Journal of vascular surgery
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Penetrating femoropopliteal injury during modern warfare: experience of the Balad Vascular Registry.
Wounding patterns, methods of repair, and outcomes from femoropopliteal injury have been documented in recent civilian literature. In Operation Iraqi Freedom, as in past conflicts, these injuries continue to be a therapeutic challenge. Therefore, the objective of the current study is to document the pattern of femoropopliteal injuries, methods of repair, and early outcomes during the current military campaign in Iraq. ⋯ Femoropopliteal vascular injury remains a significant reality in modern warfare. Femoral injuries appear more prevalent than those in the popliteal region. Early results of in-theater repair are comparable with contemporary civilian reports and are improved from the Vietnam era. Rapid evacuation and damage control maneuvers such as temporary shunting and early fasciotomy assist timely definitive repair and appear effective.
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Multicenter Study Comparative Study
Comparison of the effects of open and endovascular aortic aneurysm repair on long-term renal function using chronic kidney disease staging based on glomerular filtration rate.
It has been suggested that endovascular aneurysm repair (EVAR) in concert with serial contrast-enhanced computed tomography (CT) surveillance adversely impacts renal function. Our primary objectives were to assess serial renal function in patients undergoing EVAR and open repair (OR) and to evaluate the relative effects of method of repair on renal function. ⋯ Compared with EVAR, OR was associated with a significant but transient fall in GFR at 30 days. Renal function decline after AAA repair was common, regardless of method, especially in patients >70 years of age. However, the renal function decline was significantly greater by Kaplan-Meier analysis in EVAR than OR patients during long-term follow-up. More aggressive strategies to monitor and preserve renal function after AAA repair are warranted.
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Multicenter Study
Surgical correction of failed thoracic endovascular aortic repair.
The number of thoracic aortic endovascular procedures is increasing rapidly, and the clinical outcome largely depends on the underlying aortic pathology. When primary stent grafting is unsuccessful, secondary endovascular solutions are most often feasible. However, in recurrent endovascular failure without further minimally invasive options, conservative treatments or conversion to open surgery are the only remaining therapeutic strategies. ⋯ Failure of thoracic endovascular aortic repair comprises a new aortic pathology. Secondary endovascular treatment is feasible in most patients; however, some patients will require open surgery to repair failures of thoracic endovascular aortic treatment. These procedures constitute a large surgical trauma and require an extensive protocol, including extracorporeal circulation, neuromonitoring, and adjunctive modalities to provide organ protection. We recommend that these procedures be performed in centers with experience and the infrastructure to offer these protective measures.
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This study assessed prognostic factors regarding long-term outcome for amputation and death among patients who underwent intra-arterial thrombolysis due to lower limb ischemia. ⋯ Thrombolysis is successful, with few major complications in most patients with lower limb ischemia. Patients with ischemic heart disease and foot ulcers are at higher long-term risk for both amputation and death. A lesser degree of lysis and motor deficit were associated with higher amputation rates. The presence of such negative prognostic factors may help clinicians to deny further invasive vascular treatment. Renal insufficiency, cerebrovascular disease, and acute lower limb ischemia were associated with increased mortality.