Journal of vascular surgery
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We examined the hypothesis that a 1°C reduction in body temperature would reduce gray and white matter injury induced by spinal cord ischemia in rats. In addition, we evaluated the relationship between reactive astrogliosis and gray or white matter injury after spinal cord ischemia with a 1°C reduction in body temperature or normothermia. ⋯ Prophylactic mild hypothermia (1°C reduction in body temperature) preserved hind limb motor function and reduced neuronal death, white matter vacuolation, and astrogliosis in gray and white matter induced by spinal cord ischemia in rats. Thus, mild hypothermia may be useful for perioperative management of thoracoabdominal aortic surgery.
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Malposition, embolization, fracture, and migration of endovascular devices are unfortunate consequences of endovascular intervention and will be encountered at some point by nearly every practitioner. The existing literature on foreign body retrieval consists of large single-institution series and case reports. We provide an overview of this recent literature, clarifying what devices are being lost, what symptoms occur as a result, and how retrieval is being performed. We have identified all case series and case reports since the year 2000, summarized the results, and made some general observations and recommendations that may be useful to the practitioner faced with the prospect of retrieving a fractured medical device, malpositioned coil, or migrated inferior vena cava filter.
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Comparative Study
Thoracic endovascular aneurysm repair, race, and volume in thoracic aneurysm repair.
Volume-based disparities in surgical care are often associated with poorer results in African American patients. We examined the effect of treatment patterns and outcomes, by race, for isolated thoracic aortic aneurysm (TAA). ⋯ While racial disparities in surgical care have a significant effect on mortality with open thoracoabdominal aortic aneurysm repair, black patients undergoing TEVAR obtain similar outcomes as white patients. New technology can limit the effect of racial disparities in surgical care.
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An association of intraluminal thrombus (ILT) with abdominal aortic aneurysm (AAA) growth has been suggested. Previous in vitro experiments have demonstrated that aneurysm-associated thrombus may secrete proteolytic enzymes and may develop local hypoxia that might lead to the formation of tissue-damaging reactive oxygen species. In this study, we assessed the hypothesis that ventral ILT thickness is associated with markers of proteolysis and with lipid oxidation in the underlying AAA vessel wall. ⋯ ILT thickness appeared to be associated with VSMCs apoptosis and elastin degradation and was positively associated with MMP-2 concentrations in the underlying wall. This suggests that ILT thickness affects AAA wall stability and might contribute to AAA growth and rupture. ILT thickness was not correlated with markers of lipid oxidation.