Journal of vascular surgery
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Multicenter Study
Retroperitoneal hematoma volume is a good predictor of perioperative mortality after endovascular aneurysm repair for ruptured abdominal aortic aneurysm.
The objective of this study was to validate the usefulness of retroperitoneal hematoma volume as a predictor of perioperative mortality after endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA). ⋯ Our study suggests that retroperitoneal hematoma volume may be a good predictor of perioperative mortality after EVAR for rAAA, especially for patients with Fitzgerald classification >III and a best cutoff value of 6.97%.
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Comparative Study
Use of extracorporeal bypass is associated with improved outcomes in open thoracic and thoracoabdominal aortic aneurysm repair.
There is no consensus on the use or benefit of extracorporeal circulation (EC) during aneurysm repair of the descending thoracic aorta (DTA) or thoracoabdominal aorta (TAA). We evaluated the role of EC during DTA or TAA aneurysm repair using U.S. Medicare data. ⋯ Although important clinical variables such as DTA or TAA aneurysm extent and spinal cord ischemic complications cannot be assessed with the Medicare database, EC use during open DTA and TAA aneurysm repair is associated with improved late survival and a significant reduction in operative mortality, morbidity, and procedural costs. These data indicate that EC should be a more widely applied adjunct in open DTA or TAA aneurysm repair.
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Comparative Study
Preoperative point-of-care ultrasound and its impact on arteriovenous fistula maturation outcomes.
Duplex ultrasound as a preoperative assessment tool in the clinic may help identify anatomic factors predictive of fistula maturation. Preoperative point-of-care ultrasound (POCUS) offers surgeons an alternative to routine formal vein mapping as it can be performed by the operator during the initial clinic visit. We sought to determine the impact of POCUS as an adjunct to physical examination on arteriovenous fistula maturation. ⋯ POCUS as an adjunct to physical examination for dialysis access patients leads to decreased rates of primary failure, new access creation, and fistula abandonment compared with patients who undergo only physical examination. Ultrasound examination improved times to functional fistula maturation and secondary patency. Further studies are required to compare POCUS with formal preoperative vein mapping for arteriovenous fistula planning.
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Comparative Study
Local anesthesia for percutaneous endovascular abdominal aortic aneurysm repair is associated with fewer pulmonary complications.
Percutaneous endovascular aneurysm repair (EVAR) can be performed with general anesthesia (GA) or local anesthesia (LA). Our goal was to assess perioperative outcomes comparing anesthesia type in percutaneous EVAR. ⋯ Although it was used in only 1 in 10 cases of percutaneous EVAR, LA was associated with fewer pulmonary complications after adjustment for patient factors. Surgeons should consider expanding the use of LA for percutaneous EVAR when feasible.
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Although thoracic endovascular aortic repair (TEVAR) is commonly used for chronic DeBakey type IIIB (CDIIIB) dissections, aortic remodeling outcomes after the procedure have been unsatisfactory. Persistent retrograde flow to the false lumen (FL) through re-entry tears commonly causes treatment failure. The aim of this study was to clarify the safety and effect of the FL procedure (FLP) for aortic remodeling in patients with CDIIIB dissections. ⋯ Full-coverage TEVAR with the FLP seems to be a safe endovascular treatment and promotes thoracic FL thrombosis for patients with CDIIIB dissections.