Journal of vascular surgery
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The American Society of Anesthesiology (ASA) classification remains the most widely used risk-stratification system in the world. However, it is not practical in patients undergoing revascularization procedures because most are classified as ASA III. We hypothesized that ASA III patients can be subdivided into two subgroups, ASA IIIA and ASA IIIB, simply based on their preoperative functional capacity measured in metabolic equivalents (METS) of <4 or > or =4, which would allow the largest group of vascular surgery patients to be appropriately subgrouped for their predicted early and late postoperative morbidity and mortality. ⋯ Functional capacity assessment is an integral part of routine preoperative anesthesia evaluation, and we found this to be very reliable in predicting postoperative morbidity and mortality as well as overall survival in ASA III patients undergoing peripheral revascularization. This simple modification allows ASA III patients (approximately 80% of vascular patients) to be unbundled into two very distinct subgroups, which will potentially lead to a more accurate preoperative risk assessment.
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The optimal prophylactic strategy and treatment regimen for deep venous thrombosis (DVT) in hospitalized pediatric patients is not clearly established. This study assessed the incidence, risk factors, and treatment patterns for DVT among pediatric patients admitted to a hospital ward. ⋯ The incidence of DVT in hospitalized children is increasing. Those presenting with DVT typically have prior DVT, thrombophilia, or lower extremity disease. Our study suggests that children admitted with severe medical conditions who require a prolonged intensive care unit stay in addition to central venous access (especially via the femoral vein) should be considered candidates for DVT prophylaxis. A clinical probability scoring system alone cannot stratify patients sufficiently to forgo prophylaxis in hopes of a rapid clinical diagnosis. Childhood-specific level 1 trials aimed at determining guidelines for DVT prophylaxis are urgently required.
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The aim of this study was to evaluate the short- and midterm results following endovascular repair of a traumatic rupture of the aortic isthmus. ⋯ Short and midterm results following endovascular treatment for traumatic rupture of the aortic isthmus favor the proposition of endovascular repair as the first-line treatment in hemodynamically unstable patients. In hemodynamically stable patients, the preoperative morphological evaluations aim to assess aortic anatomy and thereby detect possible technical limitations (aortic diameter <20 mm, severe aortic isthmus angulation, short proximal aortic neck <20 mm, conical aorta). In the presence of any one of these technical restrictions, open surgical treatment should be discussed to avoid major per- or postoperative complications related to endovascular repair. Further studies and long-term survival studies are mandatory to determine the efficacy and durability of this technique.
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Comparative Study
Open repair of juxtarenal aortic aneurysms (JAA) remains a safe option in the era of fenestrated endografts.
Widespread application of infrarenal endovascular aneurysm repair (EVAR) has resulted in a proportionate increase in open juxtarenal aortic aneurysm (JAA) repairs. Fenestrated endograft technology for JAA is developing rapidly, but only limited outcomes are known. The aim of this study was to review our open JAA experience in an era of fenestrated endograft technology, identify factors associated with increased surgical risk, determine early and midterm outcome, and provide a basis for comparison for future endovascular procedures. ⋯ Open surgical repair of JAA is associated with low mortality and remains the gold standard. Although 18% had renal complications, only one patient had permanent renal failure. Patients with a combination of physiologic and anatomic risk factors identified on multivariate analysis may benefit from fenestrated endograft repair.
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We hypothesized that a subgroup of patients with frank stroke due to sudden occlusion of the internal carotid artery could safely undergo surgery to restore carotid patency and to rescue brain tissue not yet irreversibly damaged if current stroke diagnostic methods were applied. ⋯ Restoration of blood flow in an acutely occluded internal carotid artery can only be achieved in the acute stage. Our pilot study demonstrated that a thorough diagnostic workup allows selection of patients who may benefit from urgent revascularization of acute internal carotid artery occlusion in the stage of an acute stroke. A prospective randomized multicenter trial comparing surgery with conservative medical treatment is needed.