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  1. Article: Endovascular Treatment of a Multi-visceral Aortic Conduit Blowout With Parallel Stent Grafts and Coils.

    Moris, Dimitrios / Cox, Mitchell W / Williams, Zachary

    Cureus

    2024  Volume 16, Issue 2, Page(s) e53707

    Abstract: Multi-visceral transplantation (MVT) is a complex surgical procedure involving the transplantation of multiple abdominal organs as a single unit, typically used as bailout treatment of patients with devastating abdominal pathologies. Due to the ... ...

    Abstract Multi-visceral transplantation (MVT) is a complex surgical procedure involving the transplantation of multiple abdominal organs as a single unit, typically used as bailout treatment of patients with devastating abdominal pathologies. Due to the complexity of the procedure, major and even life-threatening complications can happen. Vascular complications, including anastomotic breakdowns or pseudoaneurysms due to infections, can be universally lethal. Open surgical repair is often not an option due to the hostile operative field. We report a case of endovascular salvage of multi-visceral aortic conduit blowout utilizing parallel stent grafts and coils without sacrifice of the transplanted viscera. This combination can successfully control bleeding and maintain graft perfusion in this rare but devastating complication.
    Language English
    Publishing date 2024-02-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.53707
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  2. Article: Retrograde superior mesenteric artery stenting via jejunal arterial access-how I do it.

    Quaye, Kofi B / Williams, Zachary F / Cox, Mitchell W

    Journal of vascular surgery cases and innovative techniques

    2023  Volume 9, Issue 3, Page(s) 101237

    Language English
    Publishing date 2023-05-25
    Publishing country United States
    Document type Journal Article
    ISSN 2468-4287
    ISSN 2468-4287
    DOI 10.1016/j.jvscit.2023.101237
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  3. Article ; Online: Rupture of a Common Carotid Artery Aneurysm.

    Moris, Dimitrios / Cox, Mitchell W

    European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

    2021  Volume 63, Issue 1, Page(s) 79

    MeSH term(s) Aged ; Aneurysm, Ruptured/diagnostic imaging ; Aneurysm, Ruptured/surgery ; Carotid Artery Diseases/diagnostic imaging ; Carotid Artery Diseases/surgery ; Carotid Artery, Common/diagnostic imaging ; Carotid Artery, Common/surgery ; Computed Tomography Angiography ; Emergency Service, Hospital ; Humans ; Male ; Neuroimaging ; Neurologic Examination
    Language English
    Publishing date 2021-11-26
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 1225869-6
    ISSN 1532-2165 ; 1078-5884
    ISSN (online) 1532-2165
    ISSN 1078-5884
    DOI 10.1016/j.ejvs.2021.10.033
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Endovascular Management of Aortic Stump Blowout by Parallel Grafting and Coil Embolization of Visceral Aorta.

    Shafique, Hana / Quaye, Kofi / Cox, Mitchell W / Long, Chandler A / Williams, Zachary F

    Vascular and endovascular surgery

    2024  , Page(s) 15385744231225890

    Abstract: Aortic graft and endograft infections remain a significant source of morbidity and mortality after abdominal aortic aneurysm repair. With graft excision and extra-anatomic bypass, an infrarenal aortic stump remains which can have suture line dehiscence ... ...

    Abstract Aortic graft and endograft infections remain a significant source of morbidity and mortality after abdominal aortic aneurysm repair. With graft excision and extra-anatomic bypass, an infrarenal aortic stump remains which can have suture line dehiscence and catastrophic stump blowout. Treatment of this is extremely challenging, especially for severely co-morbid patients who cannot undergo major surgery, or in patients with a hostile abdomen. We present a case study of a 74-year-old male found to have an aortoenteric fistula (AEF). This case broadens operative options for this type of patient population by demonstrating an endovascular technique for addressing aortic stump blowout by parallel grafting and coil embolization of the visceral aorta.
    Language English
    Publishing date 2024-01-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2076272-0
    ISSN 1938-9116 ; 1538-5744
    ISSN (online) 1938-9116
    ISSN 1538-5744
    DOI 10.1177/15385744231225890
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  5. Article: Vertebral artery transection with pseudoaneurysm and arteriovenous fistula requiring antegrade and retrograde embolization.

