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Biomedical subjects

William H Pearce

Publications and source records attributed to William H Pearce.

At least 19 recordsLinked to original sources
PubMed2006

Lower extremity nerve function in patients with lower extremity ischemia.

BACKGROUND: We determined whether lower extremity ischemia, as measured by the ankle brachial index (ABI), is associated with impaired lower extremity nerve function. METHODS: Participants included 478 persons with peripheral arterial disease (PAD) identified from noninvasive vascular laboratories and 292 persons without PAD identified from a general medicine practice and noninvasive vascular laboratories. Peripheral arterial disease was defined as an ABI lower than 0.90 (mild PAD: ABI, 0.70 to <0.90; moderate PAD: ABI, 0.50 to <0.70; and severe PAD: ABI, <0.50). The ABI and electrophysiologic measures of the peroneal, sural, and ulnar nerves were obtained. RESULTS: Among 546 participants without diabetes, PAD participants had significantly impaired peripheral nerve function in the upper and lower extremities compared with non-PAD participants. After adjusting for age, sex, race, smoking, height, body mass index, recruitment source, alcohol use, disk disease, spinal stenosis, cardiac disease, and cerebrovascular disease, these associations were not statistically significant. After adjusting for confounders among nondiabetic participants, those with severe PAD (ABI, <0.50) had poorer peroneal nerve conduction velocity (NCV) compared with participants without PAD (42.6 vs 44.8 m/s; P = .003) and poorer peroneal NCV compared with participants with mild PAD (42.6 vs 45.0 m/s; P = .001) or moderate PAD (42.6 vs 44.1 m/s; P = .03). Among 224 participants with diabetes, after adjusting for confounders, PAD was associated with poorer peroneal NCV (40.8 vs 43.5 m/s; P = .01), sural nerve amplitude (3.1 vs 4.8 muV; P = .045), and ulnar NCV (47.6 vs 50.2 m/s; P = .03) compared with those without PAD. CONCLUSIONS: Our findings suggest that leg ischemia impairs peroneal nerve function. This association is less strong in patients with diabetes, perhaps because of the overriding influence of diabetes on peripheral nerve function. Clinicians should consider screening for PAD in patients with idiopathic peroneal nerve dysfunction. Peripheral arterial disease-associated nerve dysfunction may contribute to PAD-associated functional impairment.

Aged↗
PubMed2006

Physical performance in peripheral arterial disease: a slower rate of decline in patients who walk more.

BACKGROUND: Exercise rehabilitation programs increase treadmill walking performance in patients with peripheral arterial disease (PAD) and intermittent claudication. However, it is unknown whether patients with PAD who walk for exercise regularly have less functional decline than those with less walking activity. OBJECTIVE: To determine whether patients with PAD who report that they walk for exercise 3 or more times per week have less annual functional decline than those who walk for exercise less frequently. DESIGN: Prospective cohort study with a median follow-up of 36 months (interquartile range, 24 to 36 months). SETTING: Academic medical center. PARTICIPANTS: 417 men and women with PAD. MEASUREMENTS: Participants were classified at baseline and annually according to the number of times they reportedly walked for exercise each week. Functional assessments (6-minute walk distance, 4-meter walking speed, summary performance score) were measured at baseline and annually. Results were adjusted for age, sex, ethnicity, comorbid conditions, body mass index, ankle-brachial index, education, leg symptoms, cigarette use, geriatric depression score, previous year's level of functioning, and patterns of missing data. RESULTS: Compared with those who exercised less frequently, patients who walked for exercise 3 or more times per week had a significantly smaller average annual decline in 6-minute walking distance (-48.0 feet per year compared with -56.6 feet per year for those who walked 1 to 2 times per week and -79.4 feet per year for nonexercisers; P for trend = 0.037). Patients who walked for exercise at least 3 times per week experienced a smaller average annual decline in the usual-paced 4-meter walking velocity (-0.014 m/s per year compared with -0.022 m/s per year for those who walked 1 to 2 times per week and -0.045 m/s per year for nonexercisers; P = 0.005). Similar findings were observed for the fast-paced 4-meter walk. The subset of asymptomatic patients who walked for exercise 3 or more times per week had annual declines in 6-minute walking performance (P = 0.107), normal-paced walking velocity (P = 0.065), and the summary performance score (P = 0.115); however, these declines were smaller than those observed in asymptomatic participants who walked fewer than 3 times per week. LIMITATIONS: Because this was an observational study, associations reported here cannot be construed as causal relationships. Sample sizes for subgroup analyses were small, which limited statistical power. CONCLUSION: Among patients with PAD, self-directed walking exercise performed at least 3 times weekly is associated with significantly less functional decline during the subsequent year. Similar trends were observed in the subset of asymptomatic patients with PAD. These findings may be particularly important for the numerous patients with PAD who do not have access to supervised walking exercise programs.

