A 3-year-old boy, who presented with progressive cyanosis and hypoxia, was diagnosed with a large congenital extrahepatic portosystemic shunt, interrupted IVC with azygos continuation, and multiple congenital anomalies. Traditionally open and laparoscopic surgical techniques have been used to treat this malformation. Endovascular repair using a 16-mm Amplatzer vascular plug (AGA Medical Corporation, Golden Valley, Minnesota, USA) was used to occlude the shunt. Immediate post-placement venography demonstrated cessation of flow within the shunt and increased portal venous flow. The patient's hypoxia and cyanosis decreased significantly, and he was discharged on the 5th post-procedure day in stable clinical condition. Three months follow-up evaluation demonstrated the vascular plug in place, unchanged in position.

No abstract

Type I endoleaks can be safely and effectively treated by embolotherapy with EVOH. Larger endoleaks resulting from grossly undersized endografts appear to be unsuitable for EVOH embolization.

Purpose: To evaluate the clinical and technical outcomes of nitinol self-expanding stents for the treatment of symptomatic chronic iliofemoral veno-occlusive disease. Materials: A retrospective review was performed of 169 consecutive patients (196 limbs) treated with self-expanding nitinol stents for chronic iliofemoral veno-occlusive disease between July 2011 and June 2017. Patients treated with non-nitinol stents and patients with IVC involvement were excluded. Procedural and follow-up data were collected for assessment of technical success, clinical outcomes, safety, and patency. Technical success was defined as the ability to recanalize and stent the obstructive lesion without significant residual stenosis. Binary patency was assessed with duplex ultrasound and calculated by Kaplan Meier analysis. Clinical outcomes were evaluated utilizing CEAP and Villalta scores. Results: A total of 378 (278 Left, 95 Right) nitinol self-expanding stents were placed with sizes ranging from 8 to 14 mm. Technical success was achieved in 195 of 196 limbs (99%). Of the 169 patients, 100, 45, and 24 presented with symptoms consistent with acute, acute on chronic, and chronic DVT, respectively. Mechanical thrombectomy was performed in 96 (49%) patients while catheter-directed thrombolysis was employed in 92 (47%) patients. Mean followup time was 9.8 months. Kaplan Meier analysis revealed a primary patency of 95%, 93%, 91%, and 91% at 6, 12, 24, and 36 months respectively. Pre-and post-CEAP or Villalta scores were available in 140 (83%) patients. CEAP and Villalta scores improved from 3.65 to 2 (-55%) and 19.15 to 8.6 (-45%), respectively. There were 5 recorded adverse events; 3 mild, 1 moderate, and 1 severe. Conclusions: Endovascular management of chronic iliofemoral veno-occlusive disease with self-expanding nitinol stents is a safe and durable procedure with high technical success, excellent midterm patency, and good clinical outcomes.

To assess cost differences between PEVAR and open surgical femoral exposure in EVAR of AAA. Materials: An IRB approved single center retrospective analysis of patients who underwent elective EVAR for AAA from 2009-2016 was performed. 50 who underwent EVAR with Medtronic Endurant and 50 Gore Excluder endografts were included. Within each group, 25 had open femoral exposures. Patient demographics, procedural variables, and hospital outcomes were collected. Primary outcomes used in cost calculations included OR time, hospital and ICU LOS. Extrapolated cost differences were based on known, published cost multipliers for the primary outcomes observed. Wilcoxon rank-sum tests were performed for continuous variables and Fisher's exact tests for categorical variables. Multiple linear regression was performed to model continuous outcomes. Results: Patients undergoing PEVAR had significant reduction in mean OR time (113.9 vs 144.9 min, p o 0.001), mean ICU LOS (19.7 vs 28.9 h, p ¼ 0.094), and overall LOS (28.3 vs 33.1 h, p ¼ 0.020). There was no difference in access related complications. Calculated cost of procedures based on mean ICU LOS, hospital LOS, and OR time, showed significant reduction in mean hospital costs with PEVAR (2.1 vs 2.7 SDU, p o 0.001). Multiple linear regression demonstrated an overall 23% cost reduction with PEVAR. Conclusions: Prior reports comparing PEVAR vs EVAR have shown improvement in time to ambulation and other metrics such as LOS. In this study, adoption of PEVAR significantly reduced OR times (19%) and hospital LOS (50%). The outcomes observed ultimately translated into significant reduction in hospital costs (23%). Multiple Linear Regression ↓ with PEVAR (%) 95% CI P Value Operating time 19 7%, 29% o0.05 LOS (floor) 50 4%, 76 o0.05 LOS (ICU) 56 15%, 77%] o0.05 Cost 23 10%, 34% o0.05