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Fulltext Update on the management of peripheral arterial disease (PAD)

Liew NC, Moissinac K, Lee L, Gee T, Zezeman RB

Med J Malaysia, 2011 Oct;66(4):386-8; quiz 389.
PMID: 22299571 MyJurnal

There has been much progress made in the management of peripheral arterial disease (PAD) in the past two decades. Progress in the understanding of the endothelial-platelet interaction during health and disease state have resulted in better antiplatelet drugs that can prevent platelet aggregation, activation and thrombosis during angioplasty and stenting. Collaborative effort by different international societies has resulted in a consensus guideline that recommends the modality of intervention in certain disease states. Progress in perioperative care has reduced the morbidity and mortality associated with peripheral vascular reconstruction surgery. Nevertheless, the advances in percutaneous peripheral intervention (PPI) have made a paradigm shift in the current management of patients. The procedure is safe and effective and is emerging as the first choice revascularization procedure.

Matched MeSH terms: Blood Vessel Prosthesis Implantation
Effect of different stent configurations using Lattice Boltzmann method and particles image velocimetry on artery bifurcation aneurysm problem

Mokhtar NH, Abas A, Razak NA, Hamid MNA, Teong SL

J Theor Biol, 2017 11 21;433:73-84.
PMID: 28844907 DOI: 10.1016/j.jtbi.2017.08.016

Proper design of stent for application at specific aneurysm effect arteries could help to reduce the issues with thrombosis and aneurysm. In this paper, four types of stent configuration namely half-Y (6 mm), half-Y (4 mm), cross-bar, and full-Y configuration will implanted on real 3D artery bifurcation aneurysm effected arteries. Comparisons were then conducted based on the flow patterns after stent placement using both LBM-based solver and PIV experimental findings. According to the data obtained from all 4 stent designs, the flow profiles and the computed velocity from both methods were in agreement with each other. Both methods found that half-Y (6 mm) stent configuration is by far the best configuration in reducing the blood velocity at the vicinity of the aneurysm sac. The analysis also show that the half-Y (6 mm) stent configuration recorded the highest percentage of velocity reduction and managed to substantially reduce the pressure at the bifurcation region. This high flow velocity reduction through the use of half-Y stent could consequently promote the formation of thrombus thereby reducing the risk of rupture in the aneurysm sac.

Matched MeSH terms: Blood Vessel Prosthesis
Personalized external aortic root support in aneurysm disease

Treasure T, Austin C, Kenny LA, Pepper J

Curr Opin Cardiol, 2022 Nov 01;37(6):454-458.
PMID: 36094493 DOI: 10.1097/HCO.0000000000000990

PURPOSE OF REVIEW: To bring together and annotate publications about personalised external aortic root support reported in the 18 months preceding submission.
RECENT FINDINGS: The total number of personalised external aortic root support (PEARS) operations is now approaching 700 in 30 centres in Australia, Belgium, Brazil, Czech Republic, Great Britain, Greece, Ireland, Malaysia, Netherlands, New Zealand, Poland and Slovakia. There are continued reports of stability of aortic dimensions and aortic valve function with the only exceptions known being where the surgeon has deviated from the instructions for use of the device. The median root diameter of Marfan patients having PEARS was 47 mm suggesting that the existing criterion of 50 mm is due for reconsideration. The peri-operative mortality currently estimated to be less than 0.3%. The first recipient remains alive and well after 18 years. The use of PEARS as an adjunct to the Ross operation to support the pulmonary autograft is being explored in several centres.
SUMMARY: The operation requires proctoring and adherence to a strict operative protocol and with those precautions excellent results are attained. The evidence and opinions provided in the cited publications indicate that PEARS is a proven and successful prophylactic operation for aortic root aneurysm.

