Vascular
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Achieving intraoperative hemostasis is essential for excellent surgical outcomes. A variety of methods, ranging from mechanical tools and energy-based technologies to topical hemostatic agents, are available to the modern surgeon. ⋯ In this article, we review the mechanism by which currently available hemostatic tools and agents stop bleeding and give recommendations for their use during surgery. Furthermore, the costs of the various methods are presented, allowing the provider to choose not only the most potent but also the most cost-effective treatment modality in each situation.
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The purpose of this study was to evaluate the efficacy of combined ipsilateral percutaneous iliac angioplasty and open infrainguinal surgical techniques for the treatment of patients with multilevel arterial occlusive disease. Combining two types of approaches in the peripheral vascular field is a less aggressive technique and may result in excellent early patency and limb salvage rates. We report our initial experience with a combined percutaneous endovascular iliac angioplasty and infrainguinal surgical reconstruction for patients with chronic lower extremity ischemia associated with multilevel arterial occlusive disease who presented with severe (disabling) lower limb claudication that significantly reduced quality of life, as well as patients with rest pain, nonhealing ulcers, and gangrene. ⋯ Combined vascular therapy may be used effectively in patients with chronic extremity ischemia owing to multiple levels of arterial occlusion and should be performed with good results. Technical success and early patency rates are excellent. The patients' symptoms improved and resistant ischemic ulcers healed within a short period of time.
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A 41-year-old woman was treated with a Figulla (Occlutec, Helsingborg, Sweden) atrial septum occluder device with no intraprocedural complications. Five months later, dislocation of the device in the abdominal aorta was detected. The occluder device was located at the level of the celiac axis, nearly obstructing the entire aorta. ⋯ Through a medial rotation approach, the device was safely removed. This is a rare complication after endoluminal closure of an atrial septum defect. The retrieval possibilities are discussed.
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Cases of mural aortic arch thromboses are generally associated with diffuse atherosclerosis of the aortic arch and have primarily been detected in elderly patients. However, the presence of mural thrombi in the aortic arch in young patients without diffuse atherosclerosis has rarely been reported. We describe a case of a hypercoagulable young patient with arterial embolism in whom investigations revealed a mural pedunculated aortic arch thrombosis without clear diffuse atherosclerotic lesions.