Asymptomatic carotid stenosis is associated with cognitive impairment independent of known vascular risk factors for vascular cognitive impairment. Approximately 49.4% of these patients demonstrate impairment in at least two neuropsychological domains. The deficit is driven primarily by reduced motor/processing speed and learning/memory and is mild to moderate in severity. The mechanism for impairment is likely to be hemodynamic as evidenced by reduced cerebrovascular reserve and the likely result of hypoperfusion from a pressure drop across the stenosis in the presence of inadequate collateralization.

No abstract

We present a unique algorithm to perform semiautomatic quantification of carotid plaque volume using 3DUS imaging. It is quick (mean time, 14 minutes), accurate, repeatable, and implementable in a clinical environment and in longitudinal studies tracking plaque progression. It reliably detects plaque volume changes as low as 4% to 6% with 95% confidence.

Objective: Quantification of carotid plaque morphology (geometry and tissue composition) may help stratify risk for future stroke and assess plaque progression or regression in response to medical risk factor modification. We assessed the feasibility and reliability of morphologic measurements of carotid plaques using computed tomography angiography (CTA) and determined the minimum detectable change in plaque features by this approach. Methods: CTA images of both carotid arteries in 50 patients were analyzed by two observers using a semiautomatic image analysis program, yielding 93 observations per user (seven arteries were excluded because of prior stenting). One observer repeated the analyses 4 weeks later.

No abstract

Objectives: Infrapopliteal arterial pseudoaneurysms (IAP) following blunt trauma with associated orthopedic injuries are uncommon, often present in a delayed fashion, and encompass a diagnostic and therapeutic dilemma. Herein, we present a series of IAPs that were diagnosed following blunt trauma and their management. Methods: Case series consisting of 3 patients and a review of the international literature. Results: Our case series included 3 patients presenting with IAPs following blunt trauma with associated orthopedic injuries. They were all identified in a delayed manner (>3 weeks) after the orthopedic injuries were treated. All patients presented with pain and a pulsatile mass while one concurrently had neurologic deficits. The pseudoaneurysms were diagnosed by duplex ultrasound and confirmed by angiography to be originating from the tibioperoneal trunk, anterior tibial, and posterior tibial arteries respectively. Two patients were treated with surgical excision. Of these, one required an arterial bypass procedure while the other underwent direct ligation only. The third patient was treated by endovascular coiling. A literature review from 1950 to the present found 51 reported cases of IAP resulting from blunt trauma. Ninety percent of trauma-related infrapopliteal injuries occurred in men with a mean delay in diagnosis of 5.6 months (median 1.8 months) after injury. Since 1950, management has shifted from primarily ligation to incorporating minimally invasive endovascular techniques when appropriate. Conclusions: Infrapopliteal artery pseudoaneurysms are rare following blunt skeletal trauma. A delay in diagnosis often occurs and can result in major morbidity and extensive surgical intervention. We recommend a high index of suspicion and a thorough vascular examination in patients with lower extremity skeletal trauma to help identify and treat these injuries early and effectively.

for a week, and participated in creating a public service announcement focused on vascular health education and awareness in their communities. An additional 2950 students participated in a survey questionnaire on the impact of the V-Healthy campaign.Results: Of the previously undiagnosed 1210 parents who participated in the Diagnosing HTN study, >50% were hypertensive; 10% had pre-HTN (120-129/<80 mm Hg), 31% had stage 1 HTN (130-139/80-89 mm Hg), and an additional 20% had stage 2 HTN ($140/$90 mm Hg). Of the 2950 students who participated in the V-Healthy survey, 99% reported that they had a better understanding of vascular health; 90% recognized HTN, diabetes, smoking, obesity, and family history as risk factors; 84% would discuss vascular health with their families; and 76% were interested in learning more about their vascular health.Conclusions: V-Healthy is a grassroots campaign that allows vascular surgeons to lead community vascular health education and awareness and to have an impact on change. HTN is prevalent and an under-recognized vascular disease risk factor that can be used as a focal point for public vascular health education and awareness. The V-Healthy project identifies a process that can be used to develop outreach programs that empower high-school students to understand the implications of vascular disease risks and promote vascular health in our communities.

in 68% (34/50) of patients, with respiratory failure being the most common (n ¼ 20 [40%]). No patient experienced stroke or upper extremity ischemia. There were 14 (28%) vascular complications, which included 2 (4%) early aorta-related reinterventions secondary to device compression; these devices were implanted outside the instructions for use. The mean follow-up was 52.4 months (range, 1 month-14.9 years). During the late follow-up period, there were two device-related complications, both repaired with Palmaz stenting. One patient required an axillofemoral bypass for device compression and subsequent Palmaz stenting at 5.5 months. In the other case, the patient originally had an attempt at open repair at another institution. The aorta was wrapped with felt to prevent bleeding, and the patient was transferred for TEVAR. The stenosis occurred in the region of the wrapping at 4 years and was treated with a Palmaz stent. Two patients died (at 8.5 and 43 months, respectively) of non-aorta-related causes (Fig). There were no endoleaks or device fracture or migration.Conclusions: Assessment of long-term outcomes demonstrated few device-related complications that were associated with early off-label device use. Therefore, it may be reasonable to decrease routine surveillance after device implantation, especially in young patients who are at increased risk from radiation exposure. Larger studies with current device iterations will be helpful in determining the optimal surveillance protocol.Objective: Infrapopliteal artery pseudoaneurysms (IAP) after orthopedic injuries are uncommon and often are manifested in a delayed fashion. Herein, we present a series of IAPs that were diagnosed after blunt orthopedic trauma and their management.Methods: This is a case series consisting of three patients and a systematic review of the international literature.Results: Our case series included three patients presenting with IAPs after blunt trauma with associated orthopedic injuries. They were identified in a delayed manner (>3 weeks) after the orthopedic injuries had been treated. All patients presented with pain and a pulsatile mass; one concurrently had neurologic deficits. Interestingly, all the pseudoaneurysms were large (4.5-10 cm), providing an important reason for suspecting this uncommon complication. All pseudoaneurysms were diagnosed by duplex ultrasound (Fig). Each of the three IAPs were confirmed by angiography and originated from the tibioperoneal trunk and anterior tibial and posterior tibial arteries. Two patients were treated with surgical excision. Of these two patients, one required bypass surgery, whereas the other underwent direct ligation only. The third patient was treated by endovascular coiling to exclude the pseudoaneurysm. After each repair, the affected limbs were free of ischemia. All patients recovered uneventfully and were doing well at follow-up. A review of the literature from 1956 to the present indicated 51 reported cases of IAPs resulting from blunt trauma. Ninety percent of trauma-related infrapop...