Matched MeSH terms: Blood Vessel Prosthesis
Aneurysmal dilatation without distal obstruction: a rare complication of valved bovine jugular vein conduit

Qureshi AU, Abbaker AE, Sivalingam S, Latiff HA

World J Pediatr Congenit Heart Surg, 2014 Apr;5(2):348-51.
PMID: 24668992 DOI: 10.1177/2150135113509819

Valved bovine jugular vein (Contegra) conduit is considered a suitable choice for pediatric population with congenital heart defect requiring right ventricle to main pulmonary artery connection. Intermediate follow-up studies have shown the propensity of developing distal conduit stenosis and valve thrombosis. We present a rare case of aneurysmal dilatation of the conduit leading to valve failure requiring conduit explantation.

Matched MeSH terms: Blood Vessel Prosthesis Implantation/adverse effects*
Malignant obstruction of superior vena cava: Endovascular stenting using Y-configuration stent in stent technique

Noor Khairiah AK, Mohamad Nazrulhisham MN, Hazman MN

Med J Malaysia, 2018 12;73(6):407-409.
PMID: 30647215

Malignant intrathoracic disease is the commonest cause of superior vena cava (SVC) obstruction. Life threatening SVC obstruction with intense dyspnoea requires urgent treatment. SVC stenting has been developed in recent years which results in rapid relief of the obstruction. The Yconfiguration technique has been reported to provide support for all three limbs of the bifurcation to prevent restenosis. At present, there are limited reports on the use of Y-configuration stent in stent techniques for endovascular stenting in malignant SVC obstruction. We share our clinical experience of two patients who received balloon-mounted stents using this technique.

Matched MeSH terms: Blood Vessel Prosthesis*
Simultaneous bypass grafting of the superior vena cava and intrathoracic biopsy in fulminant superior vena caval syndrome

Majid AA

J R Coll Surg Edinb, 1991 Dec;36(6):406-8.
PMID: 1774712
Matched MeSH terms: Blood Vessel Prosthesis
Current status in decision making to treat acute type A dissection: limited versus extended repair

Velayudhan BV, Idhrees M, Matalanis G, Park KH, Tang D, Sfeir PM, et al.

J Cardiovasc Surg (Torino), 2020 Jun;61(3):285-291.
PMID: 32337940 DOI: 10.23736/S0021-9509.20.11397-1

Acute type A aortic dissection remains one of the most challenging conditions in aortic surgery. Despite the advancements in the field, the mortality rate still remains high. Though there is a general consensus that the ascending aorta should be replaced, the distal extension of the surgery still remains a controversy. Few surgeons argue for a conservative approach to reduce operative and postoperative morbidity while others considering the problems associated with "downstream problems" support an aggressive approach including a frozen elephant trunk. The cohort in the Indian subcontinent and APAC is far different from the western world. Many factors determine the decision for surgery apart from the pathology of the disease. Economy, availability of the suitable prosthesis, the experience of the surgeon, ease of access to the medical facility all contribute to the decision making to treat acute type A dissection.

Matched MeSH terms: Blood Vessel Prosthesis
An unique case of thoracic endovascular aortic repair (TEVAR) graft infection with Streptococcus viridans

Zubaidah NH, Azim MI, Osama MH, Harunarashid H, Das S

Clin Ter, 2012;163(1):27-9.
PMID: 22362230

The incidence of infection following TEVAR is low. To the best of our knowledge, this is the first case report of post thoracic endovascular aortic repair (TEVAR) with Streptococcus viridans graft infection. A 54-year-old male underwent TEVAR for dissecting thoracic aneurysm with spinal ischaemia. He had an eventful recovery with prolonged period of stay in intensive care unit. Three months later, he presented with persistent chest discomfort and fever. Computed tomography (CT) of the thorax revealed evidence of graft infection and the blood culture grew Streptococcus viridans. The rarity of TEVAR graft infection due to Streptococcus viridans and its management are being discussed.

Matched MeSH terms: Blood Vessel Prosthesis Implantation/adverse effects*
Fulltext Unrestricted use of polymer-free sirolimus eluting stents in routine clinical practice

Krackhardt F, Kočka V, Waliszewski M, Toušek P, Janek B, Trenčan M, et al.

