The first article is a letter to the editor, EVTODAY journal on TEVAR in patients with post coarctoplasty, whether surgical or interventional, aneurysmal formation. The experts are Colin D. Bicknell, MD, FRCS Vascular surgeon and Mohamad Hamady MBChBm, FRCR Interventional radiologist. As you know post coarctoplasty aneurysmal formation is a long term complication and is much more common in patients who had treated by surgical repair, esp Dacron patch aortoplasty. The largest study on more than 800 post surgical coarctoplasty patients within 1-24 years shows 5.4% (pseudo)aneurysm formation esp among patients treated by Dacron patch aortoplasty. Although both fusiform and saccular aneurysms can be happen but saccular aneurysms are more common than usual among them. The threshold for the treatment of such patients must be lower as there is lack of knowledge of the nature of this pathology. Indeed if an aneurysm detected after surgical repair esp. if was saccular, it needs therapy, without paying attention to Guidelines. The choice of therapy in this setting is Endovascular, i.e. TEVAR. Why surgical repair of these patients is high risk? Redo surgery may damage the collaterals and cause more bleeding, Adhesion bands, fragile aortic wall, the higher risk of dissection are the main causes. TEVAR of this type of aneurysms also has challenges. The different diameter size of proximal and distal normal aorta, the angle of thoracic aorta, short proximal landing zone and need for debranching. By using custom made devices some of these problems may disappear.
Link: http://evtoday.com/2015/11/aneurysmal-complications-of-coarctation/
The 2nd article is about dialysis access management. Juxta anastomosis stenosis of dialysis access, whether AVG or Native AVF, is one of the most important causes of fistula failure. Surgical revision of native AVF into AVG is a good and viable choice, but this is not the end of story. Lesion length and specifications along with lower patency rates of AVG in comparison with native AVF should be considered. Let\'s divide the managements into 2 categories; i.e. Native AVF and AVG. Balloon angioplasty with plain high pressure balloons and cutting balloons are the first steps. It is advised to use Drug coating balloons after predilation and reserve stenting in cases with perforations and acute recoil. Although in a randomized study of 190 patients in 2010 showed the superiority of stent graft placement among AVG failure due to juxta-anastomosis stenosis. In this regard there are different recommendations for usage of stent grafts in dialysis access intervention. Some use these stents only for complications of AVF intervention, or non-infected pseudoaneurysms, but some uses them in cases of AVG failure and rapid recoil after balloon angioplasty. One should know that the nature of the stenotic lesions in dialysis access circuit differs according to its site. For example stenotic lesions near the anastomosis and puncture sites are fibrotic and predispose to recoil. So stenting may be more useful in these cases.
Links: 1. Stent graft vs balloon angioplasty for failing dialysis access grafts
2. Drug coating balloons what\'s their role in AV access
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