Journal of vascular surgery
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Multicenter Study Comparative Study
Outcomes of symptomatic abdominal aortic aneurysm repair.
Operative mortality of patients undergoing symptomatic abdominal aortic aneurysm (Sx-AAA) repair has been reported at 6% to 30% during the past 25 years. We used a multicenter regional database to describe the contemporary outcomes of patients undergoing repair of Sx-AAA. ⋯ The operative mortality of patients with Sx-AAA in contemporary practice appears better than that previously reported in the literature. Despite low operative mortality, MAE and late survival are intermediate compared with E-AAA and R-AAA repair. Review of previous series shows a trend for lower operative mortality after Sx-AAA repair in more recent series, which likely reflects improved perioperative care and more use of endovascular aneurysm repair.
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Carotid endarterectomy (CEA) has been repeatedly described as a safe and efficacious procedure to provide a stroke-risk reduction benefit in both symptomatic and asymptomatic cases. Contemporary outcomes are acceptable using the large-scale randomized trials as a metric of success. Class I and II data can be applied to improve the care process of patients undergoing CEA. ⋯ Statins are beneficial to patients undergoing CEA with trials demonstrating up to a 3% absolute reduction in the incidence of stroke following CEA. Aspirin therapy is associated with an up to 7% absolute reduction in early stroke following CEA; however, the efficacy of combination or high-dose antiplatelet therapy remains ill-defined. A treatment strategy that involves perioperative medical optimization is likely to improve surgical outcomes and long-term cardiovascular risk for patients undergoing CEA.
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Multicenter Study
Existing risk prediction methods for elective abdominal aortic aneurysm repair do not predict short-term outcome following endovascular repair.
Improving the safety of elective abdominal aortic aneurysm (AAA) repair has become an imperative. Five well-described risk-scoring systems developed on open aneurysm repair (OR) were tested on a multicenter contemporary sample of patients undergoing endovascular repair of AAA (EVR) to determine if they predicted 30-day morbidity and mortality. ⋯ None of the available scores predicted the outcome of EVR with enough accuracy to be recommended for clinical use. To improve preoperative risk prediction in EVR validation of new systems is required, taking into account morphologic features of the aneurysm to predict medium-term morbidity and re-intervention.
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To establish the relationship between quality of life (QOL) index scores and clinical indicators of lower limb ischemia. ⋯ All generic and disease-specific QOL scores show statistically significant improvement with angioplasty and/or supervised exercise in patients with claudication due to femoropopliteal atherosclerosis. However, the degree of improvement seen in clinical indicators of lower limb ischemia is not reflected in these scores. These findings support the use of composite outcome measures with mandatory, independent assessment of QOL as an independent outcome measure in intervention studies in these patients.
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Markers of inflammation and fibrin turnover are elevated in individuals with a large (>55 mm) abdominal aortic aneurysm (AAA). Fibrin degradation generates D-dimer, known to possess multiple proinflammatory effects, and levels are elevated during early AAA development. This study characterized the plasma inflammatory response during early AAA pathogenesis to determine the effect of D-dimer levels. ⋯ C-reactive protein and D-dimer levels are elevated during early AAA development. D-dimer levels are most tightly associated with AAA status, however, and may mediate the observed elevation in acute-phase reactants.