Journal of vascular surgery
-
Subclinical alterations of cerebral function can occur during or after carotid revascularization and can be detected by a variety of standard tests. This comparative study assessed the relationship among serum levels for two biochemical markers of cerebral injury, postoperative diffusion-weighted magnetic resonance imaging (DW-MRI), and neuropsychometric testing in patients undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS) for high-grade asymptomatic carotid stenosis. ⋯ Biochemical markers measurements of brain damage combined with neuropsychometric tests and DW-MRI can be used to evaluate silent injuries after CAS. The mechanisms of rise in S100beta and NSE levels at 24 hours after CAS may be due to increased perioperative microembolization rather than to hypoperfusion. Further studies are required to assess the clinical significance of those tests in carotid revascularization.
-
Comparative Study
Comparison of conservative and operative treatment for blunt carotid injuries: analysis of the National Trauma Data Bank.
Blunt carotid injury (BCI) is uncommon but potentially devastating. The best treatment modality for this injury remains undetermined. We conducted this study to better understand the hospital course and treatment outcomes for patients with BCI who received different interventions. ⋯ BCI is rare and carries a poor prognosis. Operative intervention is not associated with functional improvement or a survival advantage. This study was unable to support that less invasive endovascular treatment improves treatment outcome when compared to open surgery.
-
Case Reports
Hybrid treatment of an ascending aortic pseudoaneurysm following multiple sternotomies.
Ascending aortic pseudoaneurysm following prior cardiac or aortic surgery is a rare entity that requires reoperation. Surgical repair is a complex procedure associated with high operative mortality. We report the case of a 76-year-old male patient with an ascending aortic pseudoaneurysm developing from distal anastomosis of a Dacron aorto-aortic prosthesis. This high-risk patient had previously undergone multiple cardiovascular operations and was treated by performing an extra-anatomic bypass between the descending thoracic aorta and supra-aortic vessels, followed by endovascular stent graft placement, avoiding median re-sternotomy.
-
Comparative Study
Long-term outcomes and resource utilization of endovascular versus open repair of abdominal aortic aneurysms in Ontario.
Two large randomized trials showed that elective endovascular aneurysm repair (EVAR) had similar all-cause long-term mortality rates but increased costs compared with open repair for nonruptured abdominal aortic aneurysms (AAAs). Despite these data, the use of EVAR continues to increase in North America. Currently, there are very limited adjusted population-based data examining long-term outcomes and resource utilization. ⋯ Compared with open repair, EVAR significantly reduced short-term but not long-term mortality. The EVAR patients spent less time in health institutions, including long-term care facilities, but underwent more imaging studies. Future improvements in EVAR could result in further decreases in reinterventions and subsequent radiologic monitoring.
-
Little is known about the significance of blood transfusion in patients with peripheral arterial disease. We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to examine the effect of intraoperative blood transfusion on the morbidity and mortality in patients who underwent lower extremity revascularization. ⋯ In a large number of patients undergoing lower extremity revascularization, we have found that there is a higher risk of postoperative mortality, pulmonary, and infectious complications after receiving intraoperative blood transfusion. Additional studies are necessary to better define transfusion triggers that balance the risk/benefit ratio for blood transfusion.