Journal of vascular surgery
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Both open surgery and endovascular peripheral interventions have been shown to effectively improve outcomes in patients with peripheral arterial disease, but minimal data exist comparing outcomes performed at and below the knee among patients with diabetes (DM) specifically. The purpose of this study is to compare outcomes following open bypass (lower extremity bypass [LEB]) and peripheral vascular intervention (PVI) at and below the knee in patients with DM vs patients without DM (non-DM) with critical limb ischemia. ⋯ Critical limb ischemia resulting from arterial occlusive disease at or below the knee can be treated successfully with either open surgical bypass or endovascular interventions in both DM and non-DM patients. Aggressive attempts at limb salvage among patients with critical limb ischemia should be pursued regardless of DM status.
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Comparative Study
Results of celiac trunk stenting during fenestrated or branched aortic endografting.
Endovascular repair of aortic aneurysms involving the visceral segment of the aorta often requires placement of a covered bridging stent in the celiac axis (CA). The median arcuate ligament (MAL) is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. The ligament may compress and distort the celiac artery and result in difficult cannulation, or stenosis and occlusion of the vessel. This study evaluated the influence of the MAL compression on the technical success and the patency of the celiac artery after branched and fenestrated endovascular aortic repair. ⋯ MAL compression is associated with good celiac trunk bridging stent patency during follow-up, but with a higher rate of technical difficulties and failed bridging stent implantation during the procedure.
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Endovascular aneurysm repair (EVAR) has become the mainstay of treatment for abdominal aortic aneurysms (AAAs) requiring repair. Delayed rupture after EVAR represents a rare but potentially fatal complication. The purpose of this study was to review the frequency and characteristics of patients presenting with secondary rupture and to define the relationship between rupture after EVAR and initial compliance with instructions for use (IFU). ⋯ Delayed rupture after EVAR is a rare but potentially fatal complication. In patients presenting with secondary rupture, EVAR performed outside the IFU was associated with higher perioperative mortality and need for open repair. Careful selection of patients based on AAA anatomy and adherence to the IFU criteria may reduce the incidence of delayed rupture.
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Multicenter Study Comparative Study
Evaluation of five different aneurysm scoring systems to predict mortality in ruptured abdominal aortic aneurysm patients.
Ruptured abdominal aortic aneurysms (RAAAs) are associated with a high overall mortality (up to 25% to 35%) ≤30 days when offered surgical treatment. Risk prediction models can provide valuable information on surgical risks, guide clinical decision making, and help identify patients who should not be operated on to prevent futile surgery. Finally, they can be used to evaluate clinical outcome. Different aneurysm scores are available. New ones (with only four parameters) are being developed, such as the Dutch Aneurysm Score (DAS). This study analyzed and compared these scoring models. ⋯ The performance of the tested models for the prediction of mortality in RAAA patients was comparable, with only a statistically significant difference between the VSS and the GAS in favor of the VSS. However, an almost perfect prediction is needed to withhold intervention, and no existing scoring system is capable of that.
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Comparative Study
Predictive models for mortality after ruptured aortic aneurysm repair do not predict futility and are not useful for clinical decision making.
The clinical decision-making utility of scoring algorithms for predicting mortality after ruptured abdominal aortic aneurysms (rAAAs) remains unknown. We sought to determine the clinical utility of the algorithms compared with our clinical decision making and outcomes for management of rAAA during a 10-year period. ⋯ Clinical algorithms for predicting mortality after rAAA were not useful for predicting futility. Most patients with rAAA were not classified in the highest-risk group by the clinical decision models. Among patients identified as highest risk, predicted mortality was overestimated compared with actual mortality. The data from this study support the limited value to surgeons of the currently published algorithms.