Journal of vascular surgery
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Transfused blood can disrupt the coagulation cascade. We postulated that packed red blood cell (PRBC) transfusion may be associated with thromboembolic phenomena. We used propensity matching to examine the relationship between intraoperative PRBC transfusion and stroke during carotid endarterectomy (CEA). ⋯ Intraoperative transfusion of one to two units of PRBCs is associated with a fivefold increase in stroke risk. This holds true after consideration of stroke risk variables and operative duration as a surrogate for technical difficulty. The increased risk may be related to several effects of transfused blood on the coagulation inflammation cascade.
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Innate immunity drives numerous cardiovascular pathologies. Vein bypass grafting procedures are frequently accompanied by low-grade wound contamination. We hypothesized that a peri-graft innate immune challenge, via an outside-in route, augments inflammatory responses, which subsequently drive a component of negative vein graft wall adaptations; moreover, adipose tissue mediates this immune response. ⋯ Perivascular and distant inflammatory challenges potentiate the magnitude and duration of inflammatory responses in the early vein graft wall, negatively modulating wall adaptations, and thus, potentially contribute to vein graft failure. Furthermore, surgery activates innate immunity in adipose tissue, which is augmented (regionally > systemically) by LPS. Modulation of these local and distant inflammatory signaling networks stands as a potential strategy to enhance the durability of vascular interventions such as vein grafts.
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Case Reports
Fishbone penetration of the thoracic esophagus with prolonged asymptomatic impaction within the aorta.
A 54-year-old man with fishbone penetration of the thoracic esophagus and mediastinal hematoma was successfully managed with conservative treatment. Six-month follow-up computed tomography (CT) revealed migration of the fishbone into the aorta; however, the patient was asymptomatic and refused surgery. Six years later, CT showed persistent impaction of the fishbone within the aorta, but the patient was healthy. To our knowledge, this is the first reported case of serial CT documentation of fishbone penetration of the esophagus with migration into and prolonged asymptomatic impaction within the aorta.
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Case Reports
Late neurological recovery of paraplegia after endovascular repair of an infected thoracic aortic aneurysm.
Spinal cord ischemia is a potentially devastating complication after thoracic endovascular aorta repair (TEVAR). Patients with spinal cord ischemia after TEVAR often develop paraplegia, which is considered irreversible, and have significant increased postoperative morbidity and mortality. We report the case of a patient with unusual late complete neurologic recovery of acute-onset paraplegia after TEVAR for an infected thoracic aortic aneurysm.