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.
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Despite an increase in the incidence of hospital admissions for comorbid conditions, such as diabetes, the incidence of major limb amputation in North Carolina has decreased. The decline in amputation rate has not been uniformly realized across the state. The objective of this study was to determine the association between major vascular limb amputation and living in an underserved county in North Carolina. ⋯ Living in an underserved county in North Carolina is associated with a 29% increase in the odds of undergoing major limb amputation. Gender, age, and comorbidities, including diabetes, end-stage renal disease, and PAD, do not significantly affect the relationship.
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Comparative Study
Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population.
Endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used for emergent treatment of ruptured AAA (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications, and rates of reintervention of EVAR vs open aortic repair of rAAA in Medicare beneficiaries. ⋯ EVAR for rAAA is associated with lower perioperative and long-term mortality in Medicare beneficiaries. Increasing adoption of EVAR for rAAA is associated with an overall decrease in mortality of patients hospitalized for rAAA during the last decade.
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Comparative Study
Comparison of renal perfusion solutions during thoracoabdominal aortic aneurysm repair.
To determine whether renal perfusion with cold crystalloid solution enriched with histidine-tryptophan-ketoglutarate (Custodiol; Dr Franz-Kohler Chemie GmbH, Bensheim, Germany) provides better protection against renal ischemic injury than cold lactated Ringer's solution in patients undergoing thoracoabdominal aortic aneurysm open repair. ⋯ The use of Custodiol was safe and provided improved perioperative renal function compared with lactated Ringer's solution. Randomized trials are needed to confirm these data and to assess their clinical consequences.