Cryoplasty therapy is a safe and effective method of treating infrapopliteal disease, providing excellent acute outcomes and a high rate of limb salvage in patients with CLI. Study outcomes support the use of cryoplasty therapy as a primary treatment option for patients with CLI secondary to below- knee disease.
Cryoplasty therapy is a safe and effective method of treating infrapopliteal disease, providing excellent results and a high rate of limb salvage in patients with CLI. Study outcomes through 1 year support the use of cryoplasty as a primary treatment option for patients with CLI secondary to BTK occlusive disease.
A patient with a previous history of neck cancer and carotid endarterectomy presents with a pulsatile cervical mass. Further evaluation reveals the presence of a pseudoaneurysm of the common carotid artery. The endovascular treatment options and techniques employed to exclude the pseudoaneurysm are presented and discussed.Key words: carotid pseudoaneurysm; carotid stent; stent graft
Case presentationA 64-year-old white male presented with a 4-cm, pulsatile mass in his left mid neck. The tissue covering this mass was extremely thin. He stated he had no fever, chills, drainage or redness at the site. The mass had first been noticed approximately 1 year previously, but over the past month had become alarmingly bigger. He presented as an emergency to our institution with pain in the pulsatile mass.Fourteen years ago, he was treated for neck cancer (squamous cell) with radical neck dissection and radiation. Twenty-four months ago, he underwent a left carotid endarterectomy which was complicated by laryngeal nerve injury and dysphagia. Twenty months ago, he underwent a right carotid endarterectomy which was complicated by stroke. His stroke recovery had been nearly complete.His past medical history was significant for hypertension, hypothyroidism, and COPD secondary to cigarette smoking. His medical regimen included: fluvastatin (Lescol; Novartis, Inc.) 20 mg qd; levothyroxine (Levoxyl; Jones Pharma, Inc.) 200 mg qd; aspirin 325 mg qd; omeprazole (Prilosec; Astra Zeneca) 20 mg qd; atenolol 100 mg qd; albuterol=ipratropium (Combivent; Boehringer Ingelheim, Inc.) inhaler prn. At the time of his physical exam, his blood pressure was 170=98 mmHg on the left and 190=102 mmHg on the right. The 4-cm neck mass was protruding from firm, sclerotic skin and was purplish in color. There were no bruits in the neck or subclavian areas. Superficial temporal signals, and carotid and radial pulses were normal. Neurologic findings were normal except for a harsh and raspy voice.
Diagnostic work-upExtensive work-up at an outside facility, prior to our evaluation, included an MRA (2 months prior), a carotid arteriogram (1½ months prior), and a CTA (1 month prior); however, no treatment was rendered. Our evaluation started with a duplex ultrasound, which revealed an ectatic left common carotid artery. Emergent arteriography was then performed. The arteriogram confirmed the presence of a large pseudoaneurysm of the left common carotid artery. Figure 1 displays the angiographic findings with the diameters obtained from the duplex scan. Duplex also demonstrated a laminar thrombus throughout the left common carotid and proximal internal carotid arteries.Arteriography also demonstrated an aortic arch with the innominate and the left common carotid sharing a common origin. The left external carotid artery was patent. The entire ectatic segment of the carotid artery measured approximately 90 mm in length, coinciding with the previous endarterectomy site which extended from the base of the skull into the arch (Figure 1).
This report describes the methods used to develop and maintain the endovascular medicine certification examination, which has been offered by the American Board of Vascular Medicine (ABVM) to practicing physicians since 2005. The report covers the methods and findings used to develop examination specifications which ensure the content and construct validity of the examination assessment such that the examination is reflective of the job tasks associated with the endovascular medicine specialty, as well as being a meaningful indicator of whether a candidate possesses the knowledge and skills necessary for competent practice. Further, this report covers the procedures used to develop, maintain, and administer the examination, including a summary of the content review process and the use of statistical information. Based on psychometric evaluation of the examination's performance, the ABVM's endovascular medicine examination appears to be a valid assessment of professional competency in the specialty area; a finding that supports the inference that candidates who pass the examination are qualified to practice in a manner that protects patients.
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