Journal of vascular surgery
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Suprarenal endograft fixation is routinely used in the endovascular repair of abdominal aortic aneurysms (EVAR) to enhance proximal endograft attachment but can be associated with an adverse outcome in renal function. This prospective study assessed the effect of suprarenal fixation on serum creatinine concentration and estimated glomerular filtration rate (eGFR), calculated by the Modified Diet in Renal Disease equation, 12 months after elective EVAR. ⋯ In contrast to previous studies, this study suggests that suprarenal endograft fixation in elective EVAR is associated with a drop in eGFR at 12 months.
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The femoral vein is increasingly utilized as a conduit in major arterial and venous reconstruction. However, perioperative complications, especially venous thromboembolism (VTE) associated with femoral vein harvest (FVH), are not well described. The purpose of this study was to determine the incidence and risk factors for the development of symptomatic VTE in patients who undergo FVH. ⋯ VTE after FVH occurs more frequently in patients with malignancy. Aggressive and prolonged thromboprophylaxis and routine venous ultrasound surveillance are warranted after FVH in patients with malignancy.
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Simulation technology has a well-defined role in nonmedical professions such as aviation and over the last two decades has permeated medical training. The most successful surgical simulation is in the fields of laparoscopic and endovascular surgery. These two-dimensional scenarios, as in the aviation industry, lend themselves to simulation. ⋯ Where surgical procedures are not commonly performed or expertise is required for a new innovation, it is more appropriate to have national or internationally based workshops under the auspices of surgical boards or societies. Simulation of crisis management, well known in aviation, has also been applied to vascular surgical practice and can offer benefit to senior trainees even when their performance on a noncrisis simulator has reached a plateau. This article identifies the areas where simulation in open vascular surgery can benefit the trainee.
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To determine if a physician-modified endovascular graft (PMEG) is a safe and effective method of treating juxtarenal aortic aneurysms in patients considered to be unsuitable for open surgical repair. ⋯ PMEG is a safe and effective alternative for treating patients with juxtarenal aneurysms who have no other alternatives for repair. Longer-term follow-up is needed to assess the durability of repair and potential for device-related complications.
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Median arcuate ligament syndrome (MALS) is a syndrome associated with chronic abdominal pain and radiographic evidence of celiac artery compression. We compared the evidence for both open and laparoscopic treatment of patients with MALS. ⋯ The available evidence demonstrates that both laparoscopic and open ligament release, celiac ganglionectomy, and celiac artery revascularization may provide sustained symptom relief in the majority of patients diagnosed with MALS. The role of arterial revascularization following ligament release remains unclear. The rate of open conversion with the laparoscopic approach is high, but no perioperative deaths have been reported.