension with fenestrated or branched endovascular repair. Thoracic aortic coverage may be required, and revascularization of the left subclavian artery should be considered. Technical issues such as these, as well as target vessel cannulation and accommodation of the new graft within the previous implanted graft, require experience and careful planning. Distal extension can likewise resolve a failing repair, and this may require the use of internal iliac artery embolization or iliac-branch devices. Redo aortic operations are technically demanding and are carried out with increased risks. Improving technology, such as fusion imaging, should mitigate some of this risk and are recommended.