Journal of vascular surgery
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We sought to determine the effects of renal insufficiency on thoracic endovascular aortic repair (TEVAR) outcome and to identify predictors for adverse events. ⋯ Patients with preoperative renal insufficiency maintain renal function after TEVAR. However, this patient population may be susceptible to increased adverse events, with emergency repair and baseline creatinine >2.0 mg/dL serving as strong predictors.
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Review Meta Analysis Comparative Study
Endovenous therapies of lower extremity varicosities: a meta-analysis.
Minimally invasive techniques such as endovenous laser therapy, radiofrequency ablation, and ultrasound-guided foam sclerotherapy are widely used in the treatment of lower extremity varicosities. These therapies have not yet been compared with surgical ligation and stripping in large randomized clinical trials. ⋯ In the absence of large, comparative randomized clinical trials, the minimally invasive techniques appear to be at least as effective as surgery in the treatment of lower extremity varicose veins.
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Multicenter Study Comparative Study
The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality.
Mild obesity may have a protective effect against some diseases, termed an "obesity paradox." This study examined the effect of body mass index (Kg/m(2) BMI) on surgical 30-day morbidity and mortality in patients undergoing vascular surgical procedures. ⋯ Underweight patients have poorer outcomes and class III obesity is associated with increased morbidity. Mildly obese patients have reduced co-morbid illness, surprisingly even less than normal-class patients, with correspondingly reduced mortality. Mild obesity is not a risk factor for 30-day outcomes after vascular surgery and confers an advantage.
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Randomized Controlled Trial Comparative Study
Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair.
More effective adjuncts are needed to reduce the incidence of acute renal injury after thoracoabdominal aortic aneurysm (TAAA) repair. The purpose of this randomized trial was to determine whether renal perfusion with cold blood provides better protection against renal ischemia than perfusion with cold crystalloid in patients undergoing TAAA repair with left heart bypass. ⋯ Cold renal perfusion during TAAA repair provides effective protection against renal injury. Using cold blood instead of cold crystalloid does not enhance renal protection.
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Remote ischemic preconditioning is a physiologic mechanism in mammalian species whereby brief exposure to nonlethal ischemia in one tissue confers protection against a prolonged ischemic insult in a distant tissue. First described almost 15 years ago, it has been slow to translate into clinical practice. ⋯ In addition, a randomized trial in patients undergoing open abdominal aortic aneurysm repair reported a significant reduction in perioperative myocardial infarctions. Remote ischemic preconditioning is easily performed and likely to prove highly cost-effective. large-scale trials of the technique are warranted in patients undergoing major vascular surgery.