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n successful short-term outcomes. Based on the observed rate of resolution, management should start with anticoagulation followed by surveillance US at two-week intervals. When treated with anticoagulation, resolution can be expected to occur in one-third of patients every two weeks. OBJECTIVE Isolated internal iliac artery aneurysms (IIIAAs) are rare, life-threatening entities, for which the optimal treatment strategy has not been established. selleck inhibitor This study aimed to evaluate the outcomes of open and endovascular treatment of IIIAAs. METHODS IIIAA cases between January 2009 and March 2019 at two hospitals were retrospectively reviewed. Demographic, clinical, ancillary testing, treatment, and outcome data were collected and analyzed. RESULTS Forty-two patients (37 men and 5 women) with a mean age of 71 years were included. Twenty-five patients (60%) had a history of hypertension. Twenty-two patients (52%) were asymptomatic, and 16 (38%) presented with abdominal pain (12 with ruptured aneurysms). The 42 included patients had 43 treated IIIAAs. The following surgical techniques were used surgical resection (n=6), endovascular coil embolization (n=12), endovascular stent-graft placement across the internal iliac artery origin (n=8 with 9 aneurysms), and combined coil embolization and stent-graft placement (n=16). The immediate technical success rate was 67%, 67%, and 88% for embolization, stent-graft placement, and combined method, respectively. Open surgery was associated with the longest operative time and hospital stay. Overall 30-day mortality was 5% for all patients and 17% for patients with ruptured IIIAAs. Buttock claudication occurred in seven of 40 survived patients (18%). The median follow-up time was 56 months. This combined approach was associated with the lowest rates of endoleak and reintervention among three endovascular methods (6% vs 25% and 29%, 6% vs 17% and 29%). CONCLUSIONS Endovascular coil embolization and stent-graft placement is a feasible, safe, and effective treatment approach for large IIIAAs without adequate aneurysm necks. OBJECTIVE Vascular complications (VCs) occurring in TAVI procedures have frequently been reported in the past. Considering significant technical improvements in delivery systems and vascular closure devices, the goal of this study was to determine the incidence, impact, and prognostic factors of VCs in a recent real-world cohort. METHODS AND RESULTS We report a bicentric prospective analysis of 479 consecutive patients who underwent TAVI between January 2017 and December 2017. Vascular complications were defined according to criteria set out by the Valve Academic Research Consortium Criteria-2 (VARC-2). The incidence of VCs was 26.1% (n = 125 patients), of which 2.9% were major (n = 14) and 23.2% were minor (n = 111) . Vascular complications were related to the primary puncture point in 69% of cases, compared to 31%, at the secondary puncture site. Treatments implemented were medical in 76% of cases and surgical in 24% of cases. link2 The risk factors for VCs were as follows iliac morphology score, sheath-to-iliofemoral artery ratio (SIFAR), and moderate-to-severe iliofemoral calcifications or tortuosity. In the case of major VCs, only SIFAR was a risk factor. Major VCs significantly increased intra-hospital mortality (30.7% vs. 1.1% for minor VCs and 1.3% for no VCs, log rank p less then 0.0001) and 1-year mortality (40.6% vs. 5.6% for minor VCs and 5.6% for no VCs, log rank p less then 0.0001). CONCLUSION Using strictly VARC-2 endpoint definitions, more than one-quarter of TAVI procedures were associated with VCs, primarily minor ones. Secondary puncture points were responsible for one-third of VCs and should, therefore, also be actively monitored. Major VCs significantly impact short and mid-term survival. OBJECTIVE The pathologic nature of pediatric renal artery occlusive lesions causing renovascular hypertension has been the subject of numerous anecdotal reports. This study was undertaken to define the character of childhood renal artery stenoses. A better understanding of this disease is particularly germane given its unknown etiology and the limited success of certain contemporary treatment options. METHODS Renal artery specimens obtained during open operations in children being treated for renovascular hypertension from 2004-2016 were studied. Excluded from study were arteries subjected to earlier open or endovascular operations. Histologic preparations employing hematoxylin-eosin, Movat, Masson's Trichrome or Verhoeff Van Gieson stains allowed characterization of the intima, media, and adventitial tissues. External and luminal diameters were measured. Microscopic data were correlated with preoperative arteriographic images. The histologic and morphologic findings were assessed in regard to coexistent nonr CONCLUSIONS Pediatric renal artery stenotic disease affects exceedingly small arteries. Ostial lesions frequently exhibit extensive luminal encroachments characterized by cellular hyperplasia of intimal tissues and scant medial smooth muscle. Central and distal renal arterial stenoses were characterized most often by extensive fibrodysplasia of the media and adventitia. The early success and durability of catheter-based angioplasty may be compromised by the cellular abnormalities of pediatric renal artery occlusive disease observed in this investigation. OBJECTIVE Angiotensin Converting Enzyme inhibitors & Angiotensin Receptor Blockers (ACE/ARB) reduce the risk of cardiovascular events in patients with peripheral arterial disease (PAD). However, their effect on limb-specific outcomes is unclear. The objective of this study was to assess the effect of ACE/ARB on limb salvage and survival in patients undergoing peripheral vascular interventions (PVI) for chronic limb threatening ischemia (CLTI). METHODS Vascular Quality Initiative (VQI) registry was used to identify patients undergoing PVI for CLTI