No abstract

Methods: Data from the Society for Vascular Surgery Vascular Quality Initiative was obtained for patients undergoing endovascular treatment for isolated de novo occlusive SFA disease. A total of 7912 patients were identified undergoing angioplasty or stent placement. Based on the diameter of the intervention as an indirect measure of the vessel, patients were stratified into three groups: group 1, <4 mm (911 patients); group 2, 4.0 to 5.9 mm (2206 patients); and group 3, $6 mm (4795 patients). The primary outcome was primary and secondary patency rates; the secondary outcomes included limb salvage and major adverse limb events. Student's t-test was used to analyze continuous measurements and c 2 test of independence was used for categorical variables. Primary and secondary patency and limb salvage and major adverse limb events were estimated by the Kaplan-Meier method and compared with the log-rank test. Cox multivariate regression analysis was used to determine predictors of outcome measures. Statistical significance was accepted for a P value of <.05.Results: From January 2010 through September 2019, a total of 7912 peripheral vascular intervention patients met criteria for analysis, with a median follow-up of 13 months (interquartile range, 8-18 months). Overall patency rate was lower in group 1, compared to groups 2 and 3 (50% vs 62% and 77%, respectively; log-rank; P < .001). The outcome among small vessels was significantly worse in patients undergoing atherectomy with or without balloon angioplasty, compared to the stent group. The outcomes for limb salvage and major adverse limb events were similar among the groups. Cox proportional hazards analysis confirmed that an SFA of less than 4 mm was independently associated with significantly lower patency rates (hazard ratio, 0.78; 95% confidence interval, 0.70-0.88; P < .0009).Conclusions: In patients undergoing endovascular intervention for isolated de novo SFA stenosis, a smaller diameter of SFA, especially less than 4 mm, was associated with the worst patency rates. Stenting does improve patency in this cohort, however, overall outcomes remain poor.

Patient: Male, 33-year-old Final Diagnosis: Sclerosing mesenteritis Symptoms: Abdominal pain • diaphoresis • nausea • tachycardia Medication:— Clinical Procedure: Exploratory laparotomy Specialty: Surgery Objective: Rare co-existance of disease or pathology Background: Sclerosing mesenteritis is an inflammatory and fibrotic disease that affects the mesentery of the small intestine. This condition is non-neoplastic, although it is frequently associated with underlying malignancies. The overall etiology is unclear because of the limited number of cases available for review, yet a number of possible mechanisms have been described, including ischemia. Factor V (FV) Leiden is a hereditary condition causing hyper-coagulability, thrombosis, and ischemia. Because ischemia is one of the proposed mechanisms for the fibrosis and sclerotic findings of sclerosing mesenteritis, this case explores a possible association between FV Leiden and sclerosing mesenteritis. Case Report: Herein, we describe a case of sclerosing mesenteritis in a patient heterozygous for FV Leiden, with a strong personal and family history of venous thromboembolism. This patient presented with acute worsening of chronic abdominal pain and was found to have a small bowel obstruction requiring acute surgical intervention. Imaging findings and pathologic examination of the ileum and mesentery conclusively diagnosed sclerosing mesenteritis. Conclusions: This case serves to highlight a possible association between mesenteric ischemia secondary to chronic thrombotic activity and sclerosing mesenteritis. This patient’s virgin abdomen and lack of additional risk factors for sclerosing mesenteritis make this case a unique presentation of the disorder. This case serves to update the literature at large, as only one prior case in a FV Leiden patient has been described, in which the patient had the additional risk factor of previous abdominal surgery.