This prospective, nonrandomized clinical study indicates that eversion CEA is an effective surgical option comparable to conventional CEA with either primary arteriotomy closure or carotid patch angioplasty. No differences were found between eversion CEA and these more widely accepted CEA closure techniques with respect to operative morbidity and mortality. These data indicate, however, that eversion CEA has a lower restenosis rate than conventional CEA closure techniques and thus superior long-term durability.

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Blunt subclavian artery trauma is an uncommon but challenging surgical problem. The purpose of this study was to retrospectively review the management of blunt subclavian artery injuries treated by the Trauma and Vascular Surgery Services at the East Tennessee State University-affiliated hospitals between 1992 and 1998. Six patients with seven blunt subclavian artery injuries were identified. Physical signs indicating blunt subclavian artery injury were pain or contusion around the shoulder joint; fractures of the clavicle, scapula, or ribs; periclavicular hematomas; and ipsilateral pulse or neurologic deficits. Seven subclavian artery injuries were treated-two arterial transections, two pseudoaneurysms, and three intimal dissections. Associated injuries included four clavicle fractures, one humerus fracture, one combined rib and scapular fractures, and two pneumothoraxes. Vascular surgical treatment included three primary arterial repairs, two saphenous vein interposition grafts, and one polytetrafluoroethylene (PTFE) graft. One patient was treated nonoperatively with anticoagulation. No deaths occurred. Morbidity occurred in two patients with chronic upper extremity neuropathy producing prolonged disability from pain and weakness; one patient had reflex sympathetic dystrophy, and the other had a brachial plexus injury. In conclusion, blunt subclavian artery trauma can be successfully managed with early use of arteriography and prompt surgical correction by a variety of vascular techniques. Vascular morbidity is usually low, but long-term disability because of chronic neuropathy may result from associated brachial plexus nerve injury despite a successful arterial repair.

Purpose:To evaluate the MRI compatibility of 15 different commercially available, new generation, U.S. Food and Drug Administration (FDA)-approved stents suitable for deployment in superficial femoral arteries (SFAs), and to identify the ones that permit MRI to visualize the wall and lumen of stented arteries with sufficient spatial and contrast resolution to quantify restenosis after stent placement. Materials and Methods:A total of 13 nitinol stents and two stainless-steel stents were placed in excised cadaveric SFAs and imaged by MRI at 1.5 T ex vivo. The images were evaluated qualitatively for the presence of artifacts and for the effects of the stent on image contrast, and quantitatively for the effect on signal-to-noise ratio (SNR) of the lumen of the artery inside the stent compared to the SNR of the fluid outside the artery. A nitinol stent was placed in the SFA of a 60-year-old man and imaged at 1.5 T in vivo.Results: Both the vessel wall and the lumen could be visualized in cadaveric SFAs containing either the Absolute nitinol stent, the Dynalink nitinol stent, or the aSpire nitinol-covered stent. Their inside stent/outside stent SNR was 0.7, 0.8, and 0.8, respectively. The other 10 nitinol stents tested obscured the lumen but did not cause major image shape artifacts. Both stainless-steel stents tested, the WallGraft and WallStent, completely obscured the lumen and caused significant distortion of the image shapes. When the Dynalink stent was inserted into a highly stenosed SFA in vivo, the image showed a dark expanded eccentric lumen, circumscribed by a medium intensity band containing the stent. Conclusion:MRI can be used to visualize both the lumen and wall of SFAs containing selected nitinol stents ex vivo and in vivo. These results suggest that MRI can be used to monitor restenosis in stents placed in the femoral arterial bed.

Aortogastric fistulas are a rare but usually fatal entity that presents as an acute gastrointestinal bleeding. The authors present the case of a 65-year-old man who had undergone a Nissen fundoplication and presented in the emergency room with syncope secondary to massive upper gastrointestinal tract bleed. Despite aggressive resuscitation and prompt operative intervention with repair of the gastric ulcer and closure of the aortic side of the fistula, he succumbed to the complications of hypovolemic shock. Overview of the pertinent literature with discussion of the most common causes of aortogastric fistulas as well as guidelines for intraoperative management are also presented.