    Karatela, Maham / Weissler, E Hope / Cox, Mitchell W / Williams, Zachary F

    Journal of vascular surgery cases and innovative techniques

    2022  Volume 8, Issue 2, Page(s) 183–186

    Abstract: Traumatic vertebral artery injury is a rare, life-threatening injury that has been increasingly managed with endovascular intervention. However, an antegrade endovascular approach alone can fail to occlude traumatic pseudoaneurysms (PSAs) and ... ...

    Abstract Traumatic vertebral artery injury is a rare, life-threatening injury that has been increasingly managed with endovascular intervention. However, an antegrade endovascular approach alone can fail to occlude traumatic pseudoaneurysms (PSAs) and arteriovenous fistulas (AVFs), requiring high-risk surgical reoperation. We have presented the case of a 27-year-old man with traumatic right vertebral artery PSA and AVF. Despite successful ipsilateral coil embolization, the PSA and AVF persisted via retrograde filling from the contralateral vertebral artery. Distal coil embolization was achieved through the contralateral vertebral artery in a novel "up and over" approach through the basilar artery. The findings from our case report have broadened the endovascular options for complicated traumatic injuries.
    Language English
    Publishing date 2022-03-03
    Publishing country United States
    Document type Case Reports
    ISSN 2468-4287
    ISSN 2468-4287
    DOI 10.1016/j.jvscit.2022.01.009
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  6. Article ; Online: Restoring Venous Patency with the ClotTriever Following Deep Vein Thrombosis.

    Weissler, E Hope / Cox, Mitchell W / Commander, Sarah Jane / Williams, Zachary F

    Annals of vascular surgery

    2022  

    Abstract: Background: Although randomized data remain inconclusive, invasive endovenous therapy is increasingly favored in patients with extensive iliocaval or iliofemoral deep vein thrombosis (DVT) to reduce the rates of postthrombotic syndrome. Previously, ... ...

    Abstract Background: Although randomized data remain inconclusive, invasive endovenous therapy is increasingly favored in patients with extensive iliocaval or iliofemoral deep vein thrombosis (DVT) to reduce the rates of postthrombotic syndrome. Previously, pharmacomechanical thrombectomy was the therapy of choice, but the Inari ClotTriever device is an appealing, purely mechanical, alternative. It may reduce bleeding risk, intensive care unit admission, and the need for multiple procedures when compared with traditional thrombolysis. We present a series of 18 patients treated with the ClotTriever for extensive iliocaval or iliofemoral DVT.
    Methods: The Inari ClotTriever is a percutaneous mechanical thrombectomy system consisting of an expandable nitinol collection bag that is dragged along the vein wall, separating and capturing thrombus for collection into the retrieval sheath. We retrospectively reviewed all patients undergoing ClotTriever thrombectomy since the device became available at our quaternary referral center in June 2019. The review of these patients' records was determined to be exempt by our institutional review board.
    Results: Eighteen patients underwent ClotTriever thrombectomy between June 2019 and November 2021. Most patients (N = 16, 89%) presented within 2 weeks of symptom onset, and identifiable provoking factors were present in all patients. The most common provoking factor was anatomy, with May-Thurner syndrome present in 8 patients. All patients had restoration of unimpeded venous flow in the treated segments, although 3 had some residual nonflow limiting thrombus. There were no bleeding events or repeat venous procedures. The median postprocedure length of stay of 2 days. Postoperative venous imaging was performed in 15 patients and showed patency of the treated segment in 14 patients. Revised Clinical Venous Severity Scores were available in 14 patients during the course of follow-up. Of these, 9 patients' highest scores were 0, 2 patients' highest scores were 2, 2 patients' highest scores were 4, and 1 patient had a high score of 8.
    Conclusions: Venous flow was re-established in all 18 patients treated with the ClotTriever in this series, with no bleeding complications, and median postprocedure length of stay of 2 days. All patients with available follow-up, except 1, retained patency of the treated venous segments, and most had mild postthrombotic syndrome or none at all. These findings suggest that the ClotTriever is a safe and effective way to treat extensive iliocaval/femoral DVT.
    Language English
    Publishing date 2022-08-22
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1027366-9
    ISSN 1615-5947 ; 0890-5096
    ISSN (online) 1615-5947
    ISSN 0890-5096
    DOI 10.1016/j.avsg.2022.07.031
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  7. Article ; Online: Feasibility and Intermediate Results of Transcarotid Revascularization with a Prosthetic Conduit.

