BackgroundCirculatory collapse is a leading cause of mortality among traumatic major exsanguination and in ruptured aortic aneurysm patients. Approximately 40% of patients die before hemorrhage control is achieved. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive surgical or endovascular repair. A systematic review was conducted for the current clinical use of REBOA in patients with hemodynamic instability and to discuss its potential role in improving prehospital and in-hospital outcome.MethodsSystematic review and meta-analysis (1900–2017) using MEDLINE, Cochrane, EMBASE, Web of Science and Central and Emcare using the keywords “aortic balloon occlusion”, “aortic balloon tamponade”, “REBOA”, and “Resuscitative Endovascular Balloon Occlusion” in combination with hemorrhage control, hemorrhage, resuscitation, shock, ruptured abdominal or thoracic aorta, endovascular repair, and open repair. Original published studies on human subjects were considered.ResultsA total of 490 studies were identified; 89 met criteria for inclusion. Of the 1436 patients, overall reported mortality was 49.2% (613/1246) with significant differences (p < 0.001) between clinical indications. Hemodynamic shock was evident in 79.3%, values between clinical indications showed significant difference (p < 0.001). REBOA was favored as treatment in trauma patients in terms of mortality. Pooled analysis demonstrated an increase in mean systolic pressure by almost 50 mmHg following REBOA use.ConclusionREBOA has been used in trauma patients and ruptured aortic aneurysm patients with improvement of hemodynamic parameters and outcomes for several decades. Formal, prospective study is warranted to clarify the role of this adjunct in all hemodynamic unstable patients.Electronic supplementary materialThe online version of this article (10.1007/s00068-018-0959-y) contains supplementary material, which is available to authorized users.

Purpose: To evaluate the feasibility and efficacy of the Mollring Cutter™ remote endarterectomy (EA) technique in the treatment of occlusive superficial femoral artery (SFA) disease. Methods: A new device was developed to perform remote EA of occluded SFAs through a single groin incision. The technique initially uses a conventional ring stripper, which is exchanged for a double-ring cutter that transects the distal atheroma core. The entire core and cutter are removed simultaneously, and a Palmaz stent is implanted to secure the distal intimal flap. Results: Twenty-six consecutive patients with disabling claudication or critical ischemia were treated for long segment occlusions (n = 23) and multiple stenoses (n = 3). Patients were evaluated on the intention-to-treat basis. Clinical and anatomic success was achieved in all 26 SFAs. Average length of the endarterectomized segments was 29.9 cm (range 23 to 41). Technical problems were encountered intraoperatively in four patients, including one who required a second incision at the distal SFA to retrieve a broken ring. Recovery was uneventful in all patients. At up to 6-month follow-up, one reocclusion has been seen at 5 months. Conclusions: Based on this early experience, remote EA with the Mollring Cutter appears to be a feasible and effective method for treating occlusive SFA disease. Obviating the need for a second incision at knee level, this technique offers a less invasive approach that should facilitate postoperative recovery and earlier discharge.

MVEC seeding in dogs results in intimal hyperplasia in all patent grafts, which contains myofibroblasts. Contaminants from the transplant contribute to this intimal hyperplasia.

IntroductionPseudoaneurysm of the hand is a rare condition; most are treated surgically. Ultrasound guided thrombin injection has not previously been reported as a treatment option for pseudoaneurysms of the deep palmar arch.ReportA man was referred to the emergency department with a swollen, painful hand after penetrating trauma. On physical examination, a pulsating tumor was found on the dorsum of the hand. Imaging revealed a pseudoaneurysm vascularized by the deep palmar arch. Ultrasound guided percutaneous thrombin injection was successfully performed.ConclusionThrombin injection might be a safe alternative option in the treatment of pseudoaneurysm of the deep palmar arch.

These results show PTA to be a safe, minimally-invasive and effective alternative to surgery in case of symptomatic stenosis of the infrarenal abdominal aorta.