Stent-graft exclusion of PAAs is safe and effective, yielding primary and secondary patency rates comparable to surgical repair. In spite of encouraging results in this study, further larger studies are warranted to reconfirm our observations.

Restenosis after carotid stenting is uncommon; however, patients with previous CEA or XRT are at increased risk. Restenotic lesions may be safely treated with further percutaneous interventions.

Hypoplastic aortoiliac syndrome (HAIS) occurs in young women and is characterized by a small infrarenal aorta with a hypoplastic iliofemoral arterial system and advanced atherosclerotic disease. Of 304 aortoiliac interventions (AoI), 30 female patients (mean age, 50 +/- 5 years) had HAIS. HAIS patients were less likely to have coronary disease (33% vs. 88%; P < 0.0001) or diabetes (10% vs. 42%; P < 0.001) compared to their AoI counterparts. Twenty-three patients (73%) had hyperlipidemia with mean cholesterol of 287 +/- 42 mg/dl. Twenty-eight patients (93%) were successfully treated with AoI. The ankle/brachial indices improved from pre-AoI ABI of 0.55 +/- 0.1 to post-AoI ABI of 0.99 +/- 0.1. Complications included one groin hematoma and one case of thrombosis. Follow-up averaged 31 months (range, 3-91 months) with an early (less than 12 months) restenosis rate of 7% and late (greater than 12 months) restenosis of 21%. One patient (3%) required surgical revascularization for persistent symptoms. Percutaneous treatment of HAIS is an alternative to surgical revascularization with satisfactory long-term results.

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Background: Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) has emerged as a safe, effective alternative to redo aortic valve surgery in high-risk patients with degenerated surgical bioprosthetic valves. However, ViV-TAVR has been associated high postprocedural valvular gradients, compared with TAVR for native-valve aortic stenosis.Methods: We performed a retrospective study of all patients who underwent ViV-TAVR for a degenerated aortic valve bioprosthesis between January 1, 2013 and March 31, 2019 at our center. The primary outcome was postprocedural mean aortic valve gradient. Outcomes were compared across surgical valve type (stented versus stentless), surgical valve internal diameter (≤19 versus >19 mm), and transcatheter aortic valve type (self-expanding vs. balloon-expandable).Results: Overall, 89 patients underwent ViV-TAVR. Mean age was 69.0±12.6 years, 61% were male, and median Society of Thoracic Surgeons Predicted Risk of Mortality score was 5.4 [interquartile range, 3.2-8.5].Bioprosthesis mode of failure was stenotic (58% of patients), regurgitant (24%), or mixed (18%). The surgical valve was stented in 75% of patients and stentless in 25%. The surgical valve's internal diameter was ≤19 mm in 45% of cases. A balloon-expandable transcatheter valve was used in 53% of procedures. Baseline aortic valve area and mean gradients were 0.87±0.31 cm 2 and 36±18 mmHg, respectively. These improved after ViV-TAVR to 1.38±0.55 cm 2 and 18±11 mmHg at a median outpatient follow-up of 331 days.Higher postprocedural mean gradients were associated with surgical valves having an internal diameter ≤19 mm (24±13 versus 16±8, P=0.002) and with stented surgical valves (22±11 versus 12±6, P<0.001). Conclusions: ViV-TAVR is an effective option for treating degenerated surgical aortic bioprostheses, with acceptable hemodynamic outcomes. Small surgical valves and stented surgical valves are associated with higher postprocedural gradients.