Abstract:
BACKGROUND:Treatment of chronic venous insufficiency (CVI) has largely focused on reflux. Minimally-invasive techniques to address superficial and perforator reflux have evolved, but correction of deep reflux continues to be challenging. The advent of intravascular ultrasound (IVUS) scan and minimally invasive venous stent technology have renewed interest in the obstructive component in CVI pathophysiology. The aim of this study is to assess stent-related and clinical outcomes following treatment by iliac venous stenting alone in limbs with a combination of iliac vein obstruction and deep venous reflux. METHODS:A total of 528 limbs in 504 patients, ranging in age from 15 to 87, underwent IVUS-guided iliac vein stent placement to correct obstruction over an 11-year period. The etiology of obstruction was nonthrombotic in 196 (37%), post-thrombotic in 285 (54%) limbs, and combined in 47 (9%). Clinical severity class of CEAP was C3 in 44%, C(4,5) in 27%, and C6 in 25% of stented limbs. Deep venous reflux was present in all limbs, associated with superficial and/or perforator reflux in 69%. Reflux was severe in 309/528 (59%) limbs (reflux multisegment score > or = 3) and 224/528 (42%) limbs had axial reflux. Venography and other functional tests had poor diagnostic sensitivity to detect obstruction, which was ultimately diagnosed by IVUS. The IVUS-guided iliac vein stenting was the only procedure performed and the associated reflux was left uncorrected. RESULTS:There was no mortality; morbidity was minor. Cumulative secondary stent patency was 88% at 5 years; no stent occlusions occurred in nonthrombotic limbs. Cumulative rates of limbs with healed active ulcers, freedom of ulcer recurrence in legs with healed ulcers (C5), and freedom from leg dermatitis at 5 years were 54%, 88%, and 81%, respectively. Cumulative rate of substantial improvement of pain and swelling at 5 years was 78% and 55%, respectively. Quality of life improved significantly. Reflux parameters did not deteriorate after stenting. CONCLUSION:Iliac venous stenting alone is sufficient to control symptoms in the majority of patients with combined outflow obstruction and deep reflux. Partial correction of the pathophysiology in limbs with multisystem or multilevel disease can provide substantial symptom relief. Percutaneous stent technology in concert with other minimally-invasive techniques to address superficial and/or perforator reflux offers such partial correction in limbs with advanced CVI and complex venous pathology. Open correction of obstruction or reflux is now required only infrequently as a "last resort".
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Raju S,Darcey R,Neglén Pdoi
10.1016/j.jvs.2009.08.032subject
Has Abstractpub_date
2010-02-01 00:00:00pages
401-8; discussion 408issue
2eissn
0741-5214issn
1097-6809pii
S0741-5214(09)01675-9journal_volume
51pub_type
杂志文章abstract::Type B dissections complicated by pain, malperfusion, or aneurysm expansion mandate surgical intervention. Success of this therapy is predicated on exclusion and thrombosis of the false lumen of the aneurysm. We report a case where cessation of flow was achieved using covered stent grafts in conjunction with coil embo...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.03.012
更新日期:2008-08-01 00:00:00
abstract::Although abdominal aortic aneurysm (AAA) is a common problem in elderly patients, AAA is rare in children. Despite its rarity, early diagnosis is imperative to prevent limb-threatening or fatal complications. The treatment may be complicated, because it must allow for the growth of the child. A saccular AAA in an 11-y...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(98)70100-4
更新日期:1998-10-01 00:00:00
abstract:PURPOSE:Spinal cord injury and the resultant postoperative paraplegia are devastating complications of thoracic aortic surgery, for which no widely accepted protective interventions exist. We hypothesized that retrograde venous perfusion-cooling of the spinal cord with a hypothermic saline and adenosine solution would ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2000.105003
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVE:In-stent restenosis is a recognized complication of carotid angioplasty and stenting (CAS), and it is associated with an increased risk of stroke. Few case series have reported outcomes separately following carotid endarterectomy (CEA) and CAS for the treatment of in-stent restenosis. In this study, we perfor...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.11.041
更新日期:2017-05-01 00:00:00
abstract::Renal cell carcinoma extends into the lumen of the inferior vena cava in approximately 4% of patients at the time of diagnosis. Surgical removal of the intracaval tumor thrombus with radical nephrectomy is the preferred treatment for this malignancy. From January 1977 to June 1990, 31 such patients were examined for c...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1991.29912
更新日期:1991-09-01 00:00:00
