Faculty Bibliography

There is no universally accepted method to treat in-stent restenosis (ISR) in the superficial femoral artery (SFA). It is hypothesized that using the Viabahn expandable polytetrafluoroethylene- covered stent to treat ISR may prevent tissue infiltration and intimal hyperplasia that leads to restenosis. METHODS: We studied 22 patients (27 limbs) referred for treatment of severe ISR of the SFA. All patients were treated with the Viabahn stent implanted in the restenotic segments. We also analyzed several demographic, procedural, and laboratory parameters that could potentially be predictors of Viabahn restenosis. RESULTS: Among patients treated, 63% had severe claudication and 37% had critical limb ischemia. Mean treated lesion length was 214.8 +/- 87.2 mm, mean run-off score was 3.9 +/- 2.8. Mean follow-up period was 21.8 +/- 10.3 months. Ten patients (37%) developed Viabahn restenosis. The mean lesion length was 180.0 +/- 107.9 mm in the restenosis group and 219.4 +/- 78.9 mm in the no-restenosis group (P=.27). There was no significant difference between the two groups in the rest of demographic, procedural, and laboratory parameters. In 90%, restenosis occurred within the first 12 months and the remaining 10% occurred within 14 months. The mean time to restenosis was 6.2 +/- 4.3 months. We observed no Viabahn ISR occurring after 14 month of follow-up. CONCLUSION: The Viabahn stent can be used to treat ISR in the SFA, with favorable results of 63% primary patency at up to 3 years of follow-up. Analysis of multiple factors showed no association with restenosis occurrence. If the Viabahn remained patent for 14 months, the likelihood of restenosis was low.

Invasive aspergillosis is an often fatal disease that usually occurs in immunocompromised patients. We report a case of invasive aspergillosis presenting as a febrile respiratory infection with a cardiac mass in an immunocompetent patient. Invasive asper-gillosis should be considered in the differential diagnosis of an otherwise undiagnosed invasive febrile respiratory illness, even in immunocompetent patients. Echocardiography should be performed to evaluate for endocarditis in such cases. Prompt initiation of appropriate antifungal therapy is warranted, even before the diagnosis of invasive aspergillosis is confirmed.

Aortocaval fistula is an uncommon but often fatal complication of abdominal aortic aneurysm. Both open and endovascular repair of aortic aneurysm with aortocaval fistulae have been previously reported. We present the case of a patient with persistent aortocaval fistula after endovascular stent graft repair, which is closed using an Amplatzer muscular VSD occluder. Further studies using the Amplatzer muscular VSD occluder for closure of aortocaval fistulae are warranted.

The glycogen storage diseases are a rare form of inherited metabolic disease affecting intracellular glycogen metabolism, and several studies suggest glycogen storage disease (GSD) III predisposes patients to dyslipidemia and endothelial dysfunction. The presence of premature atherosclerotic heart disease in patients with GSD III has not been reported in the literature. We report a case of a 24- year old patient with GSD III admitted with ventricular fibrillation cardiac arrest in the setting of anterior wall myocardial infarction. Further studies are warranted on the prevalence of atherosclerotic heart disease, and potential screening and preventative strategies, in this population of patients potentially at-risk for early cardiac events.

A patent foramen ovale (PFO) can act as a conduit between the venous and arterial circulations, allowing right-to-left shunting and bypass of the pulmonary circulation. Brain abscess may develop as a result of paradoxical embolism of organisms through a PFO. In this small series, we report on the closure of PFO for the prevention of recurrent brain abscess. Only prospective, randomized trials comparing PFO closure to conservative therapy could provide a definitive answer as to the optimal strategy for preventing recurrent cerebral abscess