No abstract

The threat of a vascular complication exists in association with any percutaneous arterial catheterization, but is greater in the more complex interventional techniques. During a 3 1/2-year period from January 1985 through June 1988, 4988 percutaneous transluminal coronary angioplasty procedures were performed at Emory University Hospital. All patients were given heparin during the cardiac intervention, and all had a catheter introducer left in place for several hours after completion of the procedure. Fifty-five iatrogenic vascular complications developed in 52 patients (1%), resulting in 54 corrective operations. Pseudoaneurysm, the most frequent complication, was seen in 35 patients (64%). This was followed by arteriovenous fistula in eight (15%), uncontrolled hemorrhage in six (11%), arterial thrombosis in three (6%), peripheral embolization in two (4%), and bowel ischemia in one patient. The outcome of surgical therapy in the entire group was quite acceptable with no operative mortality, no extremity amputation, and a 7.4% complication rate. Variables that correlated with an increased risk of peripheral vascular problems after percutaneous transluminal coronary angioplasty included advanced age, female gender, thrombolytic therapy, and postprocedural anticoagulation. Variables that did not appear to correlate were hypertension, diabetes, prior percutaneous transluminal coronary angioplasty, antiplatelet therapy, or the size of the guiding catheter used.

No abstract

Patch repair is the preferred method for arteriotomy closure following femoral or carotid endarterectomy. Choosing among available patch options remains a clinical challenge, as current evidence suggests roughly comparable outcomes between autologous grafts and synthetic and biologic materials. Biologic patches have potential advantages over other materials, including reduced risk for infection, mitigation of an excessive foreign body response, and the potential to remodel into healthy, vascularized tissue. Here we review the use of decellularized extracellular matrix (ECM) for cardiovascular applications, particularly endarterectomy repair, and the capacity of these materials to remodel into native, site-appropriate tissues. Also presented are data from two post-market observational studies of patients undergoing iliofemoral and carotid endarterectomy patch repair as well as one histologic case report in a challenging iliofemoral endarterectomy repair, all with the use of small intestine submucosa (SIS)-ECM. In alignment with previously reported studies, high patency was maintained, and adverse event rates were comparable to previously reported rates of patch angioplasty. Histologic analysis from one case identified constructive remodeling of the SIS-ECM, consistent with the histologic characteristics of the endarterectomized vessel. These clinical and histologic results align with the biologic potential described in the academic ECM literature. To our knowledge, this is the first histologic demonstration of SIS-ECM remodeling into site-appropriate vascular tissues following endarterectomy. Together, these findings support the safety and efficacy of SIS-ECM for patch repair of femoral and carotid arteriotomy.

Noncylindrical neck morphology was more common in women and was associated with an increased use of aortic extender cuffs but did not increase the risk of intervention. Female gender and AAA diameter were associated with an increased need for reintervention.