Annals of Vascular Surgery

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On the Cover

November 2020

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15. Case Report: Endoanchor Fixation and Placement of Infrarenal Aortic Endografts

Precise deployment of commercially available infrarenal endografts is key to the repair of infrarenal aortic aneurysms, particularly with short, angulated, and diseased landing zones. Coverage of important branch vessels or graft migration may require advanced endovascular techniques for rescue or conversion to open repair. Aptus endoanchor technology (Medtronic, Minneapolis, MN) allows precise adjustments after deployment of endografts and improved fixation.

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Table of Contents

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14. Government-Mandated Social Distancing Did Not Alter Operative Vascular Trauma Patterns at a Single Level-One Trauma Center

On March 16, 2020, the Federal government issued the Coronavirus Guidelines for America which included recommendations for social distancing. Furthermore, Georgia issued a state-mandated shelter in place order beginning April 2, 2020 and lasting until April 30, 2020. The purpose of this study is to evaluate if government mandates for social distancing had any effects on the number of patients presenting to our urban level 1 trauma center with vascular injuries requiring operative intervention.

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13. Endovascular Management of Visceral Artery Aneurysms

Visceral artery aneurysms (VAA) are rare and can be complicated by rupture and life threatening intra-abdominal hemorrhage. Management strategies range from observation to endovascular techniques and open surgery, however, there is limited consensus regarding specific treatment approaches. Here we present a case series demonstrating the use of endovascular ablative luminal therapy and stent grafting for the management of VAAs in both elective and emergent contexts.

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12. Management of Symptomatic Brachiocephalic Artery Occlusion

Brachiocephalic artery occlusion is rare and can present with cerebrovascular and vertebrobasilar insufficiency, along with subclavian steal syndrome. Published literature describes a wide array of treatment modalities, ranging from endovascular to surgical bypass. We present a case series demonstrating the variety of available strategies, including open extra-anatomic bypass and hybrid endovascular techniques.

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11. The Utility of Coaxial Support System in the Management of Flush Visceral Arterial Occlusive Disease

Endovascular management of chronic mesenteric ischemia is well accepted, especially for patients with serious comorbidities. Flush occlusion of the visceral arteries remains a challenging entity for such an approach. This is caused by frequent inability to engage the ostium of the superior mesenteric artery (SMA). Even when engaged, the heavy calcification is not always easily crossed. Successful management of chronic mesenteric ischemia depends on a reliable coaxial support system. Usually, this system is composed of a sheath, guide catheter, support catheter and wire.

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10. In-situ Laser Technique in Complex, Fenestrated Endovascular Aortic Repair

In-situ laser fenestration of endovascular grafts has been described as a new method for complex, endovascular aortic surgery in patients unfit for open repair. Increasing number of studies have described this technique as an option for creating fenestrations during repair of complex vascular anatomy. We present our single-center experience of the use of in-situ laser fenestration during fenestrated endovascular aortic repair.

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9. Case Report: Accurate Placement of Thoracic Aortic Endografts

Endovascular repair of aortic aneurysms and pathology has advanced from physician modified devices to commercial grafts with more accurate deployment and improved sealing and fixation characteristics. Precise placement and fixation of grafts is key to the accurate repair of aortic disease and avoidance of malpositioning of appropriately sized grafts in the aorta. Aptus endoanchor technology (Medtronic, Minneapolis, MN) allows precise deployment of endografts.

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8. Cystic Adventitial Disease of Popliteal Artery

Cystic adventitial disease is a rare vasculopathy in which cysts form from mucinous accumulation within vessel adventitia, most commonly the popliteal artery. Patients typically present with claudication. Although the etiology is debated, the prevailing theory suggests that cyst origin and propagation arise from an articular branch connecting the affected vessel to the knee joint, allowing tracking of synovial fluid. Management varies from observation to surgical intervention, which includes combinations or singular strategies of cyst excision, grafts, patches, and bypass.

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