Journal of vascular surgery
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Comparative Study
Outcomes of endovascular repair for blunt thoracic aortic injury.
Consistent long-term follow-up data of thoracic endovascular repair (TEVAR) for acute blunt thoracic aortic injury (BTAI) are largely absent at this time. The late outcomes of TEVAR for BTAI are the focus of this study to evaluate the durability of this type of repair. ⋯ Midterm follow-up of TEVAR for acute BTAI is feasible with satisfactory late outcomes. In our experience, TEVAR is a durable and definitive treatment for BTAI.
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Comparative Study Clinical Trial
Discontinuation of preoperative clopidogrel is unnecessary in peripheral arterial surgery.
The optimal management of preoperative clopidogrel remains controversial, as vascular surgeons are increasingly encountering patients treated with clopidogrel as part of dual antiplatelet therapy. Current practice differs considerably, from cessation of the medication at least 5 days before surgery to proceeding with surgery without delay. The purpose of this prospective, nonrandomized, comparative study was to determine the effect of preoperative exposure to clopidogrel and aspirin on perioperative bleeding complications in patients undergoing open arterial surgery. ⋯ Combined therapy with clopidogrel and aspirin up to the day of surgery is not associated with increased bleeding complications or transfusion requirements. Data from this study do not validate the perceived higher risk of perioperative bleeding in clopidogrel patients and do support the strategy of continued clopidogrel use in patients undergoing peripheral arterial surgery.
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Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. ⋯ Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours.
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This article reports the early results in humans of hypertensive extracorporeal limb perfusion (HELP) technology in the prevention of major limb amputation due to ischemia. The short-term aim was to dilate pre-existing collateral channels, and the long-term aim was to stimulate remodeling and new collateral development by increasing endothelial shear stress and wall tension. ⋯ The collateral circulation of ischemic limbs can be augmented and regulated by a connection to an extracorporeal centrifugal pump, with isolation from the systemic circulation provided by balloons and with an access system providing repeatable pump connections. Major amputation may be avoided in selected cases.
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Retrograde laser fenestration of the left subclavian artery (LSA) during emergent thoracic endovascular aortic repair (TEVAR) uses a relatively simple intraoperative method of endograft modification to revascularize aortic branches for a variety of acute thoracic aortic pathologies. This study presents our expanded experience and midterm outcomes of TEVAR with laser fenestration to revascularize the LSA as an alternative to debranching. ⋯ In situ retrograde laser fenestration is a feasible and effective option for LSA revascularization during TEVAR involving a spectrum of acute thoracic aortic pathology. Laser fenestration provides a rapid, reproducible method of fenestrating the endograft material. The high technical success, low fenestration-related morbidity, and excellent midterm patency support this technique of intraoperative endograft modification.