between April 1, 2010 - June 1, 2017. Patients with complete comorbidities, procedural and follow-up limb and survival data were included. Propensity score matching was performed to control for baseline differences between the groups. Limb salvage (LS), amputation-free survival (AFS) and over-all survival (OS) were calculated in matched samples using Kaplan-Meier. RESULTS A total of 12,433 limbs (11,331 patients) were included. ACE/ARB group patients had significantlcations for ACE/ARB therapy. INTRODUCTION Renovascular hypertension (RVH) associated with renal artery and abdominal aortic narrowings is the third most common cause of pediatric hypertension. Untreated children may experience major cardiopulmonary complications, stroke, renal failure and death. The impetus of this study was to describe the increasingly complex surgical practice for such patients with an emphasis on anatomic phenotype and contemporary outcomes following surgical management, as a means of identifying those factors responsible for persistent or recurrent hypertension necessitating reoperation. METHODS A retrospective analysis was performed of consecutive pediatric patients with RVH undergoing open surgical procedures at the University of Michigan from 1991 to 2017. Anatomic phenotype and patient risk factors were analyzed to predict outcomes regarding blood pressure control and the need for secondary operations using ordered and binomial logistic multinomial regression model, respectively. RESULTS One hundred sixty-nine chlihood of reoperation. link3 Patients undergoing remedial surgery after earlier operative failures are less likely to be cured of hypertension. Judicious post-operative surveillance is imperative in children surgically treated for RVH. PURPOSE Endovascular aneurysm repair (EVAR) can result in high radiation dose to patients and operators. This prospective randomized study aimed to assess whether patient radiation dose sustained during EVAR could be decreased by predominantly using digital fluoroscopy (DF) versus the standard technique using digital subtraction angiography (DSA). MATERIALS AND METHODS Between February 2011 and June 2017, patients with EVAR of infrarenal abdominal aortic aneurysms were prospectively enrolled and randomly assigned to a standard-treatment DSA cohort or a DF cohort in which 2 or fewer DSA acquisitions were allowed for confirmatory imaging. Primary end points included dose area product (DAP) and cumulative air kerma (CAK). Secondary end points included technical success and conversion to DSA standard treatment (if DF was inadequate for visualization). RESULTS For all 43 patients enrolled (26 in the DF cohort, 17 in the DSA cohort), technical success was 100%. Five of 26 DF patients (19%) required conversion to the DSA cohort. In an intention-to-treat analysis, mean DAP was significantly lower in the DF cohort than the DSA cohort (132 vs 174 Gy·cm2; P=.04). When separating patients by number of DSA acquisitions (≤2 vs ≥3), mean DAP decreased 41% (109 vs 185 Gy·cm2; P=.005) and CAK decreased 40% (578 vs 964 mGy; P=.004). CONCLUSION In most patients (81%), DF or limited DSA was adequate for visualization during EVAR. In both intention-to-treat DF and limited-DSA cohorts, mean DAP was significantly decreased. If image quality allows, a DF-only or limited-DSA approach to EVAR decreases radiation dose. OBJECTIVES Despite improvements in treating human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), the risk of end-stage renal disease (ESRD) and need for long-term arteriovenous (AV) access for hemodialysis remain high in HIV-infected patients. Associations of HIV/AIDS with AV access creation complications have been conflicting. Our goal was to clarify short and long-term outcomes of patients with HIV/AIDS undergoing AV access creation. METHODS The Vascular Quality Initiative Registry (VQI) was queried from 2011-2018 for all patients undergoing AV access creation. Documentation of HIV status with or without AIDS was recorded. Data were propensity score matched (41) between non-HIV and HIV/AIDS patients. Subsequent multivariable analysis and Kaplan-Meier analysis were performed for short- and long-term outcomes. RESULTS There were 25,711 upper extremity AV access creations identified - 25,186 without HIV (98%), 424 (1.6%) with HIV, and 101 (.4%) with AIDS. Mean age was 61.8 years an08, 95% CI .83 - 1.43, P=.57). CONCLUSIONS Patients with HIV/AIDS undergoing AV access creation have similar outcomes to those without HIV, including long-term survival. Patients with HIV/AIDS had fewer traditional ESRD risk factors compared to non-HIV patients. Our findings show that contemporary approach for creation and management of AV access in patients with HIV/AIDS should be continued, however, further research is needed to identify risk factors in this population. BACKGROUND Contrast induced nephropathy is a possible adverse event in fenestrated endografting (FEVAR). Automated CO2-angiography has been proposed as an alternative to iodinated contrast media (ICM) for standard endovascular aneurysm repair; however, its use in FEVAR has not been investigated yet. The aim of this study was to analyze the possibility of reducing the amount of procedural ICM during FEVAR by combining CO2 with intraprocedural 3D preoperative computed tomography angiography overlaid onto 2D live fluoroscopic images (fusion imaging - FI). METHODS Between January and April 2018, juxta/para-renal and type-IV thoracoabdominal aneurysms undergoing FEVAR with a CO2+FI protocol were prospectively collected and compared with FEVAR cases treated with standard procedural imaging (ICM+FI) between June and December 2017. Pre, intra and post-operative data were analyzed. Amount of ICM, procedural/fluoroscopy time, total radiation dose (DAP), endoleaks (EL) and technical success (TS) - defined as absence of type I/III EL and target visceral vessels patency at completion angiography - were assessed.
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