Journal of vascular surgery
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Management of limb and other malperfusion syndromes is controversial in acute type A aortic dissection. We assessed our hypothesis that urgent proximal aortic repair resolves most cases of limb ischemia without additional peripheral revascularization. ⋯ Most cases of limb ischemia resolve after immediate repair of acute type A aortic dissection. There is no difference in renal dysfunction or in-hospital or long-term mortality between patients with isolated limb ischemia and those with nonmalperfusion dissection. If ischemia persists, limb salvage is successful if revascularization is expeditious.
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Case Reports
Endovascular aortic repair of a postdissecting thoracoabdominal aneurysm using intraoperative fusion imaging.
Computer-aided imaging can aid complex endovascular repair of aortic dissections in locating the narrow true lumen and identifying perfusion of visceral vessels by the true and/or false lumen. Although these anatomic data are available for analysis during planning, they are not readily available during the procedure with conventional imaging systems. ⋯ The preoperative computer tomographic angiograms were processed, and the true and the false lumens were individually color labeled. These data were then superimposed on the fluoroscopic images in order to facilitate deployment of a fenestrated endograft.
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Intrathoracic subclavian artery aneurysms (SAAs) are rare aneurysms that often occur in association with congenital aortic arch anomalies and/or concomitant thoracic aortic pathology. The advent of thoracic endovascular aortic repair (TEVAR) methods may complement or replace conventional open SAA repair. Herein, we describe our experience with SAA repair in the TEVAR era. ⋯ This is the largest single-institution series to date of TEVAR for SAA repair. Modern endovascular techniques expand SAA repair options with excellent results. The majority of SAAs and nearly all aberrant SAAs (Kommerell's diverticulum) can now be repaired using a TEVAR-based approach without the need for sternotomy or thoracotomy.
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In acute traumatic bleeding, permissive arterial hypotension with delayed volume resuscitation is an established lifesaving concept as abridge to surgical control. This study investigated whether preoperatively administered volume also correlated inversely with survival after ruptured abdominal aortic aneurysm (rAAA). ⋯ Aggressive volume resuscitation of patients with rAAAs before proximal aortic control predicted an increased perioperative risk of death, which was independent of systolic blood pressure. Therefore, volume resuscitation should be delayed until surgical control of bleeding is achieved.
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The chief of surgery at a large academic medical center is approached by a vascular surgical faculty member. After a repair of an aortic dissection, an elderly man has remained comatose and has worsened over several weeks, developing multiple system organ failure. Statistically, his chance of leaving the hospital alive is <1%. ⋯ A large group complained to patient affairs and was taken to the medical center director's office. Today, the director told the attending that the hospital would absorb the overall cost until the patient dies and that the unfavorable press from stopping care is unacceptable. The chief of surgery should: