Journal of vascular surgery
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Comparative Study
National outcomes for the treatment of ruptured abdominal aortic aneurysm: comparison of open versus endovascular repairs.
Endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA) has been shown to acutely decrease procedural mortality compared to open aortic repair (OAR). However, little is known about the effect of choice of procedure; EVAR vs OAR, or the impact of physician and institution volume on long-term survival and outcome. ⋯ When EVAR and OAR patients are compared using a reliable statistical technique such as propensity analysis, the perioperative survival advantage of rAAA repaired endovascularly is maintained over the long term. Institutional experience with rAAA is critical for survival after either OAR or EVAR.
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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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The concept of repeatedly connecting an extracorporeal blood pump to produce pancycle suprasystolic inflow pressures to ischemic limbs is introduced. Balloon catheters allow for limb isolation from the systemic circulation. In the acute phase, it is assumed that pressure is proportion to flow (Poiseuille's Law) and in the chronic phase that collateral growth is related to endothelial shear stress and wall tension. The primary objective was to establish that increased flow could be achieved through collateral circulation in animals and in man with extracorporeal limb hyperperfusion. The second objective was to develop and test an arterial access system capable of intermittent regional hyperperfusion similar in concept to intermittent hemodialysis. Finally, to demonstrate the translocation of these concepts into humans facing major limb amputation where all standard treatment options had been exhausted. ⋯ Blood flow through collaterals can be very significantly augmented by connection to an extracorporeal pump with isolation from the systemic circulation. The pancycle hyperperfusion can be safely repeated by implantation of an arterial access device. In the longer term, there is evidence of collateral development. When amputation is the only alternative, hypertensive extracorporeal limb perfusion should be considered.