Journal of vascular surgery
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Embolo/sclerotherapy is an important treatment modality for vascular malformations, but the rates and results of the complications associated with embolo/sclerotherapy are not well known. We report the incidence and outcome of soft tissue injury and neuropathy after performing embolo/sclerotherapy for congenital vascular malformations (CVMs) classified according to the Hamburg classification. ⋯ Soft tissue injuries occurred in 11.9% of patients (68 of 573) and neuropathies occurred in 8.6% (49 of 573) after undergoing embolo/sclerotherapy. Most of these complications recovered by themselves (58.9% from soft tissue injury and 85.1% from neuropathy). Our results suggest that embolo/sclerotherapy has an acceptable incidence of soft tissue injury and neuropathy, when considering the effect that the CVM had on the quality of life before treatment, so embolo/sclerotherapy is recommended as a treatment modality for CVM.
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Review Meta Analysis
Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture.
Traumatic thoracic aortic injuries are associated with high mortality and morbidity. These patients often have multiple injuries, and delayed aortic repair is frequently used. Endoluminal grafts offer an alternative to open surgical repair. We performed a meta-analysis of comparative studies evaluating endovascular vs open repair of these injuries. ⋯ Meta-analysis of retrospective cohort studies indicates that endovascular treatment of descending thoracic aortic trauma is an alternative to open repair and is associated with lower postoperative mortality and ischemic spinal cord complication rates.
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Multicenter Study
Factors associated with stroke or death after carotid endarterectomy in Northern New England.
This study investigated risk factors for stroke or death after carotid endarterectomy (CEA) among hospitals of varying type and size participating in a regional quality improvement effort. ⋯ Surgeons can "risk-stratify" preoperative patients by considering the variables (emergency procedure, contralateral internal carotid artery occlusion, preoperative ipsilateral cortical stroke, congestive heart failure, and age), reducing risk with antiplatelet agents, and informing patients more precisely about their risk of stroke or death after CEA. Risk prediction models can also be used to compare risk-adjusted outcomes between centers, identify best practices, and hopefully, improve overall results.
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Multicenter Study
Bleeding into the intraluminal thrombus in abdominal aortic aneurysms is associated with rupture.
The aim of this study was to determine signs of bleeding in the intraluminal thrombus and the site of rupture using multislice computed tomography (CT) imaging in patients with abdominal aortic aneurysms (AAA). ⋯ The site of rupture could be identified in a majority of cases of AAA with routine multislice CT. This study demonstrates an association between the presence of blood in the thrombus as suggested by higher attenuation levels and a crescent sign and AAA rupture. If these findings also predict AAA rupture, remains to be established.
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We present the case of a 79-year-old female who presented with severe left flank pain and a pulsatile abdominal mass. She was diagnosed with left peripelvic urinary extravasation and forniceal rupture secondary to an intact infrarenal inflammatory abdominal aortic aneurysm with extensive periaortic fibrosis. Successful operative repair was performed with staged ureteral and endovascular stenting with subsequent resolution of periaortic inflammation and ureteral obstruction, and shrinkage of the aneurysm sac. ⋯ The most commonly involved adjacent structures are the duodenum, left renal vein, and ureter. Adhesions to the urinary system can cause hydronephrosis or hydroureter and result in obstructive uropathy. An unusual case of IAAA presenting with forniceal rupture is presented, with successful endovascular and endourologic repair.