Journal of vascular surgery
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Comparative Study
Explaining racial disparities in mortality after abdominal aortic aneurysm repair.
Black patients have a higher mortality rate than nonblacks after abdominal aortic aneurysm repair. We sought to understand the factors responsible for this racial disparity in the mortality rate after aneurysm repair. ⋯ Although many factors contribute, a large proportion of observed disparities in outcomes are attributable to black patients receiving care in lower-quality hospitals. Efforts aimed at improving disparities must focus on improved access to high-quality hospitals and improved resources at the hospitals that treat higher proportions of black patients.
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The geometry and dynamics of the vena cava are poorly understood and current knowledge is largely based on qualitative data. The purpose of this study is to quantitate the dimensional changes that occur in the infrarenal inferior vena cava (IVC), in response to changes in intravascular volume. ⋯ In response to changes in intravascular volume, the IVC undergoes profound anisotropic dimensional changes, with greater displacement seen in the minor axis. In addition, the IVC is oriented left-anterior oblique and caval orientation is not altered by changes in volume status. IVC obliquity may result in underestimation of caval size by anterior-posterior venogram.
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We present a hybrid endovascular approach to a 6.5-cm aneurysm of the right-sided aortic arch with an aberrant left subclavian artery arising from a Kommerell diverticulum, connected to the left pulmonary artery through the ligamentum arteriosum. The two-step procedure consisted of a bilateral carotid-subclavian bypass, followed by an ascending aorta-bicarotid bypass and completed by an endovascular exclusion of the aneurysms by covering the whole aortic arch and its branches. The patient had no complications and is asymptomatic 21 months after surgery. Hybrid procedures may be helpful in complex aortic arch pathologies, reducing complications of challenging open surgery.
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Recruitment and entrapment of bone marrow-derived endothelial progenitor cells (EPCs) is important in vascular endothelial growth factor (VEGF)-induced angiogenesis. EPC mobilization and differentiation are modulated by stromal-derived factor-1alpha (SDF-1alpha/CXCL12), another important chemokine. In this study, we investigated the hypothesis that SDF-1alpha and VEGF might act synergistically on EPC-mediated vasculogenesis. ⋯ The combination of SDF-1alpha and VEGF greatly increases EPC-mediated angiogenesis. The use VEGF and SDF-1alpha together, rather than alone, will be a novel and efficient angiogenesis strategy to provide therapeutic neovascularization.
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Extremity vascular injury during the current war has been defined by anecdotal description and case series. These reports focused on estimation of short-term limb viability and technical description of commonly used adjuncts. Temporary vascular shunting (TVS) has been advocated in current care structures, yet mostly due to war environments, broader statistical scrutiny is lacking. This study's purpose is to provide perspective on TVS's impact on limb salvage, and estimate longer-term freedom from amputation. ⋯ Temporary vascular shunting used as a damage control adjunct in management of wartime extremity vascular injury does not lead to worse outcomes. Benefit from TVS is suggested, but not statistically significant. Injury specific variables of venous ligation, associated fracture, and penetrating blast mechanism are associated with amputation. Amputation-free survival after vascular injury in Operation Iraqi Freedom is 79% at three years. Further studies to statistically define any possible benefits of TVS are needed.