    Cui, Christina L / Reardon, Emily S / Loanzon, Roberto S / Williams, Zachary F / Cox, Mitchell W / Southerland, Kevin W

    Annals of vascular surgery

    2024  Volume 103, Page(s) 74–80

    Abstract: Background: Transcarotid artery revascularization (TCAR) is a hybrid technique with excellent initial outcomes. The technical success and safety of TCAR is heavily dependent on an anatomically suitable common carotid artery (CCA). Many patients do not ... ...

    Abstract Background: Transcarotid artery revascularization (TCAR) is a hybrid technique with excellent initial outcomes. The technical success and safety of TCAR is heavily dependent on an anatomically suitable common carotid artery (CCA). Many patients do not meet anatomic criteria and therefore are not eligible for this therapy. We sought to extend the eligibility of TCAR to patients with unfavorable CCA anatomy via the adoption of a prosthetic arterial conduit.
    Methods: A single-center retrospective study of patients with critical carotid artery stenosis who underwent TCAR via a prosthetic conduit between June 2019 and October 2021 was performed. All patients in the study were considered high-risk for carotid endarterectomy based on anatomic features, such as restenosis post-carotid endarterectomy and neck radiation. Unfavorable CCA anatomy was defined as a clavicle to carotid bifurcation distance <5 cm, a CCA diameter <6 mm, and/or significant atherosclerotic disease at the intended arterial access site. The primary outcome of interest was technical success. Secondary outcomes included perioperative complications, intermediate and long-term patency, intermediate and long-term stroke and/or mortality and in-hospital length of stay. Follow-up ranged from 1 to 29 months.
    Results: Eight patients underwent 10 TCAR procedures via a prosthetic conduit. A total of 2 procedures (20%) were performed on female patients and 8 procedures (75%) were performed on male patients. The mean age was 65 years old (standard deviation 11 years). Technical success was 100%. The 30-day ipsilateral stroke rate was 0%. The 30-day patency was 90%. There was no re-exploration for hemorrhage and 30 day mortality was 0%.
    Conclusions: TCAR is an excellent option for carotid artery revascularization. Unfavorable CCA anatomy has limited its applicability. TCAR via a prosthetic conduit has the potential to expand eligibility for this promising therapy.
    Language English
    Publishing date 2024-02-22
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1027366-9
    ISSN 1615-5947 ; 0890-5096
    ISSN (online) 1615-5947
    ISSN 0890-5096
    DOI 10.1016/j.avsg.2023.12.075
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  8. Article ; Online: Vascular stenting of a malignant arterial blowout as a bridge to effective systemic and regional therapy.

    Williams, Taylor P / Cox, Mitchell W / Jana, Bagi / Ross, Merrick I / Fisher, Sarah B / Walker, John P / Hume, Celyne B / Mayo, Lauren L / Tyler, Douglas S

    Journal of surgical oncology

    2024  

    Abstract: Locally advanced cutaneous squamous cell carcinoma can erode into blood vessels, leading to vascular blowout, requiring emergent surgical intervention. We describe a first case of this disease complication which was effectively managed with endovascular ... ...

    Abstract Locally advanced cutaneous squamous cell carcinoma can erode into blood vessels, leading to vascular blowout, requiring emergent surgical intervention. We describe a first case of this disease complication which was effectively managed with endovascular stenting as a bridge to effective systemic and regional therapy. We discuss the efficacy of this staged approach which is novel and timely in a clinical environment of increasingly effective systemic therapies.
    Language English
    Publishing date 2024-03-27
    Publishing country United States
    Document type Case Reports
    ZDB-ID 82063-5
    ISSN 1096-9098 ; 0022-4790
    ISSN (online) 1096-9098
    ISSN 0022-4790
    DOI 10.1002/jso.27623
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  9. Article ; Online: Retrograde Transamputation Revascularization: A Case Report.

