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Article: Inverted Ovation iX Limb to Treat an Isolated Common Iliac Artery Aneurysm.

Ashkar, Said / Charbonneau, Philippe / Elkouri, Stephane

Vascular specialist international

2024 Volume 40, Page(s) 1

Abstract: In recent years, endovascular aneurysm repair has become the predominant method of managing abdominal aortic and common iliac artery aneurysms. Off-label use of different endovascular devices has allowed them to remain a viable option in many cases of ... ...

Abstract	In recent years, endovascular aneurysm repair has become the predominant method of managing abdominal aortic and common iliac artery aneurysms. Off-label use of different endovascular devices has allowed them to remain a viable option in many cases of atypical anatomy. Some studies have reported the use of iliac devices in an upside-down configuration when the common iliac artery aneurysm has a reverse-tapered morphology. However, the use of the Ovation iX (Endologix) limb in an upside-down configuration has not yet been reported. This limb offers a 14 mm distal end when inverted and offers good patency in the tortuous iliac morphology. This case report describes and illustrates the precise deployment of an inverted Ovation iX limb to treat an isolated common iliac artery aneurysm.
Language	English
Publishing date	2024-01-08
Publishing country	Korea (South)
Document type	Case Reports
ISSN	2288-7970
ISSN	2288-7970
DOI	10.5758/vsi.230086
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Article: A mycotic aneurysm of a jejunal branch treated by aneurysmectomy without bowel resection.

Provost, Hubert / Drudi, Laura M / Schwenter, Frank / Elkouri, Stéphane / Blair, Jean-François / Charbonneau, Philippe

Journal of vascular surgery cases and innovative techniques

2023 Volume 10, Issue 1, Page(s) 101364

Abstract: Jejunal artery pseudoaneurysms are extremely rare, accounting for <1% of all visceral artery pseudoaneurysms. Fewer than 50 cases were reported in literature during the previous century. This case report describes the case of a 72-year-old man who ... ...

Abstract	Jejunal artery pseudoaneurysms are extremely rare, accounting for <1% of all visceral artery pseudoaneurysms. Fewer than 50 cases were reported in literature during the previous century. This case report describes the case of a 72-year-old man who underwent aneurysmectomy to treat a 21-mm mycotic jejunal artery pseudoaneurysm found in the setting of endocarditis. This pseudoaneurysm was treated with laparotomy, and gentle dissection of the tissues surrounding the pseudoaneurysm was performed before ligation and resection. This allowed for vascular collateral branch preservation, which, thus, avoided concomitant bowel resection. This report highlights the feasibility of this technique.
Language	English
Publishing date	2023-11-04
Publishing country	United States
Document type	Case Reports
ISSN	2468-4287
ISSN	2468-4287
DOI	10.1016/j.jvscit.2023.101364
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Article ; Online: Treating a Large Thoracoabdominal Aneurysm With Aberrant Right Subclavian Artery With a Physician-Modified Graft.

Rosu, Cristian / Charbonneau, Philippe / Drudi, Laura M / Blair, Jean-François / Beaudoin, Nathalie / Elkouri, Stéphane

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

2023 , Page(s) 15266028231166291

Abstract: Clinical impact: Large thoracoabdominal aortic aneurysms due to chronic aortic dissection in patients with connective tissue disorders such as Loeys-Dietz syndrome present a challenging scenario, particularly in cases of variant anatomy and when ... ...

Abstract	Clinical impact: Large thoracoabdominal aortic aneurysms due to chronic aortic dissection in patients with connective tissue disorders such as Loeys-Dietz syndrome present a challenging scenario, particularly in cases of variant anatomy and when patients are not candidates for conventional open repair. We demonstrate how by combining and modifying off-the-shelf devices during a hybrid procedure, one can create an endovascular solution tailored to the patient's complex anatomy, making use of an aberrant right subclavian artery, and allow for good clinical outcomes.
Language	English
Publishing date	2023-04-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2006618-1
ISSN	1545-1550 ; 1526-6028
ISSN (online)	1545-1550
ISSN	1526-6028
DOI	10.1177/15266028231166291
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Article ; Online: Caution: Air Embolism Related to Heli-Fx EndoAnchor System in Zone 2 Thoracic Aneurysm Repair.

