Journal of vascular surgery
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Multicenter Study Comparative Study
The impact of body mass index on perioperative outcomes of open and endovascular abdominal aortic aneurysm repair from the National Surgical Quality Improvement Program, 2005-2007.
Obesity and morbid obesity have been shown to increase wound infections and occasionally mortality after many surgical procedures. Little is known about the relative impact of body mass index (BMI) on these outcomes after open (OAR) and endovascular abdominal aortic aneurysm repair (EVAR). ⋯ Morbid obesity confers a worse outcome for death after abdominal aortic aneurysm repair. Obesity is also a risk factor for infectious complications after OAR and EVAR. Obese patients and, particularly, morbidly obese patients should be treated with EVAR when anatomically feasible.
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Inferior vena cava filters (IVCFs) can prevent pulmonary embolism (PE); however, indications for use vary. The Eastern Association for the Surgery of Trauma (EAST) 2002 guidelines suggest prophylactic IVCF use in high-risk patients, but the American College of Chest Physicians (ACCP) 2008 guidelines do not. This analysis compares cost-effectiveness of prophylactic vs therapeutic retrievable IVCF placement in high-risk trauma patients. ⋯ Analysis suggests prophylactic IVC filters are not cost-effective in high-risk trauma patients. The magnitude of this result is primarily dependent on probabilities of long-term sequelae (venous thromboembolism, bleeding complications). Even in the initial hospitalization, however, prophylactic IVCF costs for the additional quality-adjusted life years gained did not justify use.
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Stent graft-induced new entry (SINE), defined as the new tear caused by the stent graft and excluding those arising from natural disease progression or iatrogenic injury from the endovascular manipulation, has been increasingly observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B dissection in our center. SINE appears to be remarkably life threatening. We investigated the incidence, mortality, causes, and preventions of SINE after TEVAR for Stanford type B dissection. ⋯ SINE appears not to be rare after TEVAR for type B dissection and is associated with substantial mortality. The stress yielded by the endograft seems to play a predominant role in its occurrence. It is important to take this stress-induced injury into account during both design and placement of the endograft.
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In recent years, thoracic endovascular aneurysm repair (TEVAR) has been attempted for acute aortic emergencies (AAEs). However, the risk factors for achieving good results have not been identified. Besides focusing on Acute Physiology and Chronic Health Evaluation (APACHE) II score as a general indicator of patient condition, we analyzed both preoperative factors and intraoperative/postoperative factors. The purpose of this study was to identify those factors affecting the results of TEVAR using our Matsui-Kitamura stent graft (MKSG) for AAEs involving descending thoracic aortic aneurysm. ⋯ Good results were obtained using TEVAR to treat AAEs with MKSGs, both perioperatively and during medium-term follow-up. Evaluation of risk factors for TEVAR of AAEs showed the utility of APACHE II score (particularly age, hematocrit, and total score) with a score ≥ 10 indicating high risk.
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In risk stratification of aortic diseases such as aneurysm and aortic dissection, diameter is one parameter whose influence on the average aortic wall stress is directly described by the Laplace law. More advanced mechanical models can be used and may yield additional information, such as transmural stress distributions. The question then arises of how refined models need to be to provide clinicians with practical help. ⋯ Biomechanical analysis of the aorta may be refined by using increasingly detailed computational models. Simplified models can readily improve on the Laplace law in the assessment of aortic wall stress, and as such, may already contribute to better risk stratification of aortic disease. Advanced models may also enhance our understanding of the mechanistic aspects in the pathogenesis of aortic disease. However, their applicability in a patient-specific context may be limited by the large number of input data they require, some of which might stay out of the clinicians' reach.