Venous Sinus Stenting & Vascular Procedures
Pattern of pressure gradient alterations after venous sinus stenting for idiopathic intracranial hypertension predicts stent-adjacent stenosis: a proposed classification system (2017)
Objective Venous sinus stenting (VSS) is a safe and effective treatment for idiopathic intracranial hypertension (IIH) with angiographic venous sinus stenosis. However, predictors of stent-adjacent stenosis (SAS) remain poorly defined.
Conclusions The pattern of change in the trans-stenosis venous pressure gradient may be predictive of SAS and is a useful tool for classifying the response of the venous obstruction to stenting. A type I pattern appears to represent the ideal response to VSS. Some patients with type II and III changes, particularly if they have other predictors of recurrent stenosis, may benefit from longer initial stent constructs.
Raper D, Buell TJ, Ding D, et al. Pattern of pressure gradient alterations after venous sinus stenting for idiopathic intracranial hypertension predicts stent-adjacent stenosis: a proposed classification system. Journal of NeuroInterventional Surgery Published Online First: 21 June 2017. doi: 10.1136/neurintsurg-2017-013135
Endovascular Procedures in Patients With Ehlers–Danlos Syndrome: A Review of Clinical Outcomes and Iatrogenic Complications (2011)
Background Ehlers–Danlos syndrome (EDS) is a hereditary connective tissue disorder caused by mutations in genes involved with collagen matrix formation that results in weakened blood vessels. Endovascular therapy on patients with EDS is fraught with concerns of vessel dissection and access site complications. We describe the technical and clinical outcomes of patients with EDS who have undergone a range of endovascular procedures.
Results In all, 26 patients (8 with classic EDS, 15 with hypermobile EDS, and 3 with vascular EDS) who underwent 48 endovascular procedures (5 diagnostic, 43 interventional; 13 arterial, 35 venous) were identified. The indications for endovascular therapy included pelvic venous varices, visceral aneurysms/pseudoaneurysms, visceral/peripheral occlusive disease, coronary artery disease, and others. Median length of hospital stay was 2 days (range: 0-21 days). The rate of perioperative vascular injury and access site complications was low (2%), and it was not found to be associated with the type of vascular access technique, arterial versus venous procedures, target vessel site, sheath size, or method of closure (all: p > 0.1). Median follow-up period was 7.5 years. There were no late complications from the initial endovascular procedure.
Conclusions Certain endovascular procedures for patients with EDS can be safely performed with a low rate of dissections and access site complications. However, some indications (particularly aortic interventions) still remain to be determined.
Endovascular Procedures in Patients With Ehlers–Danlos Syndrome: A Review of Clinical Outcomes and Iatrogenic Complications. Lum, Ying Wei et al. Annals of Vascular Surgery , Volume 26 , Issue 1 , 25 - 33
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