Rosu, Cristian / Ruz, Ricardo / Overbeek, Charles / Elkouri, Stéphane

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

2021 Volume 29, Issue 5, Page(s) 808–812

Abstract: Purpose: We report a case of significant air embolization to the ascending aorta immediately following deployment of EndoAnchors in the aortic arch during a procedure to correct a type 1A endoleak.: Case report: The novel Heli-Fx EndoAnchor system ( ... ...

Abstract	Purpose: We report a case of significant air embolization to the ascending aorta immediately following deployment of EndoAnchors in the aortic arch during a procedure to correct a type 1A endoleak. Case report: The novel Heli-Fx EndoAnchor system (Medtronic Vascular, Santa Rosa, CA, USA) was used to deploy helical anchors in the distal aortic arch during a procedure to correct a type 1A endoleak following Zone 2 thoracic endovascular aortic repair of a saccular proximal descending thoracic aorta aneurysm (DTAA). The patient developed ST-segment elevations principally in the inferior leads and severe hypotension moments after EndoAnchor deployment at the proximal edge of the endograft. Transesophageal echocardiogram revealed severe right ventricular hypokinesis and a large amount of air in the ascending aorta. Subsequent management and clinical and radiological 30-day follow-up is presented in addition to a review of the literature and ex vivo testing with the Heli-Fx system to examine potential causes and solutions. Conclusion: Precautions, such as pressurized saline infusion to the side port of guiding sheath, should be used whenever manipulating catheters and sheaths such as the EndoAnchor system in the aortic arch to prevent this potentially lethal complication.
MeSH term(s)	Aorta, Thoracic ; Aortic Aneurysm, Abdominal/surgery ; Aortic Aneurysm, Thoracic/complications ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/surgery ; Blood Vessel Prosthesis/adverse effects ; Blood Vessel Prosthesis Implantation/adverse effects ; Embolism, Air/diagnostic imaging ; Embolism, Air/etiology ; Embolism, Air/therapy ; Endoleak/etiology ; Endovascular Procedures/adverse effects ; Humans ; Prosthesis Design ; Risk Factors ; Treatment Outcome
Language	English
Publishing date	2021-12-02
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2006618-1
ISSN	1545-1550 ; 1526-6028
ISSN (online)	1545-1550
ISSN	1526-6028
DOI	10.1177/15266028211062562
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Article ; Online: Regarding "Impact of practice patterns in shunt use during carotid endarterectomy with contralateral carotid occlusion".

Elkouri, Stephane

Journal of vascular surgery

2012 Volume 55, Issue 6, Page(s) 1838; author reply 1838

MeSH term(s)	Carotid Stenosis/surgery ; Cerebrovascular Circulation ; Endarterectomy, Carotid ; Female ; Humans ; Male ; Practice Patterns, Physicians'
Language	English
Publishing date	2012-06
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2012.02.045
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Article ; Online: Safety of transition from a routine to a selective intensive care admission pathway after elective open aneurysm repair.

Dion, Danielle / Drudi, Laura Marie / Beaudoin, Nathalie / Blair, Jean-François / Elkouri, Stéphane

Canadian journal of surgery. Journal canadien de chirurgie

2021 Volume 64, Issue 1, Page(s) E3–E8

Abstract: Background: There is a growing trend to implement intermediate care units to avoid unnecessary costs associated with intensive care unit (ICU) admission and associated resources. We sought to evaluate the safety of transitioning from a routine to a ... ...