Disability Evaluation↗
PubMed2006

Obesity, weight change, and functional decline in peripheral arterial disease.

BACKGROUND: Our objectives were to determine whether obesity is associated with a greater functional decline compared with the ideal body mass index (BMI) among persons with peripheral arterial disease (PAD) and to determine the associations between weight gain and loss and functional declines in PAD. We hypothesized that baseline obesity and weight gain during follow-up would each be associated with functional declines in persons with PAD. METHODS: The design was a prospective cohort study. The subjects were 389 men and women with PAD (mean ankle-brachial index, 0.65 +/- 0.14) who were followed up prospectively for a median of 48 months. The main outcome measures were functional assessments (6-minute walk, usual- and rapid-paced 4-m walking speed, and summary performance score). Weight and height were measured at baseline and annually. Results were adjusted for age, sex, race, comorbidities, ankle-brachial index, education, leg symptoms, exercise status, depressive symptoms, pack-years of cigarette smoking, prior-year functioning, and patterns of missing data. RESULTS: Compared with those with a baseline BMI between 20 and 25 kg/m2, PAD participants with baseline BMI greater than 30 kg/m2 had a significantly greater average annual decline in 6-minute walk performance (-13.1 vs -26.5 m/y; P = .004), usual-paced 4-m walking velocity (-0.028 vs -0.055 m/s per year; P = .024), and fast-paced 4-m walking velocity (-0.053 vs -0.086 m/s per year; P = .012). Persons with weight gain between 5 and 10 pounds after baseline who walked for exercise regularly had significantly less decline in the 6-minute walk than persons without significant weight change who did not walk for exercise (P = .04). CONCLUSIONS: Obesity is associated with functional decline in persons with PAD. Walking exercise may protect against functional decline in PAD persons with modest weight gain.

Aged↗
PubMed2006

Decreased incidence of left common iliac vein compression in patients with abdominal aortic aneurysms.

OBJECTIVE: Compression of the left common iliac vein (LCIV) by the right common iliac artery is an anatomic variant that may increase the risk for LCIV thrombosis. The incidence of LCIV compression in patients with abdominal aortic aneurysms (AAA) is unknown, however. The aim of this descriptive anatomic study was to determine (1) the incidence of LCIV compression in patients with and without AAA and (2) if endovascular AAA repair acutely alters the incidence of LCIV compression and, hence, the risk of LCIV thrombosis. METHOD: A retrospective analysis of medical records and helical computed tomography (CT) scans was conducted in 100 AAA patients and 100 non-AAA patients (n = 200). Medical records were reviewed for symptoms and risk factors for deep vein thrombosis, and data were reported according to the Joint Society Reporting Standards for acute lower-extremity venous thrombosis. The minor diameters of the aorta, inferior vena cava, and common iliac arteries and veins were measured. For AAA patients, measurements were obtained from preoperative and 30-day postoperative CT scans. RESULTS: The mean age of the study cohort was 38 years (range, 17 to 85 years) for non-AAA subjects and 73 years (range, 51 to 89 years) for AAA subjects. The mean acute lower-extremity venous thrombosis risk factor score was low for both patient groups (non-AAA, 0.82 +/- 0.12; AAA, 2.63 +/- 0.14). Mean compression of the LCIV was 37.8% (range, 0% to 74.8%) for non-AAA patients but only 27.3% (range, 0% to 74.2%; P < .0006) for AAA patients. Of non-AAA patients with venous compression, the right common iliac artery was the compressing structure in 87% of cases. However, of AAA patients with venous compression, the left common iliac artery was the compressing structure in 76% of cases. There was no statistically significant change in the degree of compression of the LCIV before and after endovascular repair (27.3% vs 25.1%, respectively) nor was there a change in the structure that compressed the LCIV. CONCLUSION: Patients with AAA were found to have more tortuous iliac arteries that led to less anatomic compression of the LCIV compared with nonaneurysmal patients. Furthermore, the left common iliac artery was found to compress the LCIV in most of the AAA patients, and the right iliac artery was found to compress the LCIV in most non-AAA patients. Endovascular AAA repair did not acutely alter these anatomic findings. Patients with AAA may therefore be at lower risk of developing LCIV thrombosis owing to the nature of their anatomy.

