Vascular
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This study examines the predictive value of intensive care unit (ICU) scoring systems in a vascular ICU population. ⋯ The good discrimination of these scoring systems indicates their value as an adjunct to clinical assessment but should not be used on an individual basis as a clinical decision-making tool.
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Observation may be an inadequate approach for injured extremities with single tibial vessel run-off.
Trauma patients with sudden loss of distal perfusion due to tibial injuries are frequently not offered vascular interventions if a single vessel retains patency. We hypothesized that sudden loss of either all or some tibial vasculature would result in increased non-operative failure and higher amputation rates. ⋯ Patients who failed an initial trial of observation were significantly more likely to have 0 or 1 tibial vessels patent. The number of open tibial vessels is significantly associated with limb salvage.
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Dynamic changes in anatomic geometry of the inferior vena cava from changes in intravascular volume may cause passive stresses on inferior vena cava filters. In this study, we aim to quantify variability in inferior vena cava dimensions and anatomic orientation to determine how intravascular volume changes may impact complications of inferior vena cava filter placement, such as migration, tilting, perforation, and thrombosis. ⋯ There is significant anisotropic variability of infrarenal inferior vena cava geometry with significantly greater expansive and compressive forces in the minor axis. There can be significant volumetric changes in the inferior vena cava with associated perimeter changes but the major axis left-anterior oblique caval configuration is always maintained. These significant dynamic forces may impact inferior vena cava filter stability after implantation. The consistent major axis left-anterior oblique obliquity may lead to underestimation of the inferior vena cava diameter used in standard anteroposterior venography, which may influence initial filter selection.
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To aid diagnosis of spontaneous isolated superior mesenteric artery dissection and planning management, we investigated the role of classification of features as observed on computed tomography angiography images. ⋯ Spontaneous isolated superior mesenteric artery dissection type IIIa is more likely to occur than other types. Long-term computed tomography angiography follow-up is valuable for determining treatment strategy for spontaneous isolated superior mesenteric artery dissection. Conservative therapy with anticoagulants is recommended for five days, and surgery or stenting should be considered if symptoms of intestinal ischemia are not relieved. Stent implantation provides relatively satisfactory mid-term outcome for true lumen construction of the superior mesenteric artery.