Journal of vascular surgery
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Comparative Study
Cerebral microembolization after protected carotid artery stenting in surgical high-risk patients: results of a 2-year prospective study.
This was a prospective single-center study to assess and analyze cerebral embolization resulting from carotid artery stenting with neuroprotective filter devices in patients considered as poor surgical candidates for surgical carotid endarterectomy. ⋯ The incidence of new focal ischemic lesions detected by DWI is higher than expected on the basis of previous reports. Embolization from the aortic arch or common carotid arteries could account for most of those events in patients considered as surgical high-risk patients. Although 90% of the events were clinically silent, this high rate of microembolization raises questions about the possible consequences on cerebral cognitive functions.
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Comparative Study
Total laparoscopic versus conventional abdominal aortic aneurysm repair: a case-control study.
This study was designed to identify differences in the per- and postoperative outcomes between total laparoscopic and open surgical repair of abdominal aortic aneurysms (AAA). ⋯ This case-control study provides preliminary results that short-term outcomes of total laparoscopic AAA repair are comparable with those of open surgery. Peroperative data demonstrate that laparoscopy is more technically demanding than open repair. However, the technical challenge of laparoscopy does not worsen the postoperative course.
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Comparative Study
Rapamycin-coated expanded polytetrafluoroethylene bypass grafts exhibit decreased anastomotic neointimal hyperplasia in a porcine model.
We tested the hypothesis that rapamycin coated onto, and eluted from, expanded polytetrafluoroethylene (ePTFE) grafts would diminish neointimal hyperplasia in a porcine model. ⋯ Rapamycin-eluting ePTFE grafts decrease neointimal hyperplasia in a porcine model. Further studies are needed to evaluate whether patency will be improved. Rapamycin-eluting ePTFE grafts may allow the use of prosthetic grafts in situations in which autologous vein is unavailable and in which neointimal hyperplasia is pronounced, such as in small-diameter (<6-mm) vessels typical of infrapopliteal interventions.
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Septic phlebitis of the internal jugular vein, Lemierre's syndrome, is extremely rare. However, Lemierre's syndrome may cause septic pulmonary emboli or result in fatal systemic sepsis, or both, if a timely diagnosis and appropriate treatment are not provided. We present a case of Lemierre's syndrome that occurred in an otherwise healthy young man. In this case, progression to a moribund state was rapid, and surgical intervention proved lifesaving.
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Comparative Study
Improvement in the visualization of superficial arm veins being evaluated for access and bypass.
Duplex ultrasound mapping of arm veins is being performed with increasing frequency. Unlike ultrasound testing in other areas, this has never been subjected to a gold standard invasive test to determine accuracy. Duplex mapping appears to have a good predictive value whenever large veins are demonstrated preoperatively, but its ability to accurately measure minimum-sized veins is unproven. In this study, we compared diameter measurements obtained under six different conditions and used the maximum diameter as the comparison gold standard. ⋯ Use of warm water immersion before vein diameter measurement in a sitting position, without a tourniquet, will result in significantly larger diameter findings in normal arm veins. These diameters are likely to more closely resemble the venous diameter after distension with arterial pressure. Further studies are needed to see if warming in patients could result in increased utilization of autogenous arm vein for dialysis access and bypass.