Adolescent↗
PubMed2006

Stent-graft treatment of thoracoabdominal aortic aneurysms after complete visceral debranching.

Complex thoracoabdominal aortic aneurysm repair remains a difficult problem from both open and endoluminal approaches. The reduced morbidity and mortality rates reported to be associated with aortic stent-graft procedures makes this option more attractive, but it is hampered by the need for adequate proximal and distal seal zones. While branched and fenestrated aortic stent-grafts are being refined, an alternative is a two-stage surgical and endoluminal approach that is particularly useful for aneurysms involving the aortic visceral segment. The present report describes stent-graft repair in two patients after complete visceral artery revascularization or "debranching."

Aged↗
PubMed2006

Abdominal aortic aneurysm as a complex multifactorial disease: interactions of polymorphisms of inflammatory genes, features of autoimmunity, and current status of MMPs.

The role of matrix metalloproteinases (MMPs) in the pathogenesis of abdominal aortic aneurysm (AAA) has focused on the degradation of the extracellular matrix (ECM). The new frontier of MMP biology involves the role of MMPs in releasing cryptic fragments and neoepitopes from the ECM and the impact of MMPs on the regulation of the inflammatory response. The ECM is a complex structure, much more important than an inert scaffold. Both MMP-2 and MMP-9 expose a cryptic epitope that controls angiogenesis. MMPs inhibit angiogenesis through the release of endostatin, endorepellin, arresten, canstatin, and tumstatin. Other breakdown products of the ECM include fragments of fragmin and elastin degradation products (EDPs). In addition, the ECM contains embedded vascular endothelial growth factor (VEGF) and transforming growth factor-beta (TGF-beta). Inflammation is a complex, highly regulated system that involves the identification of injury or infection, response to the injury or infection, repair and healing, and return to normal homeostasis. In some instances, the inflammatory process leads to a pathologic process that is damaging to the host. MMPs play an important role in the control of the inflammatory response through the modification of proinflammatory cytokines, chemokines, and shedding of membrane receptors. Genetic association studies have been performed to help determine the genetic risk associated with certain single nucleotide polymorphisms (SNPs) However, because of the variability in the patient populations and the size of the population, it is difficult to draw any conclusions from these studies. While the etiology of AAA remains unknown, understanding of the inflammatory process and its regulatory points will develop new strategies for the treatment of AAA. Perhaps one difficulty with understanding the pathogenesis of AAA is the lack of precise definition of the phenotype.

Animals↗
PubMed2005

Enhanced abdominal aortic aneurysm in TIMP-1-deficient mice.

BACKGROUND: Matrix metalloproteinases (MMPs) are known elastolytic mediators of abdominal aortic aneurysm (AAA) degeneration, and their activity is tightly regulated by the presence of tissue inhibitors of MMPs (TIMPs). Imbalances in this system may be instrumental in compromising arterial wall integrity. The aim of this study was to show that, in an elastase-induced murine model of aneurysm formation, TIMP-1 has a protective effect. MATERIALS AND METHODS: Twenty-four wild-type (TIMP-1+/+) and 22 knockout (TIMP-1-/-) mice underwent laparotomy and isolation of the infrarenal aorta. A polyethylene catheter was inserted into the aorta and dilute pancreatic elastase (0.39 Units/ml) was infused over 5 min using a perfusion pump. Pre- and postinfusion maximal aortic diameters were obtained in triplicate for each animal using NIH Image. Final aortic measurements were obtained 14 days later, prior to perfusion fixation with 10% buffered Formalin. Aortic specimens were sectioned and stained. Statistical analysis was performed using the Student's t test. RESULTS: TIMP-1-/- mice demonstrated a significant postinfusion diameter increase compared to wild-types after elastase, which was not seen after saline infusion. At sacrifice, TIMP-1-/- mice, following both saline and elastase infusion, showed a significant increase in maximal aortic diameter relative to postinfusion measurements compared to TIMP-1+/+ mice. CONCLUSIONS: TIMP-1-/- mice develop larger aneurysms than TIMP-1+/+ mice. This study illustrates the protective effects of TIMP-1 in an experimental AAA model and may provide a means for pharmacologically controlling aneurysm growth.

Animals↗
PubMed2005

Racial differences in primary and repeat lower extremity amputation: results from a multihospital study.

OBJECTIVE: African Americans have a much higher risk of major (above- or below-knee) lower extremity amputation and a lower rate of limb-preserving vascular surgery or angioplasty than white patients. This article analyzes two potential pathways for racial disparities: primary amputation, defined as a major amputation performed without any prior attempt at revascularization, and repeat amputation, defined as a major amputation subsequent to a previous through-foot or major amputation. METHODS: Randomly selected medical records were reviewed for 248 African American, 30 Hispanic, and 235 white or other-race patients undergoing above- or below-knee amputation between 1995 and 2003 at three Chicago teaching hospitals. Chronic disease prevalence and severity, preadmission functional status, clinical presentation, and vascular history were used to test the risk-adjusted effect of race and ethnicity on rates of primary and repeat amputation. RESULTS: Controlling for demographic, functional, chronic disease, and clinical characteristics, African American patients were 1.7 times more likely to have undergone both primary (P = .01) and repeat (P = .03) amputation than white or other-race amputees. Race remained a significant independent risk factor even after controlling for the higher severity of illness, greater disability, and more complex presentation of African American amputees. CONCLUSIONS: Higher rates of primary and repeat amputation for African American patients at study hospitals, which all have significant vascular surgery capacity and an aggressive policy of limb salvage, suggest that these rates may be even higher at less well equipped institutions. Improving access to primary and preventive care for lower-income patients could reduce amputation rates among African Americans.

Adult↗
PubMed2005

Carotid stenting done exclusively by vascular surgeons: first 175 cases.

BACKGROUND: Percutaneous CAS may well replace CEA as standard of care. CAS has been performed largely by interventional cardiologists; however, with recent Food and Drug Administration approval, vascular surgeons are now hurriedly attempting to obtain the requisite endovascular skills. Reported are our 30-day and midterm outcomes of CAS. METHODS: Retrospective review of 175 cervical carotid stenoses treated with elective CAS from April 2001 to February 2005. All procedures were performed under local anesthesia via percutaneous femoral access in an operating room angiosuite. Mechanical cerebral protection was used in 90% of cases. Data analysis includes demographics, procedural records, and duplex exams over a mean follow-up of 21 months. RESULTS: Mean age is 70 years (74% men and 26% women). Preprocedural neurologic symptoms were present in 32%. Intraoperative complications included 2 seizures (1.1%) and 4 asystolic arrests (2.3%), all managed medically without sequelae. Over the 30-day follow-up there were no deaths, no myocardial infarctions (MIs), 2 major strokes (1.1%), 2 minor strokes (1.1%), 3 transient ischemic attacks (TIAs) (1.7%), and 1 major access-site complication (0.6%). At late follow-up, 3 cases (1.7%) of restenosis occurred; all were treated with repeat angioplasty and remain patent. One (0.6%) asymptomatic occlusion was detected at 6-month follow-up. There have been no late carotid-related complications or deaths. CONCLUSIONS: Vascular surgeons possessing advanced catheter-based skills can safely perform CAS and achieve perioperative results comparable to CEA. Such skills are crucial to those surgeons intent on the future management of carotid occlusive disease.

Aged↗
PubMed2005

D-dimer and inflammatory markers as predictors of functional decline in men and women with and without peripheral arterial disease.

OBJECTIVES: To determine whether higher circulating levels of inflammatory and thrombotic markers are associated with greater decline in lower extremity performance. DESIGN: Prospective cohort. SETTING: Academic medical center. PARTICIPANTS: Three hundred thirty-seven men and women with lower extremity peripheral arterial disease (PAD) and 215 without PAD. MEASUREMENTS: Objective measures of leg function, including the 6-minute walk and Short Physical Performance Battery (SPPB), were obtained at baseline and annually for 3 years. D-dimer, high-sensitivity C-reactive protein, serum amyloid A, and fibrinogen levels were measured at baseline. Participants were categorized into one of three groups, ranging from low to high levels of inflammation, depending on the number of individual blood factors in the lowest and highest tertiles for each corresponding blood factor. RESULTS: Adjusting for age, sex, race, ankle brachial index, comorbidities, and other confounders, greater inflammation was associated with greater decline in the SPPB (P=.008). Results were similar when repeated in participants with and without PAD separately (P for trend=.04 for participants with PAD and .07 for participants without PAD). In fully adjusted analyses, there were no significant associations between inflammation group and decline in 6-minute walk performance. CONCLUSION: Higher baseline levels of inflammatory markers and D-dimer were associated with greater decline in the SPPB at 3-year follow-up in persons with and without PAD.

