Journal of vascular surgery
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Myocardial ischemia and infarction after surgery remain leading causes of morbidity and mortality in patients undergoing major vascular surgery. B-type natriuretic peptide has been shown to predict early postoperative cardiac events in patients undergoing major noncardiac surgery. We aimed to determine if N-terminal pro B-type natriuretic peptide (NT-pro-BNP), with its longer half-life and greater plasma stability, can predict postoperative myocardial injury in vascular patients. ⋯ Elevated preoperative plasma NT-pro-BNP levels independently predict postoperative myocardial injury, which is associated with adverse outcome in the short- and long-term regardless of the presence of symptoms of acute coronary syndrome.
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To determine if insurance status predicts severity of vascular disease at the time of treatment or outcomes following intervention. ⋯ Insurance status predicts disease severity at the time of treatment, but once treated, the outcomes are similar among insurance categories, with the exception of lower extremity revascularization. This data suggests inferior access to preventative vascular care in the Medicaid and the uninsured populations.
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Review Case Reports
Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm.
Percutaneous catheterization is a frequently-used technique to gain access to the central venous circulation. Inadvertent arterial puncture is often without consequence, but can lead to devastating complications if it goes unrecognized and a large-bore dilator or catheter is inserted. The present study reviews our experience with these complications and the literature to determine the safest way to manage catheter-related cervicothoracic arterial injury (CRCAI). ⋯ During central venous placement, prevention of arterial puncture and cannulation is essential to minimize serious sequelae. If arterial trauma with a large-caliber catheter occurs, prompt surgical or endovascular treatment seems to be the safest approach. The pull/pressure technique is associated with a significant risk of hematoma, airway obstruction, stroke, and false aneurysm. Endovascular treatment appears to be safe for the management of arterial injuries that are difficult to expose surgically, such as those below or behind the clavicle. After arterial repair, prompt neurological evaluation should be performed, even if it requires postponing elective intervention. Imaging is suggested to exclude arterial complications, especially if arterial trauma site was not examined and repaired.
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Comparative Study Controlled Clinical Trial
Endovenous laser and echo-guided foam ablation in great saphenous vein reflux: one-year follow-up results.
Great saphenous vein (GSV) reflux is the most frequent form of venous insufficiency in symptomatic patients and is commonly responsible for varicose veins of the lower extremity. This non-randomized prospective controlled study was designed to test the hypothesis that 1) endovenous laser treatment is more effective than foam sclerotherapy in the closure of the refluxing GSV (as measured by degree of great saphenous vein reflux and venous clinical severity score changes) and 2) to record the associated complications of echo-guided endovenous chemical ablation with foam and endovenous laser therapy for the treatment of great saphenous vein reflux and to further identify risk factors associated with treatment failure. ⋯ Overall, endovenous laser ablation achieved higher occlusion rates than echo-guided chemical ablation with foam after one year follow-up. Matching the patient to the technique based on great saphenous vein diameter measured before treatment may assist in boosting the treatment success rate to >90%. A larger patient cohort followed and compared over a longer period of time would be required to confirm these findings.
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Although endovascular repair of thoracic aortic aneurysm has been shown to reduce the morbidity and mortality rates, spinal cord ischemia remains a persistent problem. We evaluated our experience with spinal cord protective measures using a standardized cerebrospinal fluid (CSF) drainage protocol in patients undergoing endovascular thoracic aortic repair. ⋯ Perioperative CSF drainage with augmentation of systemic blood pressures may have a beneficial role in reducing the risk of paraplegia in patients undergoing endovascular thoracic aortic stent graft placement. However, selective CSF drainage may offer the same benefit as mandatory drainage.