    Williams, Zachary F / Gilmore, Brian / Weissler, Hope / Long, Chandler / Southerland, Kevin / Cox, Mitchell W

    Annals of vascular surgery

    2021  Volume 74, Page(s) 511–514

    Abstract: Below-knee amputation remains the most common level of amputation in patients with lower extremity gangrene and critical limb ischemia. Failure to heal, requiring additional operative debridement or conversion to an above-knee amputation remains a ... ...

    Abstract Below-knee amputation remains the most common level of amputation in patients with lower extremity gangrene and critical limb ischemia. Failure to heal, requiring additional operative debridement or conversion to an above-knee amputation remains a significant cause of patient morbidity. There remains no definitive diagnostic test that can accurately predict healing of the amputation site. We report a case utilizing a hybrid technique of retrograde transamputation revascularization via balloon angioplasty. This proximal, retrograde approach allows for relatively easy crossing and treatment of the infrainguinal chronic total occlusions (CTOs), improving arterial inflow for optimal wound healing.
    MeSH term(s) Amputation/methods ; Angioplasty, Balloon ; Chronic Limb-Threatening Ischemia/surgery ; Female ; Gangrene/surgery ; Humans ; Leg/surgery ; Middle Aged ; Vascular Surgical Procedures/methods ; Wound Healing
    Language English
    Publishing date 2021-04-02
    Publishing country Netherlands
    Document type Case Reports ; Journal Article
    ZDB-ID 1027366-9
    ISSN 1615-5947 ; 0890-5096
    ISSN (online) 1615-5947
    ISSN 0890-5096
    DOI 10.1016/j.avsg.2021.02.019
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  10. Article: D-dimer as a Rule-Out for Aortic Dissection.

    Carter, Jeremy M / Tom, Roshan B / Sunesra, Raheed / Bilby, Nathaniel J / Mireles, Blake / Paul, Krishna K / Koscumb, Paul A / Cox, Mitchell W / Jehle, Dietrich V

    Cureus

    2023  Volume 15, Issue 12, Page(s) e50170

    Abstract: Introduction Acute aortic dissection (AAD) represents a significant diagnostic challenge with a high mortality rate if not treated promptly. This challenge arises from the diverse clinical presentations of AAD, and its symptom overlap with other medical ... ...

    Abstract Introduction Acute aortic dissection (AAD) represents a significant diagnostic challenge with a high mortality rate if not treated promptly. This challenge arises from the diverse clinical presentations of AAD, and its symptom overlap with other medical conditions. Although both helical CT and transesophageal echocardiography are reliable diagnostic tools for AAD, they are not feasible for every suspected case. Furthermore, limited research on D-dimer's utility in ruling out AAD has been conducted due to the condition's rarity. Methods This study utilizes the TriNetX database (https://trinetx.com/), encompassing data from 54 healthcare organizations across the United States over the past two decades from 85 million patients. The objective is to evaluate the sensitivity of an elevated D-dimer level in diagnosing AAD across a much larger patient cohort than previously studied. Results Retrospectively analyzing this dataset, there were 1,319 patients identified with a confirmed AAD who had undergone D-dimer testing within a day of diagnosis. Of these, 1,252 patients exhibited D-dimer levels exceeding 400 ng/ml while 1,227 had levels surpassing 500 ng/ml. Notably, a D-dimer cutoff of 400 ng/ml demonstrated a sensitivity of 0.949 while a 500 ng/ml cutoff yielded a sensitivity of 0.930. Conclusion This large retrospective cohort study demonstrates that a blood D-dimer level is highly sensitive in assaying for AAD. The D-dimer levels analyzed showed a remarkable sensitivity in ruling out AAD, avoiding the need for more invasive testing in low-risk patients.
    Language English
    Publishing date 2023-12-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.50170
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