Abstract	Background: There is a growing trend to implement intermediate care units to avoid unnecessary costs associated with intensive care unit (ICU) admission and associated resources. We sought to evaluate the safety of transitioning from a routine to a selective policy of postoperative transfer to the ICU for elective open abdominal aortic aneurysm (AAA) repair. Methods: This retrospective study included consecutive open elective AAA repair procedures performed at a single centre from Aug. 8, 2010, to Dec. 1, 2014. Patients were identified through a prospectively maintained database, and electronic charts were reviewed. Patients with interventions before Mar. 13, 2012, were routinely sent to the ICU after operation (group A). Patients treated after this date were sent directly to an intermediate care unit (group B) unless preoperative or intraoperative factors deemed them suitable for ICU admission. The primary outcome was in-hospital death; secondary outcomes were perioperative complications and length of stay. We used logistic and linear regression to determine the association between the use of an intermediate care unit and the primary and secondary outcomes after adjusting for confounders and clinically relevant covariates. Results: The cohort comprised 310 patients (266 men, 44 women) with a mean age of 69.7 (standard deviation 10.1) years and a mean AAA diameter of 61.2 mm (SD 9.6 mm). Groups A and B included 118 and 192 patients, respectively. Admission to the ICU was spared in 149 patients (77.6%) in group B. Only 2 patients (1.3%) in group B were subsequently admitted to the ICU. There was no statistically significant difference in in-hospital mortality or perioperative complications between the 2 groups on multivariable logistic regression. There was a nonsignificant trend toward slightly shorter length of stay in group B. Conclusion: In this single-centre experience with the majority of patients sent directly to an intermediate care unit, there was no statistically significant difference in mortality or morbidity between routine and selective ICU admission. Our results confirm the safety of a selective ICU admission pathway.
MeSH term(s)	Aged ; Aortic Aneurysm, Abdominal/surgery ; Cohort Studies ; Elective Surgical Procedures ; Female ; Hospitalization ; Humans ; Intensive Care Units/classification ; Male ; Middle Aged ; Patient Safety ; Patient Transfer ; Retrospective Studies
Language	English
Publishing date	2021-01-07
Publishing country	Canada
Document type	Journal Article
ZDB-ID	410651-9
ISSN	1488-2310 ; 0008-428X
ISSN (online)	1488-2310
ISSN	0008-428X
DOI	10.1503/cjs.012518
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Article ; Online: Percutaneous Treatment of Concomitant Severe Aortic Stenosis and Thoracoabdominal Aortic Aneurysm.

Painchaud-Bouchard, Ariane-Sophie / Potvin, Jeannot / Forcillo, Jessica / Ruz, Ricardo / Elkouri, Stephane

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

2021 Volume 29, Issue 1, Page(s) 156–159

Abstract: Purpose: Although rare in occurrence, symptomatic severe aortic stenosis and large thoracoabdominal aortic aneurysm (TAAA) found in combination pose a real therapeutic challenge, especially in elderly frail patients. Surgical approaches for combined ... ...

Abstract	Purpose: Although rare in occurrence, symptomatic severe aortic stenosis and large thoracoabdominal aortic aneurysm (TAAA) found in combination pose a real therapeutic challenge, especially in elderly frail patients. Surgical approaches for combined treatment are complex and at high risk of complications while staged procedures carry the risk of an unfavorable evolution of the condition temporarily left untreated. Minimally invasive approaches may therefore prove a more suitable strategy for these patients. Case report: We present the case of a 78-year-old woman with symptomatic severe aortic stenosis (AS) and a TAAA of 7.8 cm in diameter. Transcatheter treatment of both conditions was successfully performed in a staged manner. The first intervention consisted of combined transfemoral transcatheter aortic valve implantation (TAVI) immediately followed by a zone 3 thoracic endovascular aortic endoprosthesis deployment. In order to reduce the extent of intercostal arteries coverage and mitigate the risk of medullar ischemia, a second-stage percutaneous endovascular treatment of the TAAA was performed with a customized 4-fenestration prosthesis. Early and 12-month clinical and radiologic follow-up were favorable. Conclusion: This case demonstrates how a strong multidisciplinary collaboration allows for successful resolution of complex clinical scenarios.
MeSH term(s)	Aged ; Aortic Aneurysm, Thoracic/complications ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/surgery ; Aortic Valve Stenosis/complications ; Aortic Valve Stenosis/diagnostic imaging ; Aortic Valve Stenosis/surgery ; Blood Vessel Prosthesis Implantation/adverse effects ; Endovascular Procedures ; Female ; Humans ; Treatment Outcome
Language	English
Publishing date	2021-08-13
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2006618-1
ISSN	1545-1550 ; 1526-6028
ISSN (online)	1545-1550
ISSN	1526-6028
DOI	10.1177/15266028211038592
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Article: Surgical management of intravascular leiomyomatosis.

