This data suggest in the elderly patients, autogenous fistulas may not be the best option for this set of patients.

Selective stents placed for suboptimal results after subintimal angioplasty produce similar patency rates to primary SIA without stents. Patients receiving stents with prior lower extremity bypass surgery will have worse outcomes than those without. Use of a stent diameter < or =6 mm and indication of critical limb ischemia will likely produce worse results. It appears that other stent variables (location, number, length, and overlap) do not alter patency. Finally, selective stent use after SIA provides excellent limb salvage.

CAS is as technically feasible, safe, and durable in anatomically high-risk patients as in medically high-risk patients, with similar rates of periprocedural stroke and death and late restenosis. However, patients with radiation-induced stenosis appear to be at an increased risk for restenosis.

Objectives: Patients presenting with digital ischemia and arterial occlusion distal to the wrist are a disadvantaged population with renal failure, collagen vascular disease and hypercoaguable states and difficult technical options for revascularization. A nonaggressive stance to treatment in these patients often leads to significant digit/hand loss and thus we have approached these patients aggressively in order to try to improve limb salvage.Methods: A retrospective review of all upper extremity bypasses performed to arteries distal to the wrist was performed. All patients were evaluated with biplanar arteriography. Patients with hypercoaguable states and rheumatoid arthitides/collagen vascular disease (RA) were medically evaluated prior to operation. Postoperative surveillance was performed with PVR and Duplex scan. Vein bypasses were performed in all cases. Patency was computed according to life table methods.Results: Between 1993 and 2008, 40 bypasses were performed in 34 patients for digital gangrene (20), rest pain (13) and ulcer (5). There were 19 males and 15 females. Patient risk factors included diabetes (17), active smoking (17), hypertension (13), hyperlipidemia (8), Coronary disease (10) and renal failure (18). Documented hypercoaguable states and RA were present in four and 12 patients, respectively. Outflow arteries included distal radial (29), distal ulnar (1), palmar arch (7) and common digital arteries (3). Venous conduit included saphenous and cephalic veins in reversed (34), nonreversed (3) and spliced (3) configuration. There was no operative mortality. Digital amputation was performed in 19 patients for gangrene and minor debridement in 4 patients. There were 5 bypass occlusions all of which occurred in the first year. Cumulative patency from this point on was 84% (mean follow up: 22 months (range: 1-184 months)). Cumulative survival was 57% at 2 years and 26% at 5 years.Conclusions: Arterial bypass in patients with infracarpal upper extremity arterial disease is challenging but may be achieved with excellent patency. Digital amputation is often required. Long term survival in these patients is limited and perioperative management of patient risk factors important. Objectives: Hybrid debranching procedures and branched stent grafts have been proposed as alternative treatments to lower the morbidity and mortality associated with open thoracoabdominal aortic aneurysm (TAAA) repair. The purpose of this study was to determine in-hospital mortality and factors predicting in-hospital death after open repair of TAAA in the United States (US) prior to the widespread use of new technologies. Methods: The Nationwide Inpatient Sample (NIS) identified open repair procedures for non-ruptured TAAA during the years 2000-2006. Risk stratification was based on the Charlson comorbidity index (CCI), which provides aggregate measures of 18 clinical parameters. Weighted logistic regression analyses were used to determine independent predictors of inhospital mortality and complications taking into account the NI...

Endovascular reintervention after SIA is a safe and technically feasible procedure for recurrences and offers good limb salvage rate. Early reinterventions performed within 3 months of the original SIA portend a worse outcome. In addition, reinterventions are less durable in patients with CLI compared with claudication. Finally, by identifying a recurrent stenosis instead of an occlusion, close surveillance may contribute to improved overall outcome.