Journal of vascular surgery
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The purpose of this study was to identify predictors of decreased survival after open abdominal aortic aneurysm (AAA) repair at a single university hospital. ⋯ Open AAA repair can be done with low morbidity and mortality in the era of endovascular aneurysm repair. Careful consideration should be given to preoperative optimization and perioperative care in patients with chronic obstructive pulmonary disease, chronic renal insufficiency, and cerebrovascular disease. Postoperative decrease in renal function and pulmonary complication portend decreased 5-year survival; strategies to ameliorate these factors should be sought.
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Multicenter Study Comparative Study
Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database.
This study examined outcomes of endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) using general, spinal, epidural, and local/monitored anesthesia care (MAC) in a multicenter North American hospital database reflecting contemporary anesthesia and surgical practices. ⋯ In contemporary North American anesthetic and surgical practice, general anesthesia for EVAR was associated with increased postoperative LOS and pulmonary morbidity compared with spinal and local/MAC anesthesia. These data suggest that increasing the use of less-invasive anesthetic techniques may limit postoperative complications and decrease the overall costs of EVAR.
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Multicenter Study
Thrombolysis for lower extremity bypass graft occlusion.
Thrombolysis is a common method in the treatment of lower extremity bypass graft occlusion. The purpose of this study was to investigate the results of thrombolytic therapy in the management of acute bypass graft occlusion and to identify risk factors for technical failure and amputation. ⋯ Our findings support the use of thrombolysis in the treatment of acute bypass graft occlusion in the lower limb given its acceptable short- and long-term amputation-free survival rates. Technical failure and higher age were factors associated with major amputation. Synthetic grafts appeared to have a somewhat increased likelihood of technically successful thrombolysis compared with vein grafts, but on the other hand, they exhibited an increased risk of amputation during follow-up.
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Multicenter Study
Anticoagulation monitoring by an anticoagulation service is more cost-effective than routine physician care.
Vitamin K antagonists (VKAs) are the mainstay of long-term anticoagulation but require careful monitoring for effectiveness and safety. Physicians manage anticoagulation for most patients, although anticoagulation services are becoming increasingly popular. A new anticoagulation service (AS) run by nurses and overseen by a physician was established and its effectiveness vs usual physician care was independently assessed using costs of emergency department (ED) visits and hospitalizations resulting from failure or complication of anticoagulation. We report the results of this independent analysis of anticoagulation monitoring of patients treated with VKAs. ⋯ Management of long-term VKA therapy by an AS using established protocols appears to reduce anticoagulation morbidity and results in significant cost savings by reducing the number of ED visits and hospitalizations.
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To identify preoperative clinical features that predict a durable improvement in renal function with renal artery stenting (RAS). ⋯ The current study found that a steep decline in preoperative renal function portends a higher likelihood of renal salvage from RAS among patients with renal insufficiency. Incorporating this finding into patient selection may improve outcomes for RAS.