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Definition of Best Medical Treatment in Asymptomatic and Symptomatic Carotid Artery Stenosis
Paraskevas, Kosmas I; Mikhailidis, Dimitri P; Veith, Frank J; Spence, J David
Implementation of best medical treatment (BMT) is the cornerstone of the management of patients with either asymptomatic or symptomatic carotid artery stenosis. We review the literature to define the components of BMT. Smoking cessation, maintaining a healthy body weight, moderate exercise, and a Mediterranean diet are essential lifestyle measures. Moderate alcohol consumption may also be beneficial but recommending it to patients may be hazardous if they consume too much. The importance of lifestyle measures is largely underestimated by both physicians and patients. Blood pressure and diabetes control, antiplatelet agents, and lipid-lowering treatment with statins/ezetimibe comprise the pharmacological components of BMT. Initiation of an intensive regimen of BMT is a sine qua non for patients with carotid artery stenosis whether or not they are offered or undergo an invasive revascularization procedure.
PMID: 26721504
ISSN: 1940-1574
CID: 1895322
How Many of You Can Read But Still Not See? A Comment on a Recent Review of Carotid Guidelines
Veith, F J; Bell, P R F
PMID: 26701193
ISSN: 1532-2165
CID: 1884292
Commentary: Transcervical Carotid Artery Stenting (CAS) With Flow Reversal: A Promising Technique for the Reduction of Strokes Associated With CAS
Paraskevas, Kosmas I; Veith, Frank J; Parodi, Juan C
PMID: 26984815
ISSN: 1545-1550
CID: 2031432
Endovascular grafts for abdominal aortic aneurysm
Steuer, Johnny; Lachat, Mario; Veith, Frank J; Wanhainen, Anders
During the last two decades, endovascular technology has revolutionized the management of patients with abdominal aortic aneurysm (AAA). Today, endovascular aortic repair (EVAR) is the treatment of choice for the majority of patients with an AAA. Randomized controlled trials provide robust evidence for the indication of AAA repair and the rationale for the use of EVAR in selected patients. However, despite that, practice varies and several areas need further elucidation. Important future challenges and areas of research include the role of medical therapy in AAA, whether the indication for repair should be any different in women and in the elderly, and long-term follow-up of patients undergoing complex EVAR with adjuncts, both for elective treatment and for ruptured AAA. Continuous rapid technical and clinical development is to be expected. In this paper, we review the current practice and evidence of stenting in AAA.
PMID: 26543044
ISSN: 1522-9645
CID: 2039852
Tips and tricks for obtaining supraceliac aortic control for rAAA [Meeting Abstract]
Veith, F J
Learning Objectives 1. To learn when and how supraceliac aortic control is applied 2. Technical tips for interventions during aortic control 3. To learn about complications during aortic control Endovascular aneurysm repair (EVAR) is being increasingly used to treat ruptured abdominal aortic aneurysms (RAAAs). Approximately 25% of RAAAs suffer complete circulatory collapse before or during the procedure. Their survival depends on obtaining and maintaining supraceliac balloon control until the endograft is fully deployed. This is accomplished with a sheath-supported compliant balloon inserted via the groin contralateral to the side to be used for insertion of the endograft main body. After the main body is fully deployed, a second balloon is placed within the endograft and the first balloon is removed so that extension limbs can be placed at the contralateral side. A third balloon can be placed via the contralateral side and ipsilateral extensions can be deployed as necessary. This technique of supraceliac balloon control is important to achieve good outcomes with RAAAs. In addition to minimizing blood loss, this technique minimizes visceral ischemia and maintains aortic control until the aneurysm rupture site is fully excluded
EMBASE:613932993
ISSN: 1432-086x
CID: 2395482
Sustained Late Branch Patency and Low Incidence of Persistent Type Ia Endoleaks Following Snorkel/chimney EVAR Shown in the Updated PERICLES Registry [Meeting Abstract]
Lee, Jason T; Pecoraro, Felice; Dalman, Ronald L; Tran, Kenneth; Torsello, Giovanni; Veith, Frank J; Lachat, Mario; Donas, Konstantinos P
ISI:000376230600232
ISSN: 0741-5214
CID: 2146762
The PERICLES registry [Meeting Abstract]
Donas, K P; Torsello, G; Veith, F J
Learning Objectives 1. To learn what the PERICLES registry is 2. To learn about the outcomes of the PERICLES registry The aim of the performance of the chimney technique for the treatment of complex aortic pathologies (PERICLES) registry was to provide the latest pooled evidence about chimney grafts in pararenal pathologic processes and to evaluate if the sceptisicm about the grafts is justified. Overall, data of 517 patients (398 of whom were treated at European vascular centres and 119 at US centres) who underwent chimney EVAR between 2008 and 2014 were reviewed. The mean number of chimney grafts placed was 1.7 per patient (overall 898 target aortic branch vessels). In total, 49.2% of the chimney grafts were balloon-expandable covered stents and 39.6% were self-expanding covered stents. Primary chimney graft patency was 94.1%. The mean aortic aneurysm diameter was significantly decreased to 61.2+/-19.7 mm from 65.9+/-16.5 mm, p.001. The technical success was 97.1%. The mean new neck/seal length after placement of the chimney grafts increased from 4.8+/-7.4 mm to 21.1+/-12.7 mm. Persistent type IA endoleak rate was 2.9%. The 30-day mortality rate for the elective cases was 3.7%. The present global experience with the chimney/snorkel graft underlines the complementary role of parallel grafts and supports wider usage and further evaluation. Based on the mid-term results, it seems that the widespread scepticism is not justified
EMBASE:613932855
ISSN: 1432-086x
CID: 2395492
Carotid Artery Stenting (CAS) Outcomes May Vary Between Operators/Institutions. The Results from Centers of CAS Excellence May Not Be Generalizeable
Paraskevas, Kosmas I; Veith, Frank J
PMID: 26362617
ISSN: 1615-5947
CID: 1772762
Collected World Experience About the Performance of the Snorkel/Chimney Endovascular Technique in the Treatment of Complex Aortic Pathologies: The PERICLES Registry
Donas, Konstantinos P; Lee, Jason T; Lachat, Mario; Torsello, Giovanni; Veith, Frank J
OBJECTIVES: We sought to analyze the collected worldwide experience with use of snorkel/chimney endovascular aneurysm repair (EVAR) for complex abdominal aneurysm treatment. BACKGROUND: EVAR has largely replaced open surgery worldwide for anatomically suitable aortic aneurysms. Lack of availability of fenestrated and branched devices has encouraged an alternative strategy utilizing parallel or snorkel/chimney grafts (ch-EVAR). METHODS: Clinical and radiographic information was retrospectively reviewed and analyzed on 517 patients treated by ch-EVAR from 2008 from 2014 by prearranged defined and documented protocols. RESULTS: A total of 119 patients in US centers and 398 in European centers were treated during the study period. US centers preferentially used Zenith stent-grafts (54.2%) and European centers Endurant stent-grafts (62.2%) for the main body component. Overall 898 chimney grafts (49.2% balloon expandable, 39.6% self-expanding covered stents, and 11.2% balloon expandable bare metal stents) were placed in 692 renal arteries, 156 superior mesenteric arteries (SMA), and 50 celiac arteries. At a mean follow-up of 17.1 months (range: 1-70 months), primary patency was 94%, with secondary patency of 95.3%. Overall survival of patients in this high-risk cohort for open repair at latest follow-up was 79%. CONCLUSIONS: This global experience represents the largest series in the ch-EVAR literature and demonstrates comparable outcomes to those in published reports of branched/fenestrated devices, suggesting the appropriateness of broader applicability and the need for continued careful surveillance. These results support ch-EVAR as a valid off-the-shelf and immediately available alternative in the treatment of complex abdominal EVAR and provide impetus for the standardization of these techniques in the future.
PMID: 26258324
ISSN: 1528-1140
CID: 1720942
A 12-Year Experience With Chimney and Periscope Grafts for Treatment of Type I Endoleaks
Montelione, Nunzio; Pecoraro, Felice; Puippe, Gilbert; Chaykovska, Lyubov; Rancic, Zoran; Pfammatter, Thomas; Mayer, Dieter; Amman-Vesti, Beatrice; Husmann, Marc J; Veith, Frank J; Mangialardi, Nicola; Lachat, Mario
PURPOSE: To evaluate the midterm outcomes of chimney and/or periscope grafts (CPGs) in patients presenting type I endoleak after a previous endovascular aneurysm repair (EVAR). METHODS: Between June 2002 and April 2014, 24 consecutive patients (mean age 73.9+/-9.2 years; 23 men) presenting a type I endoleak were addressed with CPGs to extend the proximal and/or distal landing zone and to maintain side branch perfusion. Indication for treatment was a type Ia endoleak in 23 (96%) patients and a type Ib endoleak in one. Median interval from the previous EVAR to endoleak treatment with CPGs was 52.2+/-48.9 months (range 0.2-179). All patients had proximal/distal landing zones precluding any standard endovascular reintervention. Measured outcomes included technical success and perioperative mortality and morbidity. Technical success was defined as a procedure completed as intended, with no secondary procedures within 30 days. Midterm outcomes included survival, CPG patency, endoleaks, and freedom from reintervention. RESULTS: Technical success was 96%; a single patient required an additional procedure to seal a recurrent type Ia endoleak. Intraoperative revascularization of all 55 target vessels (2.3/patient) with CPGs was successful. One (4%) patient died within 30 days. Estimated survival at 12, 24, and 36 months was 83%; estimated CPG patency at the same intervals was 94%. Over a mean follow-up of 23.4+/-29 months, 6 (25%) reinterventions were performed; of these, 4 were secondary to type I endoleak. Aneurysm diameters reduced from 88.3+/-26 to 85.5+/-33 mm (p=0.49) over the mean follow-up. CONCLUSION: The CPG technique is a safe and effective tool for treatment of type I endoleak after previous EVAR. The CPG technique is feasible even in nonelective patients, with excellent outcomes in terms of patency. Close imaging follow-up is warranted to rule out recurrent or de novo endoleaks.
PMID: 25969150
ISSN: 1545-1550
CID: 1579342