Journal of vascular surgery
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Distal cerebral embolization is a known complication of carotid interventions. We prospectively investigated whether subclinical microembolization seen on postoperative magnetic resonance imaging (MRI) leads to cognitive deficits in patients undergoing carotid revascularization procedures. ⋯ Although CEA and CAS are effective in stroke prevention, with minimal neurologic complication, neurocognitive effects remain uncertain. Procedure-associated microembolization and pre-existing neurologic symptoms are associated with poor baseline cognitive function and memory decline after the procedures. Further comprehensive cognitive evaluation to determine the benefit of carotid interventions is warranted.
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Multicenter Study
Predictors and outcomes of acute kidney injury after thoracic aortic endograft repair.
This study analyzed the incidence and the predictive factors of postoperative acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR) and evaluated the effect of AKI on postoperative survival. ⋯ Preoperative poor renal function, blood transfusions, and the thoracoabdominal extent of the aortic disease were the most important predictors for AKI.
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While randomized trials have shown improved operative mortality with endovascular aneurysm repair (EVAR) but similar long-term mortality rates, enthusiasm for EVAR persists, and rates of EVAR use continue to increase. Currently, knowledge of utilization rates of EVAR in Canada is limited. ⋯ Use of EVAR in Canada for AAAs has increased in the past 5 years, without affecting overall AAA procedure volumes. Large discrepancies in EVAR use exist across Canada. The Atlantic Provinces had the highest rates of RAAAs despite having the highest rates for total AAA procedures, suggesting a population with higher susceptibility for AAAs. This region may also have the largest potential for future increased use of EVAR.
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Previous studies have correlated increasing great saphenous vein (GSV) diameter with increasing CEAP clinical classification. Some insurance carriers are currently using specific GSV diameters to determine coverage for treatment of axial venous insufficiency. The aim of this study was to investigate the correlation of patient quality of life (QOL) measures with GSV diameters in varicose vein patients with GSV reflux. ⋯ GSV diameter is a poor surrogate marker for assessing the effect of varicose veins on a patient's QOL; thus, using GSV diameter as a sole criterion for determining medical necessity for the treatment of GSV reflux is inappropriate. Further correlations between QOL measures and duplex-derived objective findings are warranted.
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Aortic aneurysm repair is a high-risk surgical procedure. Patients are often elderly, with multiple comorbidities that predispose them to perioperative morbidity. Use of endovascular aneurysm repair (EVAR) has increased due to reduced early perioperative risk. This study assessed whether preoperative cardiopulmonary exercise testing (CPET) could be used to predict morbidity and hospital length of stay (LOS) after aortic aneurysm repair. ⋯ Cardiorespiratory fitness holds significant clinical value before aortic aneurysm repair in predicting postsurgical complications and duration of critical care and hospital LOS. Preoperative measurement of fitness could then direct clinical management with regard to operative choice, postoperative resource allocation, and informed patient decision making.