Vascular
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Delirium is a common problem in elderly patients undergoing surgery. Standard delirium care is not available at all surgical wards. We determined the incidence, risk factors, and outcomes of postoperative delirium among patients undergoing elective/emergency aortoiliac surgery at a surgical ward with high-standard delirium care. ⋯ The incidence was 14% after elective surgery. Delirium occurred in 59% after emergency surgery and more often after open than after endovascular aneurysm repair (p < .01). Delirium was associated with age (p < .01) and emergency surgery (p = .01) and is an important and frequent complication after aortoiliac surgery.
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Comparative Study
Thoracic aortic trauma: outcomes and hospital resource utilization after endovascular and open repair.
Thoracic endovascular aortic repair (TEVAR) has evolved as a treatment option for the management of thoracic aortic trauma as an alternative to open thoracic aortic repair (OTAR). Population-level outcomes are not known and were evaluated. Secondary data analysis of the 2005-2006 Nationwide Inpatient Sample data was performed, and 1,561 patients with thoracic aortic injury (mean age 44.8 +/- 18.8 years; men 77.2%) were identified. ⋯ An increase in patients with thoracic aortic injury undergoing repair was found (23.0% vs 40.3%; p < .0002). In trauma, TEVAR was associated with decreased hospital mortality, hospital use, and pulmonary complications but increased rates of stroke. Further implementation of TEVAR for management of thoracic aortic trauma may improve future outcomes and reduce hospital resource use.
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A computed tomographic angiogram for pseudoaneurysm after previous puncture in the groin showed duplication of the superficial femoral artery in a 52-year-old man without symptoms or signs of arterial insufficiency. It is doubtful whether this very rare anatomic variant has clinical relevance, but it should be known by vascular specialists.