Activities of Daily Living↗
PubMed2004

Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms.

CONTEXT: Among individuals with lower-extremity peripheral arterial disease (PAD), specific leg symptoms and the ankle brachial index (ABI) are cross-sectionally related to the degree of functional impairment. However, relations between these clinical characteristics and objectively measured functional decline are unknown. OBJECTIVE: To define whether PAD, ABI, and specific leg symptoms predict functional decline at 2-year follow-up. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study among 676 consecutively identified individuals (aged > or =55 years) with and without PAD (n = 417 and n = 259, respectively), with baseline functional assessments occurring between October 1, 1998, and January 31, 2000, and follow-up assessments scheduled 1 and 2 years thereafter. PAD was defined as ABI less than 0.90, and participants with PAD were categorized at baseline into 1 of 5 mutually exclusive symptom groups. MAIN OUTCOME MEASURES: Mean annual changes in 6-minute walk performance and in usual-paced and fast-paced 4-m walking velocity, adjusted for age, sex, race, prior-year functioning, comorbid diseases, body mass index, pack-years of cigarette smoking, and patterns of missing data. RESULTS: Lower baseline ABI values were associated with greater mean (95% confidence interval) annual decline in 6-minute walk performance (-73.0 [-142 to -4.2] ft for ABI <0.50 vs -58.8 [-83.5 to -34.0] ft for ABI 0.50 to <0.90 vs -12.6 [-40.3 to 15.1] ft for ABI 0.90-1.50, P =.02). Compared with participants without PAD, PAD participants with leg pain on exertion and rest at baseline had greater mean annual decline in 6-minute walk performance (-111 [-173 to -50.0] ft vs -8.67 [-36.9 to 19.5] ft, P =.004), usual-pace 4-meter walking velocity (-0.06 [-0.09 to -0.02] m/sec vs -0.01 (-0.03 to 0.003] m/sec, P =.02), and fastest-pace 4-meter walking velocity (-0.07 [-0.11 to -0.03] m/sec vs -0.02 [-0.04 to -0.006] m/sec, P =.046). Compared with participants without PAD, asymptomatic PAD was associated with greater mean annual decline in 6-minute walk performance (-76.8 (-135 to -18.6] ft vs -8.67 (-36.9 to 19.5] ft, P =.04) and an increased odds ratio for becoming unable to walk for 6 minutes continuously (3.63; 95% confidence interval, 1.58-8.36; P =.002). CONCLUSIONS: Baseline ABI and the nature of leg symptoms predict the degree of functional decline at 2-year follow-up. Previously reported lack of worsening in claudication symptoms over time in patients with PAD may be more related to declining functional performance to than lack of disease progression.

Activities of Daily Living↗
PubMed2004

Does carotid stenting measure up to endarterectomy? A vascular surgeon's experience.

HYPOTHESIS: Carotid angioplasty and stenting seems to have equal or better outcomes in high-risk patients than carotid endarterectomy. DESIGN: Single-center case-control study. SETTING: University hospital tertiary referral center. PATIENTS: Individuals (n = 53) undergoing elective carotid angioplasty and stenting for cervical carotid stenosis (n = 57) between April 2001 and October 2003. All patients were referred to and treated by the primary author (M.K.E.). RESULTS: Mean +/- SD age was 68.8 +/- 1.2 years (64% men [34] and 36% women [19]), and overall mean +/- SD rate of stenosis was 79% +/- 10%. Preprocedural neurologic symptoms were present in 42% of the group. Indications for treatment included prior neck surgery with irradiation (4), recurrent stenosis (19), and severe comorbidities (34). Duplex scanning 24 hours after stenting showed immediate mean percentage reductions in peaksystolic velocity and end diastolic velocity of 74% and 76%, respectively. After a 30-day follow-up period, there were no deaths and no major or minor strokes. One patient (1.7%) developed transient amaurosis fugax 12 hours after the procedure. Four patients (7.0%) experienced access-related complications. Intraoperative complications included 1 seizure (1.7%) and 1 asystolic arrest (1.7%), both treated successfully. During follow-up, 3 cases of re-stenosis (5.0%) occurred. One asymptomatic occlusion (1.7%) was detected at the 6-month follow-up visit. There have been no late carotid-related complications or deaths. CONCLUSIONS: Vascular surgeons possessing advanced catheter-based skills can safely perform carotid angioplasty and stenting and can achieve perioperative results comparable with carotid endarterectomy. Determination of the true efficacy and durability of carotid angioplasty and stenting as compared with endarterectomy awaits ongoing randomized national trials.

