Journal of vascular surgery
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If it were not for the ongoing collaboration between vascular surgeons and the medical technology industry, many of these advanced treatments used every day in vascular interventional surgery would not exist. The flip side of this coin is that these vital relationships create multiple roles for surgeons and must be appropriately managed. The dynamic process of innovation, along with factors such as product delivery technique refinement, education, testing and clinical trials, and product support, all make it necessary for ongoing and close collaboration between surgeons and the device industry. ⋯ First introduced in 1993, the AdvaMed Code strongly encourages both industry and physicians to commit to openness and high ethical standards in the conduct of their business interactions. The AdvaMed Code addresses many of the types of interactions that can occur between companies and health care professionals, including training, consulting agreements, the provision of demonstration and evaluation units, and charitable donations. By following the Code, companies send a strong message that treatment decisions must always be based on the best interest of the patient.
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Comparative Study
Comparison of modern open infrarenal and pararenal abdominal aortic aneurysm repair on early outcomes and renal dysfunction at one year.
This study was conducted to review contemporary results of elective open infrarenal abdominal aortic aneurysm (IAAA) and pararenal abdominal aortic aneurysm (PAAA) repairs and determine predictors of death and acute and 1-year renal dysfunction (RD). ⋯ Open PAAA repair can be performed without a significant increase in mortality compared to open IAAA repair. Although the incidence of renal function deterioration after open PAAA repairs remains higher than with open IAAA repairs, the overall incidence remains low at 1-year follow-up.
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Comparative Study
Resident and fellow experiences after the introduction of endovascular aneurysm repair for abdominal aortic aneurysm.
This study assessed trends in open and endovascular repair (EVAR) of intact and ruptured abdominal aortic aneurysm (AAA) in the Medicare population and evaluated recent trends in AAA repair at vascular fellowship training programs. ⋯ Contrary to the expectation of a plateau, use of EVAR for intact AAA continues to rise at fellowship and nonfellowship hospitals. Use of EVAR for rupture is being used more often at fellowship programs. The decline in open repairs performed by vascular fellows, and at fellowship and non-fellowship hospitals, may have important implications for future attending experience.
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Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) has been associated with lower operative mortality and morbidity than open surgery but comparable long-term mortality and higher delayed complication and reintervention rates. Attention has therefore been directed to identifying preoperative and operative variables that influence outcomes after EVAR. Risk-prediction models, such as the EVAR Risk Assessment (ERA) model, have also been developed to help surgeons plan EVAR procedures. The aims of this study were (1) to describe outcomes of elective EVAR at the Royal Brisbane and Women's Hospital (RBWH), (2) to identify preoperative and operative variables predictive of outcomes after EVAR, and (3) to externally validate the ERA model. ⋯ The outcomes of elective EVAR at the RBWH are broadly consistent with those of a nationwide Australian audit and recent randomized trials. Age and ASA score are independent predictors of midterm survival after elective EVAR. The ERA model predicts mortality-related outcomes and initial type I endoleak well for RBWH elective EVAR patients.
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Perigraft seroma (PGS) causing enlargement of the native aneurysm sac after open abdominal aortoiliac aneurysm (AAA) repair is a rarely recognized complication with unknown clinical consequences. This study was undertaken to determine the frequency of PGS, identify associated risk factors, and review resulting complications and their management strategies. ⋯ PGS after open AAA repair occurs more frequently than previously reported. Complications requiring intervention can occur in up to 20% of patients with PGS. A variety of treatment modalities can be used to deal with the complications. Earlier CT surveillance is advised after open AAA repair with a PTFE graft if symptoms are suggestive of PGS development.