Journal of vascular surgery
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Randomized Controlled Trial Multicenter Study Comparative Study
Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysm in the OVER trial.
This study was conducted to determine the costs and comparative cost-effectiveness of two methods of abdominal aortic aneurysm (AAA) repair in the Open Versus Endovascular Repair (OVER) Veterans Affairs (VA) Cooperative Study, a multicenter randomized trial of 881 patients. ⋯ In this multicenter randomized trial, endovascular AAA repair resulted in lower cost and better survival than open repair after the initial hospitalization for repair; but after 2 years, survival, quality of life, and costs were not significantly different between the two treatments.
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Multicenter Study
Superficial venous thrombosis and compression ultrasound imaging.
A current debate concerning suspected superficial vein thrombosis (SVT) focuses on the need of performing a compression ultrasound (CUS) exploration for confirming the diagnosis of SVT. This study was conducted to determine the clinical relevance and optimal CUS exploration in patients with symptomatic SVT. ⋯ In patients with symptomatic SVT, a CUS exploration screening the whole venous system of the affected limb is useful because it provides information that has important consequences for the management of these patients.
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Treatment of head and neck malignancy commonly involves radiotherapy, which is associated with the development of carotid artery stenosis. There is little evidence to guide clinicians on how to intervene in significant postradiotherapy carotid stenosis. This systematic review collated data pertaining to perioperative outcomes of carotid artery surgery and carotid stenting in postradiotherapy carotid stenosis to aid the clinical decision-making process. ⋯ The published outcomes from high-volume centers demonstrate that surgical revascularization and stenting are both technically feasible in postradiotherapy carotid stenosis and have similar safety profiles to nonirradiated necks. Radiation should therefore not be considered a contraindication to surgical intervention.
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Case Reports
Intra-arterial injection of acrylic cement as a complication of percutaneous vertebroplasty.
Percutaneous vertebroplasty (PVP) with polymethylmethacrylate (PMMA) is a minimally invasive procedure that provides significant pain relief in a high percentage of patients with osteoporotic fractures. The complication rate of PVP is reported to be below 6%. This case illustrates, for the first time, an arterial PMMA embolus to the aorta and its branches as a complication of PVP.
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Case Reports
Modified use of the Hemodialysis Reliable Outflow (HeRO) graft for salvage of threatened dialysis access.
The Hemodialysis Reliable Outflow (HeRO) graft (Hemosphere Inc, Eden Prairie, Minn) offers a new option to provide upper extremity arteriovenous (AV) dialysis access in patients with central venous occlusive disease. Creative use of this device can allow for salvage of failing or threatened AV fistulas and grafts. We present two patients who underwent a modified implantation of the HeRO device for immediate salvage of a malfunctioning AV access. Ipsilateral central venous occlusions were successfully overcome by anastomosing a HeRO device to the existing AV access and tunneled across the chest to the contralateral internal jugular vein.