Medicine (Baltimore), 2020 Feb;99(8):e19119.
PMID: 32080086 DOI: 10.1097/MD.0000000000019119

Stent designs with ultrathin struts may further increase the procedural success of challenging lesion subsets. The objective of this study was to assess the safety and efficacy of ultrathin strut, polymer-free sirolimus eluting stent (PF-SES) implantations in a large scale, unselected patient population.Adult patients underwent percutaneous coronary interventions (PCI) with a thin-strut PF-SES. Data from two all-comers observational studies having the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled. The accumulated target lesion revascularization (TLR) rate at 9-12 months was the primary endpoint. All dual antiplatelet therapy strategies according to the applicable guidelines were permissible.In total, 7243 patients were prospectively enrolled for PCI with PF-SES in stable coronary artery disease or acute coronary syndrome (ACS). Major risk factors in the overall cohort were diabetes (37.3%), ST elevation myocardial infarction (18.1%) and non-ST myocardial infarction (24.6%). The follow-up rate was 88.6% in the overall population. The TLR rate in the overall cohort was 2.2% whereas definite/probable stent thrombosis (ST) occurred in 0.7%. In patients with in-stent restenosis lesions, the major adverse cardiac events rate was 6.4% whereas the corresponding rate for isolated left main coronary artery (LMCA) disease was highest with 6.7% followed by patients with culprit lesions in vein bypasses (VB, 7.1%). The mortality rate in patients treated in VB lesions was highest with 5.4%, followed by the isolated LMCA subgroup (3.4%) and ACS (2.6%).PCI with PF-SES in an unselected patient population, is associated with low clinical event and ST rates. Furthermore, PF-SES angioplasty in niche indications demonstrated favorable safety and efficacy outcomes with high procedural success rates.

Matched MeSH terms: Blood Vessel Prosthesis Implantation/methods
Fulltext Blunt trauma to the antecubital fossa causing brachial artery injury and minor fractures around the elbow joint, an easily missed diagnosis with potential devastating consequences: a case report

Phang ZH, Miskon MFB, Ibrahim SB

J Med Case Rep, 2018 Jul 18;12(1):211.
PMID: 30016981 DOI: 10.1186/s13256-018-1751-7

BACKGROUND: Blunt trauma causing brachial artery injury in a young patient is very rare. Cases of brachial artery injury may be associated with closed elbow dislocation or instability. Elbow dislocation may not be evident clinically and radiologically on initial presentation.
CASE PRESENTATION: This is a case of a 37-year-old, right-hand dominant, Malay man who fell approximately 6 meters from a rambutan tree and his left arm hit the tree trunk on his way down. He was an active tobacco smoker with a 20 pack year smoking history. On clinical examination, Doppler signals over his radial and ulnar arteries were poor. He proceeded with emergency computed tomography angiogram of his left upper limb which showed non-opacification of contrast at the distal left brachial artery just before the bifurcation of the left brachial artery at his left elbow joint. Radiographs and computed tomography scan also showed undisplaced fracture of left lateral epicondyle and radial head with no evidence of elbow dislocation. He subsequently underwent left brachial to brachial artery bypass which was done using reversed saphenous vein graft and recovered well. His fractures were treated using 90 degree long posterior splint for 2 weeks and he was then allowed early range of motion of the left elbow. This patient developed left elbow dislocation 6 weeks postoperatively. Closed manipulative reduction of his left elbow resulted in incomplete reduction. The functional outcome of his left elbow was limited with a range of motion of left elbow of 0-45 degrees. However, he was not keen for surgery to stabilize his elbow joint during his last follow-up 6 months post injury.
CONCLUSIONS: This is an uncommon case of brachial artery injury in a civilian caused by blunt trauma associated with occult elbow instability/dislocation and minor fractures around the elbow joint. The treatment of brachial artery injury with clinical evidence of distal ischemia is surgical revascularization. The possibility of elbow instability and dislocation need to be considered in all cases of brachial artery injury because early radiographs and computed tomography scans may be normal. Short-term posterior splint immobilization is not sufficient to prevent recurrent dislocations.

Matched MeSH terms: Blood Vessel Prosthesis Implantation