Journal of vascular surgery
-
To determine whether the introduction of endovascular technology changed the relationship of hospital volume to mortality with abdominal aortic aneurysm repair. ⋯ As the endovascular repair becomes more widespread, the relationship between hospital volume and operative mortality still remains. High-volume hospitals are more likely to use the endovascular approach, and this explains a significant portion of the observed impact of hospital volume on mortality.
-
Randomized Controlled Trial Multicenter Study Comparative Study
A comparison of recombinant thrombin to bovine thrombin as a hemostatic ancillary in patients undergoing peripheral arterial bypass and arteriovenous graft procedures.
Recombinant thrombin (rThrombin) is a potential hemostatic alternative to bovine and human plasma-derived thrombin. This report examines the clinical results for the vascular surgery subgroup of patients enrolled in a larger double-blind, randomized, multicenter trial, which evaluated the comparative safety and efficacy of rThrombin and bovine plasma-derived thrombin (bThrombin) when used as adjuncts to surgical hemostasis. ⋯ rThrombin or bThrombin used as a hemostatic ancillary for anastomotic bleeding was equally effective at 10 minutes; however, rThrombin compared with bThrombin may provide a more rapid onset of hemostasis at 3 minutes in PAB procedures. Adverse events were similar between the two thrombins. In patients undergoing vascular surgery, both treatments were similarly well tolerated, although rThrombin demonstrated a superior immunogenicity profile.
-
The Leapfrog Group established evidence-based standards for abdominal aortic aneurysm (AAA) repair, including targets for case volume and perioperative beta-blocker usage. The purpose of this study was to determine whether meeting these benchmarks correlated with improved patient outcomes over time. ⋯ This population-based study supports the effectiveness of meeting Leapfrog AAA repair standards towards improving mortality outcomes over time and suggests that their impact depends upon procedure type. Further studies are needed to help promote the standardization of evidence-based measures that may improve vascular surgery outcomes.
-
Comparative Study
Expanding use of emergency endovascular repair for ruptured abdominal aortic aneurysms: disparities in outcomes from a nationwide perspective.
Endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) has become widely accepted in the elective setting but remains controversial for emergency repair of ruptured aneurysms (rAAA). We sought to examine the national trends in use and associated outcomes with EVAR. ⋯ Endovascular repair is being increasingly used in the emergency management of ruptured AAA, with steadily decreasing mortality during the study period. Endovascular AAA repair is associated with improved mortality and outcomes compared with open repair, but results in nonteaching centers are substantially worse than those in teaching hospitals.
-
Comparative Study
The impact of race and insurance type on the outcome of endovascular abdominal aortic aneurysm (AAA) repair.
Although mortality and complication rates for abdominal aortic aneurysm (AAA) have declined over the last 20 years, operative complication rates and perioperative mortality are still high, specifically for repair of ruptures. The goal of this study was to determine the influence of insurance type and ethnicity while controlling for the influences of potential confounders on procedure selection and outcome following endovascular AAA repair (EVAR). ⋯ After controlling for previously identified associative factors for AAA outcome, ethnicity and insurance type does influence EVAR surgical outcome. Subsequent studies that break down emergent repair vs elective surgery and that longitudinally stratify delay in surgery, or time to admission may be useful.