Journal of vascular surgery
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This study analyzed 30-day hospital readmissions after aortoiliac (AI) and infrainguinal (II) revascularization to further characterize readmissions and to identify modifiable targets for reducing readmission rates. ⋯ AI and II revascularization procedures result in readmission of 16.5% of patients. The most frequent reason for readmission was surgical site infection. Interventions focused on wound care management and avoidance of infectious complications could help reduce readmission rates.
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Bypass surgery is regularly performed for the treatment of critical limb ischemia, but the risk of occlusion remains significant. Antiplatelet therapy in patients with arterial disease is useful for secondary cardiovascular and bypass occlusion prevention. However, despite the common use of an antiplatelet agent, especially aspirin, which became the standard of care, the risk of graft occlusion persists. The best antithrombotic treatment for bypass patency therefore remains a matter of debate. ⋯ Although aspirin remains the first-line treatment to prevent infrainguinal bypass occlusion, future studies are needed to define stronger recommendations.
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The objective of this study was to assess midterm results of emergency endovascular stent grafting for patients with life-threatening complications of acute type B aortic dissection. ⋯ Endovascular repair of complicated acute type B aortic dissection is proven to be a technically feasible and effective treatment modality in this relatively difficult patient cohort. Short-term and midterm results are persuasive; however, the long-term efficacy needs to be further evaluated.
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Comparative Study
Race and gender affect outcomes of lower extremity bypass.
Race and gender have individually been associated with affecting outcomes in vascular interventions. We hypothesized that race and gender stratification would identify variations in outcomes of lower extremity bypass (LEB) procedures. ⋯ BF had higher early graft failure and LOS compared with WM. WF and BM also had increased LOS compared with WM. Race-gender stratification may predict outcomes in patients undergoing LEB procedures that may not be predicted by gender or race alone. Further studies using this stratification methodology may provide better insight into optimal therapeutic strategies and preventative measures for these patient subgroups. Investigation into causes of increased LOS in black patients and increased graft failure in BF may help improve outcomes.
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Comparative Study
Trends and outcomes of endovascular therapy in the management of civilian vascular injuries.
The rapid evolution of endovascular surgery has greatly expanded management options for a wide variety of vascular diseases. Endovascular therapy provides a less invasive alternative to open surgery for critically ill patients who have sustained arterial injuries. The purpose of this study was to evaluate recent trends in the management of arterial injuries in the United States with specific reference to the use of endovascular strategies and to examine the outcomes of endovascular vs open therapy for the treatment of civilian arterial traumatic injuries. ⋯ The use of endovascular therapy in the United States has increased dramatically during the last decade, in particular among severely injured blunt trauma patients. Endovascular therapy was associated with improved in-hospital mortality and lower rates of sepsis.