Painchaud-Bouchard, Ariane-Sophie / Samouelian, Vanessa / Vandenbroucke-Menu, Franck / Gougeon, François / Stevens, Louis-Mathieu / Elkouri, Stephane

Journal of vascular surgery cases and innovative techniques

2021 Volume 7, Issue 4, Page(s) 711–717

Abstract: Intravascular leiomyomatosis is a rare entity defined by benign smooth uterine muscle cells that typically originate from the uterus with the potential to spread into veins possibly up to the heart. The diagnosis for patients presenting with cardiac ... ...

Abstract	Intravascular leiomyomatosis is a rare entity defined by benign smooth uterine muscle cells that typically originate from the uterus with the potential to spread into veins possibly up to the heart. The diagnosis for patients presenting with cardiac symptoms may be difficult and imaging often interpreted as thrombus or atrial myxoma.
Language	English
Publishing date	2021-07-21
Publishing country	United States
Document type	Case Reports
ISSN	2468-4287
ISSN	2468-4287
DOI	10.1016/j.jvscit.2021.07.005
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Article ; Online: Carotid endarterectomy after systemic thrombolysis in a stroke population.

Fortin, William / Chaput, Miguel / Elkouri, Stephane / Beaudoin, Nathalie / Blair, Jean-François

Journal of vascular surgery

2019 Volume 71, Issue 4, Page(s) 1254–1259

Abstract: Objective: Vascular specialists are increasingly being requested to perform carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) for stroke patients, raising concerns about hemorrhagic complications. Few case series and registry reports ... ...

Abstract	Objective: Vascular specialists are increasingly being requested to perform carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) for stroke patients, raising concerns about hemorrhagic complications. Few case series and registry reports have assessed the question, and even fewer studies have included a control group. The aim of this study was to evaluate the overall outcome of patients undergoing CEA after IVT and to compare them with contemporary patients with CEA after simple stroke (non-IVT group). It also aimed to evaluate the differences in outcomes of stroke patients requiring CEA between nonvascular and vascular centers. Methods: The data of 169 consecutive patients who have undergone CEA after stroke in a single center was analyzed from January 2011 to December 2016, 27 of them (16%) having undergone previous IVT. A comparative analysis between the non-IVT and the IVT groups was performed. The time between stroke diagnosis and referral to a vascular specialist was also studied. Results: Age, sex, and cardiovascular comorbidities were similar in both groups. Median time between stroke and CEA was 13 days (Q1-Q3, 8-23 days), with 16 of the 27 patients (59%) in the IVT group undergoing CEA less than 14 days after the initial event. There were three intracranial hemorrhages (2.1%) in the non-IVT group versus one (3.7%) in the IVT group (P = NS). The overall 30-day combined stroke and death rate was 7.1% (6.3% in the non-IVT group vs 11.1% in the IVT group; P = .70). The incidence of postoperative cervical hematoma requiring reoperation was similar in both groups (2.1% vs 3.7%; P = NS). The median time between diagnosis of stroke and referral to a vascular specialist was higher for patients in nonvascular centers compared with vascular centers (3.5 days vs 1.0 day; P < .001), which translated to fewer patients referred from nonvascular centers undergoing surgery in the 14-day window period (38% vs 67%; P < .001). Conclusions: In this retrospective analysis, CEA after IVT showed similar outcomes when compared with the overall CEA after stroke population. Stroke patients diagnosed in nonvascular centers were referred later than those in vascular centers and, although postoperative outcomes were similar, that was correlated with fewer patients undergoing surgery in a timely fashion.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Carotid Stenosis/complications ; Carotid Stenosis/therapy ; Endarterectomy, Carotid ; Female ; Humans ; Male ; Middle Aged ; Referral and Consultation/statistics & numerical data ; Retrospective Studies ; Stroke/etiology ; Thrombolytic Therapy ; Time Factors
Language	English
Publishing date	2019-09-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2019.05.061
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Zs.A 1933: Show issues

