Journal of vascular surgery
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Multicenter Study Comparative Study
Carotid-subclavian bypass and subclavian-carotid transposition in the thoracic endovascular aortic repair era.
Beyond traditional indications, subclavian revascularization is increasingly performed to allow for aortic arch debranching in the setting of thoracic endovascular aortic repair (TEVAR). Endovascular treatment options for subclavian disease have emerged, perhaps altering the patient population undergoing open revascularization. We leveraged prospectively collected American College of Surgeons (ACS)-National Surgical Quality Improvement Program (NSQIP) data to delineate evolving stroke and mortality rates after carotid-subclavian bypass (CSB) and subclavian-carotid transposition (SCT) in this dynamic context. ⋯ In this contemporary data set, there was no significant difference in CVA/D by surgical approach. TEVAR trended toward an association with CVA/D compared with isolated subclavian reconstruction. CVA/D continues to complicate contemporary CSB and SCT, especially among elderly and nonindependent patient subsets.
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Comparative Study
Early quantitative evaluation of indocyanine green angiography in patients with critical limb ischemia.
Patients requiring lower extremity revascularization are increasingly complex. Traditional means of evaluating perfusion before and after revascularization are often limited by the presence of medial calcinosis, open wounds, prior toe or forefoot amputations, and infection. We evaluated the initial application of indocyanine green angiography (ICGA) to patients with severe lower extremity ischemia to develop quantitative, reproducible parameters to assess perfusion. ⋯ ICGA provides rapid visual and quantitative information about regional foot perfusion. We believe this is the first report describing quantification of foot perfusion before and after lower extremity revascularization for severe limb ischemia. Further study is warranted to help define the utility of this intriguing new technology to assess perfusion, response to revascularization, and potentially, to predict likelihood of wound healing.
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To assess the biomechanical implications of excessive stent protrusion into the aortic arch in relation to thoracic aortic stent graft (TASG) collapse by simulating the structural load and quantifying the fluid dynamics on the TASG wall protrusion extended into a model arch. ⋯ A potentially devastating complication that may occur after endovascular repair of traumatic thoracicaortic injuries is stent graft collapse. Although usually asymptomatic, stent graft collapse may be accompanied by adverse hemodynamic consequences. Numerous anatomic and device-related factors contribute to the development of collapse, but predictive factors have not yet been clearly defined. In the present study, we assessed the relevant hemodynamics and solid mechanics underlying stent graft collapse using a computational fluid-structure interaction framework of stent graft malapposition. Our findings suggest that both increased stent graft angle and extension into the aortic arch lead to a markedly increased transmural pressure across the stent graft wall, portending collapse. Patient-specific computational modeling may allow for identification of patients at high risk for collapse and aid in planning for an additional, prophylactic intervention to avert its occurrence.