abstract:OBJECTIVE:This study was conducted to investigate factors influencing the outcome of all open operations for aortoiliofemoral (AIF) revascularization performed by a single surgeon at a tertiary referral center. METHODS:The series included 355 direct reconstructions and 181 extra-anatomic bypass (EAB) grafts in 339 men...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2006.09.065
更新日期:2007-03-01 00:00:00
abstract::We report the vascular surgical strategies and results in 13 patients with heparin-associated thrombocytopenia and describe useful in vitro techniques for the evaluation of anticoagulant therapy. Thirteen of 40 patients with heparin-associated thrombocytopenia had 18 cardiovascular procedures done to save life or limb...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1988-10-01 00:00:00
abstract::Endovascular techniques with coil embolization have been used in certain visceral aneurysm cases, often resulting in sacrifice of the involved visceral vessel and end-organ thrombosis. We describe two cases in which stent grafts were used to treat these aneurysms, allowing preservation of visceral artery and end-organ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2002.129645
更新日期:2002-12-01 00:00:00
abstract:OBJECTIVES:Our aim was to identify important microRNAs (miRNAs) that might play an important role in contributing to aortic dissection by conducting a miRNA profile comparison between thoracic aortic dissection (TAD) and normal thoracic aorta. METHODS:The differentially expressed miRNA profiles of the aortic tissue be...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2010.11.113
更新日期:2011-05-01 00:00:00
abstract::Based on our previous study that the outcome of reconstructive surgery for lower limbs could well be predicted by flow waveforms and that this state was defined by variation of wall shear stress (tau) in a cardiac cycle, we set up a desktop computer that could calculate wall shear stress in a given patient. This work ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1984-11-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to present the results for patients with atherosclerotic aneurysm of the descending thoracic aorta (DTA) treated with a novel thoracic stent graft. METHODS:A single-center retrospective review of prospectively collected data was performed. We extracted demographic variables as well a...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2018.07.065
更新日期:2019-04-01 00:00:00
abstract:OBJECTIVE:This study assessed preliminary results of the Ventana Fenestrated System (Endologix, Irvine, Calif) as an off-the-shelf integrated device for juxtarenal aortic aneurysm (JAA) or pararenal aortic aneurysm (PAA) endovascular repair. METHODS:From November 2010 to April 2012, seven centers enrolled 31 patients ...
journal_title:Journal of vascular surgery
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/j.jvs.2012.12.065
更新日期:2013-07-01 00:00:00
abstract:OBJECTIVE:Fenestrated endovascular aneurysm repair (FEVAR) is an alternative to treat complex abdominal aortic aneurysms. Patency of visceral vessels remains high when covered stents are used. The use of distal uncovered stents to prevent kinking has been associated with loss of branch patency. The aim of this study wa...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2019.03.054
更新日期:2020-01-01 00:00:00
abstract:PURPOSE:The purpose of this study was to determine whether the combined insults of hemorrhagic shock and aortic clamping simulating ruptured abdominal aortic aneurysm repair had a synergistic effect on the production of pulmonary injury, indicating remote organ injury. METHODS:Animals were randomized to one of three g...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(95)70081-1
更新日期:1995-07-01 00:00:00
abstract::This article summarizes our experience with the operative management of renovascular hypertension in a contemporary population of elderly patients. During a recent 18-month period 35 of 74 patients (47%) undergoing an operation for renovascular hypertension at our center were in their seventh (21 patients) or eighth (...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1989-09-01 00:00:00
abstract::Paper-based information systems are cumbersome and inefficient. The microcomputer is an attractive, affordable, and powerful alternative to traditional paper-based record keeping. This article reviews fundamentals of data base management and microcomputer technology for the surgeon interested in microcomputer-based in...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1984.avs0010585
更新日期:1984-07-01 00:00:00
abstract:BACKGROUND:The main cause of occlusion and vein graft failure after peripheral and coronary arterial reconstruction is intimal hyperplasia. Transforming growth factor beta-1 (TGF-beta1) is a pleiotropic cytokine known to have powerful effects on cell growth, apoptosis, cell differentiation, and extracellular matrix syn...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2006.01.016
更新日期:2006-05-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to analyze a single-center experience in which descending thoracic aortic aneurysms (TAAs) were treated with a new self-expanding endovascular prosthesis (Medtronic AVE). METHODS:Twenty-six patients (13 men, 13 women) with American Society of Anesthesiology grades II to IV and...
