Journal of vascular surgery
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Aortic injury is the second leading cause of death in trauma. Thoracic endovascular aortic repair (TEVAR) has recently been applied to traumatic thoracic aortic injuries (TTAIs) as a minimally invasive alternative to open surgery. We sought to determine the impact of TEVAR on national trends in the management of TTAI. ⋯ TEVAR has replaced open repair as the primary operative treatment for TTAI and has extended operative treatment to those patients not previously considered candidates for repair. Increased utilization of TEVAR is associated with improved overall mortality. There is no difference in mortality between TEVAR and open repair groups in our study, which likely reflects the multisystem nature of injury and greater preoperative risk in the TEVAR group.
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Hospital quality in vascular surgery is often measured using mortality. We sought to determine whether adjusting mortality for statistical reliability changes hospital quality rankings for vascular surgery. ⋯ Adjusting mortality for reliability reduces statistical noise and provides more stable estimates of hospital quality. Reliability adjustment should be standard for comparing hospital quality.
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Carotid angioplasty and stenting (CAS) is increasingly being used as a treatment alternative to endarterectomy (CEA) for patients with significant carotid stenosis. However, diffusion-weighted imaging (DWI) has indicated that CAS is associated with a significantly higher burden of microemboli. This study evaluated the potential effect on intellectual functions of new DWI lesions after CEA or CAS. ⋯ The findings support the assumption that new brain lesions, as detected with DWI after CAS or CEA, do not affect cognitive performance in a manner that is long-lasting or clinically relevant. Despite the higher embolic load detected by DWI, CAS is not associated with a greater cognitive decline than CEA.
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Randomized Controlled Trial
Standardization is superior to traditional methods of teaching open vascular simulation.
Standardizing surgical skills teaching has been proposed as a method to rapidly attain technical competence. This study compared acquisition of vascular skills by standardized vs traditional teaching methods. ⋯ This study demonstrates the feasibility of open vascular simulation to assess the effect of differing teaching methods on performance outcome. Findings from this report suggest that for simulation training, standardized may be more effective than traditional methods of teaching. Transferability of simulator-acquired skills to the clinical setting will be required before open simulation can be unequivocally recommended as a major component of resident technical skill training.
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Comparative Study
Thirty-day mortality and late survival with reinterventions and readmissions after open and endovascular aortic aneurysm repair in Medicare beneficiaries.
Late survival is similar after open and endovascular abdominal aortic aneurysm (AAA) repair (EVAR), despite a perioperative benefit with EVAR. AAA-related reinterventions are more common after EVAR, whereas laparotomy-related reinterventions are more common after open repair. The effect of reinterventions on survival, however, is unknown. We therefore evaluated the rate of reinterventions and readmission after initial AAA repair, 30-day mortality, and the effect on long-term survival. ⋯ Reintervention and readmission are slightly higher after EVAR. Survival is negatively affected by reintervention or readmission after EVAR and open surgery, which likely contributes to the erosion of the survival benefit of EVAR over time.