Journal of vascular surgery
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This study reports the results of a prospective continuous cohort of patients treated for endovascular aneurysm repair (EVAR) with a unified anesthetic strategy based on the use of local anesthesia (LA) in all patients, while reserving regional (RA) or general anesthesia (GA) only for those with predefined individually or surgically specific indications. ⋯ A strategy based on the preferential use of LA for EVAR restricting RA or GA only to those with predefined contraindications is feasible and appears to be well tolerated.
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Insufficient blood flow through end-resistance arteries leads to symptoms associated with peripheral vascular disease. This may be caused in part by poor macrocirculatory inflow or impaired microcirculatory function. ⋯ Microcirculatory structure and function can be evaluated with transcutaneous oxygen, pulp skin flow, iontophoresis, and capillaroscopy. We discuss the importance of the microcirculation, investigative methods for evaluating its function, and clinical applications and review the literature of the microcirculation in these different states.
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Endovenous laser therapy (EVLT) and radiofrequency ablation (RFA) are new, minimally invasive percutaneous endovenous techniques for ablation of the incompetent great saphenous vein (GSV). We have performed both procedures at the Mayo Clinic during two different consecutive periods. At the time of this report, no single-institution report has compared RFA with EVLT in the management of saphenous reflux. To evaluate early results, we reviewed saphenous closure rates and complications of both procedures. ⋯ GSV occlusion was achieved in >90% of cases after both EVLT and RFA at 1 month. We observed three cases of thrombus protrusion into the CFV after EVLT and recommend early duplex scanning in all patients after endovenous saphenous ablations. DVT prophylaxis may be considered in patients >50 years old. Long-term follow-up and comparison with standard GSV stripping are required to confirm the durability of these endovenous procedures.
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Case Reports
Survival with intact cerebral function after gunshot injury to both internal carotid arteries.
A 24-year-old man was admitted after sustaining a single gunshot wound to the neck with an expanding hematoma on the left. Computed tomography angiography demonstrated bilateral internal carotid artery pseudoaneurysms, with disruption of flow on the left and a carotid-jugular fistula on the right. At operation, transection of the left internal carotid artery necessitated ligation of the artery. ⋯ This served to close the pseudoaneurysm and the arteriovenous fistula while preserving distal flow. The patient recovered with intact cerebral function and with mild paresis of the tongue related to hypoglossal nerve injury. He was discharged home after 7 days.