Journal of vascular surgery
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Multicenter Study
The effect of congestive heart failure on perioperative outcomes in patients undergoing lower extremity revascularization.
As the management of peripheral arterial disease evolves, determining the factors affecting the outcome of lower extremity interventions is important. The presence of peripheral arterial disease is associated with a twofold increase in the prevalence of congestive heart failure (CHF), with reports of increased perioperative complications. This study evaluated CHF as a predictor of acute postoperative complications in patients undergoing lower extremity bypass. ⋯ Recently diagnosed or exacerbated CHF does not affect acute IIB graft patency. However, CHF may increase the complication rates for perioperative pneumonia, prolonged intubation, reintubation, sepsis, return to the operating room, extended length of stay, and mortality. Therefore, before pursuing lower extremity interventions in patients with a history of CHF, one should incorporate an individualized approach to optimize the success of the revascularization while minimizing medical comorbidities.
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The objective of this report was to define the natural history of penetrating aortic ulcers (PAUs) in the descending thoracic and abdominal aorta. ⋯ PAU growth rate and risk of rupture are low. Endovascular repair of symptomatic, ruptured, and large PAUs is safe and effective with excellent long-term results. For asymptomatic PAUs, serial CT surveillance is associated with a low rate of rupture or complications.
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Multicenter Study Comparative Study
Volume analysis of true and false lumens in acute complicated type B aortic dissections after thoracic endovascular aortic repair with stent grafts alone or with a composite device design.
This study compared the 12-month evolution of the aortic volume in patients who underwent thoracic endovascular aortic repair (TEVAR) with stent grafts alone or a composite device (Zenith TX2 stent graft and Zenith Dissection stent; Cook Medical, Bloomington, Ind) for acute (≤2 weeks from onset) complicated type B aortic dissection. ⋯ According to this volume analysis, thoracic endografting for acute complicated type B dissections promotes significant thoracic aortic remodeling. The use of bare-metal dissection stents leads to significant true lumen expansion and false lumen regression in the early follow-up and to subsequent continued true lumen expansion in the abdominal aorta; however, a definitive benefit in aortic remodeling over TEVAR alone was not demonstrated at 1 year.
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Multicenter Study
Dual antiplatelet therapy reduces stroke but increases bleeding at the time of carotid endarterectomy.
Controversy persists regarding the perioperative management of clopidogrel among patients undergoing carotid endarterectomy (CEA). This study examined the effect of preoperative dual antiplatelet therapy (aspirin and clopidogrel) on in-hospital CEA outcomes. ⋯ Preoperative dual antiplatelet therapy was associated with a 40% risk reduction for neurologic events but also incurred a significant increased risk of reoperation for bleeding after CEA. Given its observed overall neurologic protective effect, continued dual antiplatelet therapy throughout the perioperative period is justified. Initiating dual therapy in all patients undergoing CEA may lead to decreased neurologic complication rates.
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The management of degenerative aneurysms of the aortic arch requires careful selection of patients, taking into consideration risk of rupture and operative risks, which is more relevant with the emergence of hybrid debranching and branched and fenestrated endovascular options. The natural history of true arch aneurysms has not been previously studied. We aimed to determine the expansion rate of thoracic aortic arch aneurysm and to identify predictors for rupture. ⋯ Aneurysm expansion rate >5.5 mm/y is a significant rupture predictor in addition to size compared with aneurysm morphology and other demographic factors. Aneurysm size >6.5 mm and hyperlipidemia are determining factors of expansion rate. These may have implications in selection of patients for surgery. Better control of hyperlipidemia may alleviate the risk of rupture.