Journal of vascular surgery
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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.
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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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The national burden of venous disease and use of ultrasound (US) in the outpatient and emergency department (ED) settings has not been well described. The objective of this study is to describe venous disease in the outpatient and ED settings nationally as well as to characterize the use of US for diagnosis of venous disease, including phlebitis. ⋯ Nationally, a significant and growing number of patients with venous disease are being seen in the outpatient setting by PCPs and specialists. A significant number of patients with DVT are being seen in the outpatient setting, but without a trend away from care in the ED over the 10-year study period. Additionally, the majority of patients with DVT diagnosis do not seem to be getting ultrasounds at the same visit. Many of these patients are being seen by PCPs who may require additional training and infrastructure for appropriate patient care.
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This study was conducted to define the outcomes of treating aortic aneurysms involving the arch vessels with a hybrid approach using extra-anatomic reconstruction and endovascular repair with nonfenestrated stents. ⋯ Aneurysms involving the aortic arch vessels can be effectively treated by staged endovascular-surgical hybrid procedures with good outcomes that can be further improved through prior revascularization of the LSA.