Journal of vascular surgery
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Endovascular repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) has become first-line therapy at our institution and is performed under a standardized protocol. We compare perioperative mortality, midterm survival, and morbidity after EVAR and open surgical repair (OSR). ⋯ EVAR of rAAA has a superior perioperative survival advantage and decreased morbidity vs OSR. Although not statistically significant, overall survival favors EVAR. We recommend that EVAR be considered as the first-line treatment of rAAAs and practiced as the standard of care.
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Randomized Controlled Trial Multicenter Study Comparative Study
A prospective randomized study comparing fibrin sealant to manual compression for the treatment of anastomotic suture-hole bleeding in expanded polytetrafluoroethylene grafts.
The ideal hemostatic agent for treatment of suture-line bleeding at vascular anastomoses has not yet been established. This study evaluated whether the use of a fibrin sealant containing 500 IU/mL thrombin and synthetic aprotinin (FS; marketed in the United States under the name TISSEEL) is beneficial for treatment of challenging suture-line bleeding at vascular anastomoses of expanded polytetrafluoroethylene (ePTFE) grafts, including those further complicated by concomitant antiplatelet therapies. ⋯ The findings from this phase 3 study confirmed that FS is safe and its efficacy is superior to manual compression for hemostasis in patients with peripheral vascular ePTFE grafts. The data also suggest that FS promotes hemostasis independently of the patient's own coagulation system, as shown in a representative population of patients with vascular disease under single- or dual-antiplatelet therapies.
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This meta-analysis was initiated to assess the efficacy and safety of anticoagulation therapy for adult patients with isolated calf vein deep venous thrombosis (DVT). ⋯ Our review suggests that anticoagulation therapy for calf vein DVT may decrease the incidence of PE and thrombus propagation. However, due to poor methodologic quality and few events among included studies for PE, this finding is not robust. Thrombus propagation appears reduced with anticoagulation treatment. A rigorous RCT will assist in treatment decisions for calf vein DVT.
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Multicenter Study
Outcomes of carotid endarterectomy under general and regional anesthesia from the American College of Surgeons' National Surgical Quality Improvement Program.
Despite multiple studies over more than 3 decades, there still is no consensus about the influence of anesthesia type on postoperative outcomes following carotid endarterectomy (CEA). The objective of this study was to investigate whether anesthesia type, either general anesthesia (GA) or regional anesthesia (RA), independently contributes to the risk of postoperative cardiovascular complications or death using the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) database. ⋯ This analysis of a large, prospectively collected and validated multicenter database indicates that GA for CEA is an independent risk factor for postoperative MI, particularly in patients with preoperative neurologic symptoms.
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The proximal aortic neck is one of the limiting factors for endovascular aneurysm repair (EVAR) and represents a crucial factor for success or failure of the procedure. In contrast to open surgery, where a clamp can be placed suprarenally but the repair performed infrarenally, EVAR requires a good infrarenal neck for durable fixation and seal. In a high-risk surgical 79-year-old patient with juxtarenal aortic aneurysm with unsuitable infrarenal neck, a hybrid procedure was chosen: juxtarenal aortic banding and EVAR. The banding allowed a successful EVAR by reshaping the juxtarenal aneurysmal aortic segment, hence converting a previously untreatable anatomy into a treatable one.