This article investigates the results of endovascular aneurysm repair with the Endovascular Technologies Tube and Bifurcated Endograft. During a three year period, 30 patients were operated on as part of an FDA-supervised international trial. A tube graft was inserted in 17 cases and a bifurcated graft in 13. All patients were treated in the operating theater, using a mobile fluoroscopy arm. Successful cases were subjected to a follow-up regime of repeated physical and radiological exams. The endograft could be inserted in 27 patients (90%). In two cases the graft could not be advanced due to severe calcification of the iliac arteries. In one patient, inadequate distal positioning of a tube graft could not be corrected by endovascular techniques. One patient died (3%) due to a proximal aortic tear. Except abdominal wound dehiscence in a converted patient, no serious postoperative complications were seen. Endoleak was encountered in 11 patients (37%), resulting in conversion in five (17%). The success rate at a median follow-up of 12 months was 70%; however, 6 out of 8 technical failures occurred in the first 15 patients. This study demonstrated a learning curve in endovascular aneurysm repair. Arrest of growth or shrinkage of the aneurysm was seen in all patients with a completely thrombosed aneurysm sac. No evidence of graft migration, infection, or thrombosis was found in this series during follow-up.
BACKGROUND Thrombus regression in heparin-treated, acute deep venous thrombosis of the lower extremity is poorly documented in the literature; different rates of thrombus resolution and recanalization are reported. METHODS AND RESULTS In a prospective follow-up study, duplex scanning was used to evaluate the thrombus regression in patients with documented acute femoropopliteal thrombosis. Eighty vein segments in 20 legs of 18 patients were subjected to repeat duplex scans at 1, 3, 6, 12, and 26 weeks after diagnosis; 49 segments showed thrombus at diagnosis. The popliteal vein showed the highest thrombus load at diagnosis, followed in descending order by the superficial femoral, profunda femoris, and common femoral vein segments (p less than 0.001). Thrombus regression was significant (p less than 0.001) in all segments and proceeded at an exponential rate that was equal in the different vein segments of the upper leg. Both thrombus resolution and recanalization appeared to be a function of the initial thrombus load and could not be related to individual vein segments. Recanalization was seen in 23 of 31 initially occluded segments and occurred within the first 6 weeks after diagnosis in 20 of 23 segments. Extension of thrombus despite anticoagulant therapy was observed in 15 vein segments and was not related to the initial thrombosis score (p = 0.1) or individual vein segments (p = 0.23). Thrombus extension in seven patients with prethrombotic conditions was not different (p = 0.9) from the other patients. CONCLUSIONS Duplex scanning is an important noninvasive tool to quantify thrombus regression in acute deep venous thrombosis in detail without unnecessary discomfort to the patient.
Occlusion or severe stenosis, with a reduction in the diameter of more than 70% of the extracranial arteries may lead to hpoperfusion of the brain with an increased risk of cerebral infarction. The aim of this study was to investigate whether endarterectomy of stenosed internal carotid arteries leads to alternations in cerebral metabolism in regions in which no infarcts were visible with magnetic resonance imaging (MRI). We studied 10 healthy control subjects and 20 patients with transient or nondisabling cerebral ischemia with MRI and 1H magnetic resonance spectroscopic imaging. All patients underwent carotid endarterectomy. Patients were examined 1 week before and 3-6 months after carotid endarterectomy. The N-acetyl aspartate (NAA)/choline ratio in the symptomatic hemisphere before endarterectomy (2.29 +/- 0.42) was significantly (p < 0.001) lower than for control subjects (3.18 +/- 0.32). In five of the patients lactate was detected preoperatively in regions that were not infarcted. The NAA/choline ratio in the symptomatic hemisphere of these five patients did not increase significantly after endarterectomy (1.99 +/- 0.22 vs. 2.23 +/- 0.48). The NAA/choline ratio in patients without lactate preoperatively increased significantly (p < 0.01) after endarterectomy to a normal level (from 2.39 +/- 0.42 to 2.92 +/- 0.52). These results indicate that the presence of cerebral lactate may predict whether the NAA/choline ratio increases after carotid endarterectomy.
