Journal of vascular surgery
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We describe a case of Kommerell's diverticulum involving the distal portion of a right-sided aortic arch and the origin of an aberrant left subclavian artery (LSA). The patient underwent a total endovascular repair with the use of a modified Valiant endograft (Medtronic, Minneapolis, Minn) to which a branch was attached to keep LSA patency. Postoperative computed tomography showed complete exclusion of the lesion, without endoleaks. The use of "customized off-label" devices to treat special conditions was feasible in this case, keeping patency of the LSA without risk of arm claudication or the requirement for a complementary surgical bypass.
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Multicenter Study Comparative Study
Deep venous thrombosis after repair of nonruptured abdominal aneurysm.
To examine venous thromboembolism (VTE) rates, timing, and risk factors after nonruptured open or endoluminal abdominal aortic aneurysm (AAA) repair. ⋯ VTE after AAA repair was infrequent but was associated with higher mortality, and one-third of VTEs were diagnosed after discharge. Open AAA repair increased risk for in-hospital VTE compared with endoluminal repair. Patients with the identified risk factors may benefit from pharmacologic thromboprophylaxis after AAA repair. Pharmacologic thromboprophylaxis may be unnecessary after endoluminal repair.
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Comparative Study
Effect of hospital-level variation in the use of carotid artery stenting versus carotid endarterectomy on perioperative stroke and death in asymptomatic patients.
Perioperative stroke and death (PSD) are more common after carotid artery stenting (CAS) than after carotid endarterectomy (CEA) in symptomatic patients, but whether this is also true in asymptomatic patients is unclear. Furthermore, use of both CEA and CAS varies geographically, suggesting possible variation in outcomes. We compared odds of PSD after CAS and CEA in asymptomatic patients to determine the impact of this variation. ⋯ Carotid endarterectomy has lower odds of PSD compared with CAS in asymptomatic patients. Increased utilization of CAS at the hospital level is associated with increased odds of PSD among asymptomatic patients, but this effect appears to be related to generally worse outcomes after CAS compared with CEA.
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Groin wound infection is an important cause of postoperative morbidity in vascular surgery patients, especially when prosthetic grafts are involved. The objective of this study was to investigate if Prevena (Kinetic Concepts, Inc, San Antonio, Tex), a negative pressure incision management system, could reduce the risk of groin wound infection in patients after vascular surgery. ⋯ In this clinical study, Prevena negative pressure dressing significantly decreased the incidence of groin wound infection in patients after vascular surgery.