Journal of vascular surgery
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Case Reports
Surgical conversion for intragraft thrombosis following endovascular repair of traumatic aortic injury.
We report the case of a 32-year-old man with severe polytrauma, submitted to urgent endovascular exclusion of a posttraumatic thoracic aortic pseudoaneurysm. Two years later, computed tomography scan showed asymptomatic mural atherothrombosis of the aortic stent graft in its middle-distal portion, and the patient was placed on oral anticoagulants. As subsequent computed tomography scan showed progression of the thrombosis, the patient underwent surgical conversion, with stent graft explantation and in situ aortic replacement. Gross examination revealed mural organized thrombosis and a significant infolding of the distal end of the stent graft.
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Patients with healed venous ulcers often experience recurrence of ulceration, despite the use of long-term compression therapy. This study examines the effect of closing incompetent superficial and/or perforating veins on ulcer recurrence rates in patients with CEAP 5 who have progressive lipodermatosclerosis and impending ulceration. ⋯ Patients with CEAP 5 healed venous ulcers that undergo endovenous ablation of incompetent superficial and perforating veins and maintain compression have reduced ulcer recurrence rates compared with historical controls that are treated with compression alone.
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This study investigated whether remote (rIPC) and local ischemic preconditioning (IPC) similarly limit skeletal muscle dysfunction induced by aortic cross-clamping. ⋯ Acute and chronic ischemia induce mitochondrial dysfunction in human skeletal muscles, and improving muscle mitochondrial function improves subjects’ status. Compared with local ischemic preconditioning (IPC), remote IPC (rIPC) appears easier to perform and is safer for the vessel and territory involved in ischemic injury. This study demonstrates that the muscle protection afforded by rIPC is equivalent to that achieved by IPC. Acknowledging that IPC procedures should be specifically adapted to patient characteristics to be successful, our results support a broader use of rIPC in the setting of vascular surgery.
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Comparative Study
Mesenteric/celiac duplex ultrasound interpretation criteria revisited.
Several published studies with a small sample size have reported differing results of duplex ultrasound (DUS) utilizing different threshold velocities in detecting significant stenosis of superior mesenteric (SMA) or celiac arteries (CA). The present study is based on the largest number of mesenteric duplex/angiography correlations reported to date for the diagnosis of SMA/CA stenosis. ⋯ PSV values can be used in detecting ≥50% and ≥70% SMA/CA stenosis and were better than EDVs and ratios. Previously published data must be validated in individual vascular laboratories. Our results will need prospective validation.