Journal of vascular surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Hemostatic efficacy of fibrin sealant (human) on expanded poly-tetrafluoroethylene carotid patch angioplasty: a randomized clinical trial.
The efficacy of solvent-detergent-treated fibrin sealant (human [FSH]) for controlling anastomotic bleeding from expanded polytetrafluoroethylene (ePTFE) patch angioplasty during carotid endarterectomy was evaluated, and FSH was compared with thrombin-soaked gelatin sponge (Gelfoam; TSG). ⋯ FSH was equivalent, but not superior to, TSG in achieving hemostasis during carotid endarterectomy performed with ePTFE patch angioplasty. Adhesion properties of FSH to ePTFE are possibly different than those to native tissue and warrant additional investigation.
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Comparative Study
Comparison between the transabdominal and retroperitoneal approaches for aortic reconstruction in patients at high risk.
The purpose of this study was to compare the transabdominal approach with the retroperitoneal approach for elective aortic reconstruction in the patient who is at high risk. ⋯ In this subset of patients who were at high risk for aortic reconstruction, the postoperative complications were common. However, the number of complications was significantly lower in the retroperitoneal group. Aortic reconstruction in patients of ASA class IV appears to be more safely and economically performed with the retroperitoneal approach.
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The efficacy of prophylactic inferior vena cava filters in selected trauma patients at high risk has come into question in relation to risk/benefit assessment. To evaluate the usefulness of prophylactic inferior vena cava filters, we reviewed our experience and overall complication rate. ⋯ This study's results show that prophylactic inferior vena cava filters can be placed safely with low morbidity and no attributable long-term disabilities. In this patient population with a high risk of pulmonary embolism, prophylactic inferior vena cava filters offered a 99.5% protection rate, with only one of 187 patients having a nonfatal pulmonary embolism.
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The intermediate success and outcome of primary forefoot amputations in patients with diabetes mellitus who have sepsis limited to the forefoot and presumed adequate forefoot perfusion, as determined by means of noninvasive methods, was studied. ⋯ Patients with diabetes mellitus who have sepsis limited to the forefoot requiring acute hospitalization and undergoing primary digit amputations have a high incidence of intermediate-term, persistent, and recurrent infection, leading to a modest rate of limb loss, despite having apparently salvageable lesions and noninvasive evidence of presumed adequate forefoot perfusion.
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Spinal cord ischemia after operation on the abdominal aorta is a rare event that is attributed to variations in the spinal cord blood supply. The purpose of this study was to evaluate the possible causes of this devastating event. ⋯ Interference with pelvic blood supply from prolonged aortic cross clamping, intraoperative hypotension, aortic embolization, and interruption of internal iliac artery circulation have all been suggested as possible causes of spinal cord ischemia. In this survey, none of these factors proved to be significant as the sole cause of spinal cord ischemia. In the performance of an aortic operation with an end-to-end proximal anastomosis in the presence of severe external or internal iliac artery disease, there may be an increased incidence of spinal cord ischemia despite appropriate surgical techniques to ensure internal iliac perfusion. Spinal cord ischemia after abdominal aortic operations appears to be a tragically unpredictable, random, and unpreventable event.