journal_title:Journal of vascular surgery
pub_type: 临床试验,杂志文章
doi:10.1067/mva.2001.114998
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:It is well known that the clinical outcome of patients with critical limb ischemia (CLI) is poor. However, the relationship between stress-related hormone levels and CLI outcome remains unclear. The aim of this study was to reveal the association of stress hormones with the risk of a perioperative major adve...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2018.11.044
更新日期:2019-09-01 00:00:00
abstract::Contrast angiography with carbon dioxide (CO2) is frequently used in patients with renal dysfunction or iodinated contrast allergies, as CO2 is nonallergenic, nontoxic, and rapidly absorbed in the blood. However, when delivered intra-arterially, there is a possibility that CO2 may create a vapor lock with resultant tr...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2012.06.075
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:Constriction of vein grafts with braided external nitinol meshes had previously led to the successful elimination of neointimal tissue formation. We investigated whether pulse compliance, smaller kink-free bending radius, and milder medial atrophy can be achieved by knitting the meshes rather than braiding, w...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2011.05.023
更新日期:2011-11-01 00:00:00
abstract:BACKGROUND:Endovascular procedure simulators are now commercially available and in use for physician training. The purpose of this study was to evaluate the role of simulation-based training in vascular surgery residencies. METHODS:Residents from vascular surgery programs in a five-state area were invited to participa...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2006.09.003
更新日期:2007-01-01 00:00:00
abstract:OBJECTIVE:Little is known about the natural history and management of aneurysmal aortic arch branch vessels (AABVs). The objectives of this study were to assess the natural history of aneurysmal AABVs and to examine the outcomes of operative intervention. METHODS:A retrospective review of the Yale radiologic database ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2018.03.412
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Reoperative carotid endarterectomy (CEA) is an accepted treatment for recurrent carotid stenosis. With reports of a higher operative morbidity than primary CEA and the advent of carotid stenting, catheter-based therapy has been advocated as the primary treatment for this reportedly "high-risk" subgroup. This...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.02.047
更新日期:2005-06-01 00:00:00
abstract::A 46-year-old woman was admitted with acute abdominal pain radiating to the back. Computed tomography examinations showed a needle-thin perforation of the aorta, opposite the origin of the superior mesenteric artery, with a pseudoaneurysm. A needle-sharp spinal osteophyte was located exactly opposite the perforation. ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2006.12.070
更新日期:2007-05-01 00:00:00
abstract::Exclusion of the accessory renal arteries (ARAs) is required during endovascular aneurysm repair if they arise from the sealing zone or aneurysm sac. Here, we report a case of successful endovascular treatment for a common iliac artery aneurysm located close to the aortic bifurcation and associated with nephrotic synd...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2014.05.042
更新日期:2016-02-01 00:00:00
abstract:OBJECTIVES:To determine (a) whether patients with peripheral artery disease (PAD) who walked at least 7,000 and 10,000 steps/day had better ambulatory function and health-related quality of life (HRQoL) than patients who walked less than 7,000 steps/day, and (b) whether differences in ambulatory function and HRQoL in p...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2020.10.073
更新日期:2020-11-27 00:00:00
abstract:BACKGROUND:Vascular smooth muscle cell (SMC) migration is an important component of the development of intimal hyperplasia. Sphingosine-1-phosphate (S-1-P) is a lipid released from activated platelets with numerous cellular effects including the stimulation of SMC migration in vitro. We examined the role of the mammali...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2004.08.058
更新日期:2005-01-01 00:00:00
abstract::True aneurysms of the innominate artery are rare. Successful axial reconstruction in the past has required a combined cervical and transthoracic approach with placement of a prosthetic graft. We describe herein the occurrence of an innominate artery aneurysm that extended to and involved the proximal common carotid ar...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2007.06.034
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVE:Low psoas muscle area is shown to be an indicator for worse postoperative outcome in patients undergoing vascular surgical. Additionally, it has been associated with longer durations of hospital stay in patients with cancer who undergo surgery and subsequently greater health care costs in Europe and the Unite...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2018.06.224
更新日期:2019-04-01 00:00:00