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Article ; Online: Anticoagulation Obtained below the Arterial Clamp Using a Single Fixed Bolus of Heparin in Vascular Surgery: A Pilot Study.

Roy, Maxim / Todorov, Alexandre / Ruel, Monique / Elkouri, Stéphane / Hardy, Jean-François

Annals of vascular surgery

2018 Volume 50, Page(s) 242–248

Abstract: Background: No clear recommendations exist regarding the optimal dosing of unfractionated heparin (UFH) during vascular surgery. Moreover, little is known about the effect of the UFH bolus downstream of the arterial clamp, where stasis and inflammation ... ...

Abstract	Background: No clear recommendations exist regarding the optimal dosing of unfractionated heparin (UFH) during vascular surgery. Moreover, little is known about the effect of the UFH bolus downstream of the arterial clamp, where stasis and inflammation can possibly alter the anticoagulation obtained. Methods: The aim of our prospective observational study was to assess anticoagulation below the arterial clamp and its clinical impact on the quality of revascularization. Thirty-six patients American Society of Anaesthesiologists physical status (ASA) grade I-III undergoing open revascularization surgeries were included. A baseline activated coagulation time (ACT) was obtained. Thirty minutes after a single bolus of 5,000 units of UFH, we measured an upstream ACT via a radial arterial catheter and an ACT below the arterial clamp via surgeon sampling. The quality of revascularization was assessed with preoperative and postoperative ankle-brachial and toe-brachial indexes (TBIs). Results: The upstream postheparin ACT was significantly higher than the downstream postheparin ACT, with a mean difference of 24.3 sec (P < 0.0001). In 7 patients, the downstream ACT was lower than the baseline ACT. The upstream and downstream heparin concentrations were similar. There was no relationship between the downstream ACT and either ankle-brachial index improvement (28 patients, P = 0.51) or TBI improvement (27 patients, P = 0.21). Conclusions: Our study demonstrates a significant difference between the ACT above and below the arterial clamp without any clinical impact of this possibly insufficient anticoagulation. Further investigations are warranted to determine the optimal dose of UFH in vascular surgery. Trial registration: Clinicaltrials.gov, NCT02477072.
MeSH term(s)	Aged ; Aged, 80 and over ; Ankle Brachial Index ; Anticoagulants/administration & dosage ; Anticoagulants/adverse effects ; Constriction ; Female ; Heparin/administration & dosage ; Heparin/adverse effects ; Humans ; Male ; Middle Aged ; Monitoring, Intraoperative/methods ; Peripheral Arterial Disease/blood ; Peripheral Arterial Disease/diagnosis ; Peripheral Arterial Disease/surgery ; Pilot Projects ; Prospective Studies ; Treatment Outcome ; Vascular Surgical Procedures/adverse effects ; Vascular Surgical Procedures/instrumentation ; Vascular Surgical Procedures/methods ; Whole Blood Coagulation Time
Chemical Substances	Anticoagulants ; Heparin (9005-49-6)
Language	English
Publishing date	2018-02-23
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article ; Observational Study
ZDB-ID	1027366-9
ISSN	1615-5947 ; 0890-5096
ISSN (online)	1615-5947
ISSN	0890-5096
DOI	10.1016/j.avsg.2017.11.060
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