Journal of vascular surgery
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Comparative Study
The utility of intravascular ultrasound compared to angiography in the diagnosis of blunt traumatic aortic injury.
Blunt traumatic aortic injury (TAI) refers to a spectrum of pathology that ranges from intimal tears to aortic rupture. Computed tomography angiography (CTA) has been widely used as a diagnostic tool in this setting. Additional imaging is required when CTA studies are equivocal. The purpose of this study is to evaluate the utility of intravascular ultrasound (IVUS) versus angiography in the diagnosis of TAI. ⋯ CTA is useful as a screening test in suspected TAI. When additional imaging is required after an equivocal CTA, IVUS is better than angiography. Therefore, we advocate the use of IVUS in potential TAI patients in whom angiography is being considered.
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Comparative Study
Late outcomes following open and endovascular repair of blunt thoracic aortic injury.
Previous studies have focused on early outcomes of open (descending thoracic aortic repair [DTAR]) and endovascular (thoracic endovascular aneurysm repair [TEVAR]) repair of blunt aortic injury (blunt thoracic aortic injury [BTAI]). Late results remain ill-defined and are the focus of this study. ⋯ With careful selection, open or endovascular repair of BTAI has excellent early and late results. Although TEVAR has an increased risk for reintervention, factors other than treatment strategy impact late survival. These data support the growing role of an endoluminal approach for BTAI in anatomically appropriate patients.
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This study evaluated the safety and benefit of urgent carotid endarterectomy (CEA) in patients with carotid disease and an acute stable neurologic event. ⋯ In patients with acute neurologic event, a high NIHSS score does not contraindicate early surgery. To date, guidelines recommend treatment of symptomatic carotid stenosis ≤ 2 weeks from onset of symptoms to minimize the neurologic recurrence. Our results suggest that minimizing the time for intervention not only reduces the risk of recurrence but can also improve neurologic outcome.
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Comparative Study
Skills training after night shift work enables acquisition of endovascular technical skills on a virtual reality simulator.
Adoption of residents' working time restrictions potentially undermines surgical training by reduction of operating room exposure. Simulation has been proposed as a way to acquire necessary skills in a laboratory environment but remains difficult to incorporate into training schedules. This study assessed whether residents working successive nights could acquire endovascular skills similar to colleagues working day shifts. ⋯ Technical skills training after night shift work enables acquisition of endovascular technical skills, although it takes longer than after day shift training. This study provides evidence for program directors to organize simulation-based training schedules for residents on night shift rotations.
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Comparative Study
A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia.
Few centers have adopted endovascular therapy for the treatment of acute mesenteric ischemia (AMI). We sought to evaluate the effect of endovascular therapy on outcomes for the treatment of AMI. ⋯ Endovascular therapy has altered the management of AMI, and there are measurable advantages to this approach. Using endovascular therapy as the primary modality for AMI reduces complications and improves outcomes.