Journal of vascular surgery
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Comparative Study
The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients.
Initially, patients with a short angulated aortic neck were considered unfit for endovascular aneurysm repair (EVAR). Recently, however, more liberal use of EVAR has been advocated. This study analyzes the correlation of aortic neck length to early and late outcomes. ⋯ EVAR can be used for patients with a short aortic neck; however, it was associated with a significantly higher rate of early and late type I endoleaks, resulting in an increased use of proximal aortic cuffs for sealing the endoleaks.
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Comparative Study
Carotid angioplasty and stenting in anatomically high-risk patients: Safe and durable except for radiation-induced stenosis.
Carotid angioplasty and stenting (CAS) is used in patients considered high-risk for carotid endarterectomy (CEA). Patients qualify as high-risk because of medical comorbid conditions or for anatomic considerations (previous CEA, radical neck dissection, radiation). We compared the technical feasibility and durability of CAS in medically high-risk patients (MED) vs anatomically high-risk patients (ANAT). ⋯ CAS is as technically feasible, safe, and durable in anatomically high-risk patients as in medically high-risk patients, with similar rates of periprocedural stroke and death and late restenosis. However, patients with radiation-induced stenosis appear to be at an increased risk for restenosis.
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Comparative Study
Explaining racial disparities in mortality after abdominal aortic aneurysm repair.
Black patients have a higher mortality rate than nonblacks after abdominal aortic aneurysm repair. We sought to understand the factors responsible for this racial disparity in the mortality rate after aneurysm repair. ⋯ Although many factors contribute, a large proportion of observed disparities in outcomes are attributable to black patients receiving care in lower-quality hospitals. Efforts aimed at improving disparities must focus on improved access to high-quality hospitals and improved resources at the hospitals that treat higher proportions of black patients.
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The geometry and dynamics of the vena cava are poorly understood and current knowledge is largely based on qualitative data. The purpose of this study is to quantitate the dimensional changes that occur in the infrarenal inferior vena cava (IVC), in response to changes in intravascular volume. ⋯ In response to changes in intravascular volume, the IVC undergoes profound anisotropic dimensional changes, with greater displacement seen in the minor axis. In addition, the IVC is oriented left-anterior oblique and caval orientation is not altered by changes in volume status. IVC obliquity may result in underestimation of caval size by anterior-posterior venogram.
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We present a hybrid endovascular approach to a 6.5-cm aneurysm of the right-sided aortic arch with an aberrant left subclavian artery arising from a Kommerell diverticulum, connected to the left pulmonary artery through the ligamentum arteriosum. The two-step procedure consisted of a bilateral carotid-subclavian bypass, followed by an ascending aorta-bicarotid bypass and completed by an endovascular exclusion of the aneurysms by covering the whole aortic arch and its branches. The patient had no complications and is asymptomatic 21 months after surgery. Hybrid procedures may be helpful in complex aortic arch pathologies, reducing complications of challenging open surgery.