Journal of vascular surgery
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This study hypothesized that preoperative statin therapy would have a protective effect on patients undergoing elective abdominal aortic aneurysm (AAA) repair and that the risk-reduction effect of these agents would result in a reduction in subsequent total hospital costs. ⋯ With respect to both clinical outcome measures and subsequent resource utilization, statin therapy is associated with a beneficial effect in patients undergoing elective AAA repair. These data suggest that preoperative statin therapy should be an integral part of the risk optimization for patients undergoing AAA repair.
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No generally accepted treatment of multiple mycotic aortic aneurysms of the thoracic and abdominal aorta has yet been established. We report a 67-year-old man with widespread mycotic aortic aneurysms previously treated for malignant lymphoma and interstitial pneumonia. He was successfully treated by a two-stage hybrid surgical procedure comprising open and endovascular methods. This is apparently the first report of repair of multiple mycotic aortic aneurysms using a hybrid procedure.
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Case Reports
Endovascular management of multiple arteriovenous fistulae following failed laser-assisted pacemaker lead extraction.
A woman presented for evaluation of new-onset left arm edema after failed laser-assisted pacemaker lead extraction. Initial workup demonstrated a left subclavian artery to vein arteriovenous fistula (AVF). ⋯ Her symptoms subsequently resolved. Multiple iatrogenic AVF can be repaired endovascularly, however, a high degree of suspicion for multiple injuries should be maintained.
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Randomized Controlled Trial
Ferritin levels, inflammatory biomarkers, and mortality in peripheral arterial disease: a substudy of the Iron (Fe) and Atherosclerosis Study (FeAST) Trial.
This study delineated correlations between ferritin, inflammatory biomarkers, and mortality in a cohort of 100 cancer-free patients with peripheral arterial disease (PAD) participating in the Veterans Affairs (VA) Cooperative Study #410, the Iron (Fe) and Atherosclerosis Study (FeAST). FeAST, a prospective, randomized, single-blind clinical trial, tested the hypothesis that reduction of iron stores using phlebotomy would influence clinical outcomes in 1227 PAD patients randomized to iron reduction or control groups. The effects of statin administration were also examined in the Sierra Nevada Health Care (SNHC) cohort by measuring serum ferritin levels at entry and during the 6-year study period. No difference was documented between treatment groups in all-cause mortality and secondary outcomes of death plus nonfatal myocardial infarction and stroke. Iron reduction in the main study caused a significant age-related improvement in cardiovascular disease outcomes, new cancer diagnoses, and cancer-specific death. ⋯ These data demonstrate statistical correlations between levels of ferritin, inflammatory biomarkers, and mortality in this subset of patients with PAD.
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Comparative Study
Open vs endovascular repair of abdominal aortic aneurysm involving the iliac bifurcation.
Aneurysmal involvement of the iliac bifurcation increases the level of difficulty during surgery for abdominal aortic aneurysm (AAA) repair, potentially increasing the risk of early postoperative complications. Three previous randomized trials comparing endovascular aneurysm repair (EVAR) and open repair (OR) for AAAs showed that EVAR is associated with a lower early mortality rate. However, whether these results are valid for AAA involving the iliac bifurcation (AAAIB) remains unclear. The aim of this study was to evaluate early and late results after OR and EVAR for patients with AAA involving the iliac bifurcation. ⋯ In this series, the postoperative mortality and systemic complication rates after either EVAR or OR for AAAIB were not statistically different. In the OR group, there were more abdominal wall complications and a trend toward a higher rate of colonic ischemia. In the EVAR group, buttock claudication was more frequent.