With greater sensitivity of modern CT scans, PI and PVG are being detected in patients with a wide range of surgical and non-surgical conditions. This clinical algorithm can identify subgroups to direct surgical intervention for acute ischemic insults and prevent non-therapeutic laparotomies for benign idiopathic PI and PVG.

There were a total of 312 CAS procedures (n ¼ 299 patients) and 344 CEA procedures (n ¼ 335) in this time period. For patients who had reoperation on the same carotid vessel (n ¼ 5 for CAS, n ¼ 5 for CEA), we used the last documented ultrasound prior to the date of reoperation. These ultrasounds were used to identify ECA occlusions and in-stent restenosis using consensus panel velocity criteria.Results: There were 210 CAS patients with follow-up ultrasounds (67%), and there were 207 CEA patients with follow-up ultrasounds in our system (60%). The average follow-up of CAS was significantly shorter than the CEA group (0.7 vs 1.7 years; P < .001), and CAS patients were more likely to take Plavix (97% vs 35%; P < .001). All other variables were similar between groups. We identified significantly more occluded ECA in the CAS ( 14) compared with the CEA (4) group (P ¼ .03). Additionally, eight (57%) of 14 arteries with ECA occlusions had >50% ISR, whereas 48 (26%) of 186 arteries without ECA occlusions had >50% ISR (P ¼ .02) (Fig).Conclusions: This is the first demonstration of increased ECA occlusion after CAS in the literature, but prior publications have identified increased external carotid stenosis. This finding was in spite of decreased follow-up time periods and increased use of Plavix in the CAS group, lending more validity to our results. A recent report identified disturbed flow in the ECA after CAS. This may be the biologic reason for these findings. The association of in-stent restenosis with ECA occlusion is also very interesting and warrants further investigation. We are currently determining whether ECA stenosis/occlusion occurs before, at the same time, or after in-stent restenosis. Establishing the timeline will be critical to identifying whether disturbed flow in the ECA has a causative role in in-stent restenosis.

Mural aortic thrombus is a challenging clinical problem with significant potential complications. Particularly precarious are situations with involvement of the visceral segment of the aorta. We describe a technique for percutaneous thrombectomy of mural aortic thrombus using intravascular ultrasound to guide an angled mechanical thrombectomy catheter in conjunction with a continuous aspiration system (Indigo mechanical thrombectomy system; Penumbra, Alameda, Calif). Use of this technique in three patients with challenging cases of mural aortic thrombus is discussed. All patients were treated successfully and without complication using this technique.

Risk of short-term RAA growth or rupture was low. These findings suggest that annual (or less frequent) imaging surveillance is safe in the majority of patients and do not support pre-emptive repair of asymptomatic, small-diameter RAAs.

Problematic dialysis vascular access is a major health issue. The purpose of this study was to evaluate for potentially modifiable factors associated with access patency, particularly, the association of early postoperative, or maturation period, blood pressure with patency. A retrospective review was performed of patients who had undergone placement of an arteriovenous fistula or graft. Demographic, operative, and postoperative factors were evaluated for possible association with access primary patency using univariate and multivariate Cox regression analyses. Seventy-three patients over a 3-year review period were examined. Overall analysis showed a significant association of absence of peripheral vascular disease, aspirin use, and absence of previous permanent dialysis access with higher primary patency rates. Fistula subgroup analysis showed that higher blood pressure during the maturation period relative to preoperative blood pressure was associated with lower patency rates. For grafts, race was significantly associated with patency, with blacks having higher patency rates than whites. Multiple clinical factors were found to have a significant association with dialysis access primary patency. The finding of an association of maturation period blood pressure with fistula patency suggests that the maturation period environment, specifically hemodynamics during this time, may play an important role in dialysis access patency.

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Dysphagia Lusoria is a condition when aberrant right subclavian artery (ARSA) causes esophageal compression. We report 2 cases of Dysphagia Lusoria treated by hybrid endovascular technique which included subclavian to carotid transposition and embolization of origin of ARSA. By using this technique, we avoided the need for thoracotomy. Both patients had complete symptom relief without any surgery related complication.

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