Aged↗
PubMed2004

Leg strength in peripheral arterial disease: associations with disease severity and lower-extremity performance.

OBJECTIVE: The purpose of this study was to determine relationships between lower-extremity arterial obstruction, leg strength, and lower-extremity functioning. DESIGN: The study design was cross-sectional. A total of 514 outpatients (269 with ankle-brachial index [ABI] <0.90), aged 55 and older, were identified from three Chicago-area hospitals. Individuals with history of lower-extremity revascularization were excluded. Main outcome measures Strength in each leg, 6-minute walk, 4-meter walking velocity, accelerometer-measured physical activity, and a summary performance score were measured. The summary performance score is a composite measure of lower-extremity functioning, ranging from 0 to 12 (12 = best). The leg with the lower ABI was defined as the "index" leg, and the leg with higher ABI was defined as the "contralateral" leg. RESULTS: Index leg ABI levels were associated linearly and significantly with strength for hip extension (P <.001), hip flexion (P <.001), knee extension (P =.066), and knee flexion (P =.003), adjusting for known and potential confounders. In adjusted analyses, the index ABI was also associated linearly and significantly with strength in the contralateral leg. Adjusting for confounders, including ABI, knee extension strength, was associated independently with functional measures. CONCLUSION: Among patients without prior leg revascularization, strength in each leg is highly correlated with the lower-leg ABI. Leg strength is associated independently with functional performance. Further study is needed to determine whether lower-extremity resistance training improves functioning in patients with peripheral arterial disease.

Aged↗
PubMed2004

Percutaneous repair of abdominal aortic aneurysm.

OBJECTIVE: Percutaneous treatment of an abdominal aortic aneurysm (AAA) is feasible, but is associated with a unique set of risks. A comparison of Excluder endograft deployment with femoral artery cutdown (FAC) versus percutaneous femoral access (PFA) for treatment of infrarenal AAA was undertaken. METHODS: A single-institution, controlled, retrospective review was carried out in patients who underwent either bilateral FAC or bilateral PFA for endovascular repair of infrarenal AAA with the Gore bifurcated Excluder endograft between March 1999 and November 2003. To November 2000, 35 patients underwent bilateral FAC; since then, 47 patients have undergone bilateral PFA. All have been followed up for at least 30 days. RESULTS: Mean AAA size was 5.7 cm in the FAC group and 6.0 cm in the PFA group. During hospitalization there were six access-related complications in the FAC group; three required early surgical intervention. In the PFA group nine perioperative access-related complications occurred, all consisting of either hemorrhage or arterial occlusion; seven required additional intervention, and were recognized and ameliorated while the patient was still in the operating room. At 30-day follow-up there were no additional access-related complications in the PFA group. There were eight other access-related complications in eight additional patients who underwent FAC. In patients undergoing bilateral PFA total operative time was shorter (PFA 139 minutes vs FAC 169 minutes; P =.002), total in-room anesthesia time was less (PFA 201 minutes vs FAC 225 minutes; P <.008), and use of general anesthesia was reduced (P <.001). No significant differences were observed between groups with respect to estimated blood loss (PFA 459 mL vs FAC 389 mL; P =.851). CONCLUSION: Complete percutaneous treatment of AAA may have some advantages over open femoral artery access, but it is not free from risk. Percutaneous treatment of AAA can be completed successfully in most patients, but should be performed at an institution where conversion to an open procedure can be completed expeditiously if necessary.

Aged↗
PubMed2004

What's new in vascular ultrasound.

Duplex ultrasound has long been the method of choice in the diagnosis and evaluation of deep venous thrombosis and carotid artery stenosis and in monitoring lower extremity bypasses. In recent years, innovative procedures and technology have fostered new applications for duplex ultrasound, such as detection of in-stent stenosis and endoleaks, intraoperative evaluation of in situ vein bypasses and monitoring of endovenous procedures, and treatment of common femoral pseudoaneurysms. The low cost and noninvasiveness of duplex ultrasound make it ideal for such studies,as well as for screening for asymptomatic vascular disease.

Aneurysm, False↗