Journal of vascular surgery
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Thrombolysis as a treatment for acute limb ischemia (ALI) has become a first-line therapy based on studies published over 2 decades ago. The purpose of this study was to assess outcomes of patients treated for ALI using contemporary thrombolytic agents and endovascular techniques. ⋯ Endovascular therapy with thrombolysis using tissue plasminogen activator remains an effective treatment option for patients presenting with mild or moderate lower extremity ALI, with equal benefit derived with CDT or PMT. Patients with end-stage renal disease or poor pedal outflow have an increased risk of limb loss and may benefit from alternative revascularization strategies.
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The simulation and rehearsal of virtual endovascular procedures are anticipated to improve the outcomes of actual procedures. Contemporary, high-fidelity simulation is based on feedback systems that combine concepts of mechanical, electrical, computer, and control systems engineering to reproduce an interactive endovascular case. These sophisticated devices also include psychometric instruments for objective surgical skill assessment. The goal of this report is to identify the design characteristics of commercially available simulators for endovascular procedures and to provide a cross-section comparison across all devices to aid in the simulator selection process. ⋯ Despite our limited knowledge about the potential of high-fidelity simulation within the endovascular world, today's currently available simulators successfully provide high-fidelity reproductions of the endovascular environment. We have found that all of the commercially available devices incorporate the necessary features for a high-fidelity experience: (1) haptic technology, (2) vessel reconstruction, (3) physiology feedback, and (4) performance feedback. Significant variations in design do exist and may influence differences in skill development, evaluation, or cost. However, further validation of these differences is still needed and would benefit program directors interested in expanding these platforms for vascular training and certification as this technology matures.