Hematology Oncology Associates of Fredericksburg

Background: Atherectomy is widely used in treating peripheral artery disease (PAD), especially for heavily calcified femoropopliteal and tibial lesions. However, procedural risks remain notable, with reported dissection rates of 3–15%, perforation 0.5–2.0%, embolization 1–6%, and access-site complications like hematoma or pseudoaneurysm in 2–4%. Outcomes can vary by device type and access strategy. This study compared the safety and procedural outcomes of laser atherectomy (LA) versus orbital atherectomy (OA), all performed via pedal access, in patients with calcified PAD at a single center between 2021 and 2024. Methods: We conducted a retrospective cohort study of 259 patients with Rutherford class 3–4 PAD who underwent intervention with LA (n=61) or OA (n=198). One patient treated with both modalities was excluded. Primary endpoints were technical success, defined as residual stenosis <30% without in-lab complications, and periprocedural events (arterial occlusion, dissection, perforation, pseudoaneurysm). Secondary endpoints included one-year amputation, mortality, ED visits within one week, and procedure time. Results: Technical success was 100% in LA and 99.5% in OA (p<0.01), confirming high effectiveness for both. Periprocedural complications occurred in 4.9% of LA and 6.1% of OA cases. In LA, occlusion occurred in 1.6% and dissection in 3.3%. In OA, dissection and pseudoaneurysm each occurred in 1.0%; no perforations were observed. At one year, amputation occurred in 3.3% (LA) vs. 0.5% (OA), and mortality was 1.6% vs. 4.5%, respectively. ED visits within one week were 0% (LA) vs. 2.5% (OA). Mean procedure time was slightly shorter with OA (61 ± 25 min) vs. LA (66 ± 35 min). Logistic regression showed no significant difference in adjusted complication rates (OR 0.83, 95% CI: 0.27–2.53, p=0.75). Pedal access was used in all patients and associated with minimal access-site complications: one access-site dissection (1.6%) and no hematoma, pseudoaneurysm, retroperitoneal bleeding, or bleeding requiring intervention. Access via anterior tibial, posterior tibial, or peroneal arteries was successfully obtained under ultrasound guidance in all cases. Conclusion: In this single-center cohort of patients with calcified PAD, both LA and OA achieved high technical success and low complication rates. Device selection may be guided by lesion and procedural factors. Pedal access was safe and effective, supporting its role in atherectomy-based interventions.

Anastomotic leaks are a dreaded surgical complication following colorectal operations. Creation of a temporary proximal diverting ileostomy is used in high-risk anastomoses, however, additional surgical risk is accumulated with its creation and reversal. Endoluminal vacuum therapy has been shown to seal anastomotic defects in the prophylactic setting in a pig model and we hypothesized it could be utilized in a delayed fashion to rescue subjects with an active anastomotic leak. Yorkshire pigs underwent rectal resection, intentional leak confirmed by fluoroscopy, and endoluminal vacuum therapy device placement to low continuous suction. Following treatment, a contrast enema and necropsy was performed for gross and histopathology. Pigs underwent 2 (or 5) days of free intraperitoneal leak prior to device placement and 5 (or 7) subsequent days of endoluminal vacuum therapy. Six of seven early-treated pigs sealed their anastomotic defect, while two of the four treated pigs in this extended group sealed the defect. Endoluminal vacuum therapy is feasible and well tolerated in a pig model, and it has been shown to seal a significant number of freely leaking anastomoses in the early period (86%). This technology warrants further study as it may provide a noninvasive means to treatment of anastomotic leaks.

Explosive blast has been extensively used as a tactical weapon in Operation Iraqi Freedom (OIF) and more recently in Operation Enduring Freedom(OEF). The polytraumatic nature of blast injuries is evidence of their effectiveness,and brain injury is a frequent and debilitating form of this trauma. In-theater clinical observations of brain-injured casualties have shown that edema, intracranial hemorrhage, and vasospasm are the most salient pathophysiological characteristics of blast injury to the brain. Unfortunately, little is known about exactly how an explosion produces these sequelae as well as others that are less well documented. Consequently, the principal objective of the current report is to present a swine model of explosive blast injury to the brain. This model was developed during Phase I of the DARPA (Defense Advanced Research Projects Agency) PREVENT (Preventing Violent Explosive Neurotrauma) blast research program. A second objective is to present data that illustrate the capabilities of this model to study the proximal biomechanical causes and the resulting pathophysiological, biochemical,neuropathological, and neurological consequences of explosive blast injury to the swine brain. In the concluding section of this article, the advantages and limitations of the model are considered, explosive and air-overpressure models are compared, and the physical properties of an explosion are identified that potentially contributed to the in-theater closed head injuries resulting from explosions of improvised explosive devices (IEDs).