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Case report

Late carotid restenosis with contralateral oclusion and no femoral axis – Tough case

76-year-old man with right internal carotid artery occlusion. In 2009, left carotid endarterectomy for symptomatic carotid stenosis.

Follow-up protocol with yearly carotid ultrasound and 10 years later an asymptomatic restenosis of 90-95% was diagnosed and proposed for re-intervention.

PAD with severe bilateral aorto-iliac disease. Femoral pulses were absent.

Under local anesthesia, stenting of the left carotid axis (Roadsaver® 8x40mm) by surgical approach of the left primitive carotid artery was performed. SpiderFx 6.0 filter for cerebral protection.

The procedure and the postoperative period were uneventful and the patient was discharged one day after surgery under double antiplatelet therapy. Control ultrasound showed patency of the stent as well as the downstream artery, with no evidence of thrombi or residual stenosis.

Pedro Amorim
October 5, 2020 No Comments
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Case report

Endovascular treatment of in-stent restenosis of right ICA using dual layer micromesh Roadsaver stent

This is an interesting and unusual case of in-stent restenosis after CAS.

The patient had been stented on both ICA , left side with dual layer micro mesh stent and right side with an open cell design, Protege, Medtronic.

Restenosis occured on the right side where open cell stent was placed, even though leftside was stented before.

We decided to go for a “stent in stent” solution in order to achieve better result, and Roadsaver stent was chosen for this purpose.

Final result was satisfaying.

 

Aleksandar Gjoreski
August 5, 2020 No Comments
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Recorded case
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Iliac vein compression visualised with IVUS

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Recorded case
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IVUS guided deep venous stenting

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Recorded case

Venous stenting for iliofemoral occlusive disease

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Experts opinion
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IVUS vs Angiography in patients with peripheral vascular disease

Dr Konstantinos Stavroulakis (St. Franziskus Hospital, Münster, DE) discusses Angiography alone in the lower limb - First results comparing IVUS and angiography in the leg. Questions : 1.What was the need for comparing IVUS and angiography in the leg? 2.What are your findings to date and what conclusions (if any) can be made? 3.What further data should be anticipated from the trial? 4.What further research, in your opinion, is needed? Source: https://www.radcliffevascular.com
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Recorded video case

Carotid artery stenting in a complex anatomy CEA restenosis

A 73-years old female with history of previous left carotid endarterectomy and recent acute transient ischemic attack was referred to our Center to undergo carotid stenting. Her Duplex ultrasound showed severe left internal carotid artery restenosis with significant Doppler flow acceleration.

Antonio Micari
February 19, 2020 No Comments
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Poll 04/10/2019 – 31/10/2019

Choice of antiplatelet therapy around complex revascularisation

A 79-year-old diabetic male patient with no history of coronary disease is referred to you to undergo angioplasty for tissue loss on the tips of the hallux and second toe. He is taking Aspirin 75mg. From preoperative imaging he needs a 20cm SFA occlusion stopping before the adductor hiatus recanalizing as well as multilevel tibial disease which appears to be a combination of short occlusions and stenoses. The dorsal pedal is seen in the foot and is in continuity with the arch. The PT artery appears occluded through it’s whole length.

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Poll 05/09/2019 – 30/09/2019

Online education in vascular medicine

Shape your learning experience on Vascupedia

 

Dear colleagues, our mission is to help physicians worldwide to bring their interventions to perfection. Our hope is to indirectly contribute to safety and well-being of patients with vascular diseases.

Over a year ago, we started Vascupedia as a unique online project that we believe fulfills the need for free education in the challenging field of Vascular Medicine. Now it’s time to ask you to help us to become better for you! Are we offering the right information in the right way at the right level? Is there anything missing to support you in your quest to grow your knowledge to treat your patients in the best possible way? Please complete this short survey to make sure we will work on improving the platform to serve YOUR educational needs!

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Technical note

How to perform Carotid Artery Stenting. Perugia way to do it

Carotid artery stenting is a delicate surgery being sometimes as fast as insidious.

We strongly believe that in order to minimize complications rate an almost obsessive attention to details in each procedural moment is essential.

In this video we report probably the most standardized procedure performed at our institution with 6 operators currently doing each passage exactly the same way.

Of course we don’t claim to show the way it should be done, but just the way we learned to do it after more than 3000 performed cases

Gioele Simonte
August 21, 2019 No Comments
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E-Poster

TCAR: PUSHING CAS TO THE PIPELINE. PRELIMINARY RESULTS OF A PROSPECTIVE COHORT.

TCAR is a hibryd option for CAS offering the best cerebral protection with reverse flow system engaging the common carotid artery with the contralateral common femoral vein. The Roadster Trial has the best data never published regarding Peri-operative neurological events for a prospective multicentre Trial. The procedure could be perform under local anesthesia with the patient copletely awake.

Rubén Rodríguez Carvajal
May 10, 2019 No Comments
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Technical note

Management of vascular trauma of the upper limbs

Dr. Giovanni Tinelli presents a very comprehensive overview regarding the treatment of the vascular trauma of upper limbs. His presentation includes all relevant information about definition and anatomy, classification of the injury, the different types of treatment and tips from his personal experience.

CACVS I CONTROVERSIES & UPDATES IN VASCULAR SURGERY
March 4, 2019 No Comments
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Case report

Ministernotomy for ascending aorta and aortic arch replacement with left carotid artery, right carotid artery and left axillary artery debranching.

Clinical Summary
– 28 year old male
– Traumatic aortic injury (TAI)
– Endovascular treatment
Complications
– Aortic arch and brachiocephalic trunk dissection
– Right carotid artery and left sublcavian artery occlusion
– Stroke
– Orthostatic Hypotension (Extracranial Steal Syndromes from Disease of the Aortic Branches?)
Surgery Technique
– Femoro-femoral and right axillary artery cannulation
– The aorta was accessed through a Ministernotomy

Paolo Magagna
February 7, 2019 No Comments
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Vascular images

Step-by-Step. OFF-PUMP TRIPLE EXTRA-ANATOMICAL BY-PASS

1. The heart is accessed through a full midline sternotomy
2. An off-pump coronary artery bypass graft is performed on the left anterior descending artery using a saphenous vein graft and 7-0 prolene continuous suture
3. The aorta is partially clamped with a side clamp and is opened through a longitudinal incision, about 2 cm length
4. A prosthesis is sutured onto the aorta with a continuous 4-0 prolene suture
5. One branch of the prosthesis is passed behind the ascending aorta,

Paolo Magagna
August 8, 2018 1 Comment
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Poll 01/08/2018 – 31/08/2018

Asymptomatic carotid artery disease

Patient’s characteristics

 

Gender: Female

Age: 72 years old

Comorbidity: Arterial hypertension, hypercholesterinemia, previous smoker

Symptoms: None

Previous operations: None

Vascular Imaging of the left internal carotid artery: Duplex ultrasound with peak systolic velocity (PSV)> 230 cm/sec

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Recorded video case

Carotid artery stenting with the Mo.Ma™ Ultra proximal cerebral protection device

This is a recorded case presenting all the important steps of carotid artery stenting (CAS). These steps include the use of transbrachial access, the advancement of the sheath in the common carotid artery, the placement of the Mo.Ma cerebral protection device to remove all sizes of debris and the final procedure of carotid artery stenting. Finally, the interventionalists demonstrate all relevant aspects of intraoperative monitoring by transcranial doppler.

Piero Montorsi
July 26, 2018 No Comments
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