Journal of vascular surgery
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Acute proximal aortic dissection may be complicated by stroke due to malperfusion of the arch vessels. We report a novel case of successful endovascular treatment of acute cerebral malperfusion due to a dissection involving the aortic arch. ⋯ Endovascular techniques may be safely applied to correct cerebral malperfusion that results from type I aortic dissection.
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With carotid artery stenting (CAS) becoming an ever-increasing procedure, we sought to determine risk factors for in-stent restenosis after CAS. ⋯ CAS has been shown to be safe and effective in high-risk patients, with minimal adverse events.
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Matrix metalloproteinase (MMP)-2 has been shown to play a pivotal role in aortic aneurysm formation. Its activation requires formation of a trimolecular complex of MMP-2, tissue inhibitor of metalloproteinase-2 (TIMP-2), and membrane type 1 (MT1)-MMP, which is attached to the cell surface. At higher concentrations, TIMP-2 becomes an inhibitor of MMP-2. Thus, TIMP-2 could both augment and inhibit matrix degradation. This study was undertaken to define the net effect of TIMP-2 on matrix destruction and aneurysm formation. ⋯ Abdominal aortic aneurysmal (AAA) disease is a potentially fatal disorder that screening studies have detected in 2% to 9% of the general population. Medical therapy designed to inhibit the progression of small aneurysms includes control of hypertension and smoking cessation; neither of these measures is of proven benefit. Effective and directed medical treatments for small AAAs await elucidation of key etiologic factors. Understanding precisely which molecules mediate AAA development, and blocking the activity of these molecules, could lead to important new therapies. Through our research, we have found that tissue inhibitor of metalloproteinase (TIMP)-2 has a role in this process in an experimental model of aortic aneurysms. We believe that TIMP-2 promotes aortic enlargement in vivo by activating matrix metalloproteinase 2.
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Multicenter Study
The effects of the type of anesthesia on outcomes of lower extremity infrainguinal bypass.
Three main types of anesthesia are used for infrainguinal bypass: general endotracheal anesthesia (GETA), spinal anesthesia (SA), and epidural anesthesia (EA). We analyzed a large clinical database to determine whether the type of anesthesia had any effect on clinical outcomes in lower extremity bypass. ⋯ Although GETA is the most common type of anesthesia used in infrainguinal bypasses, our results suggest that it is not the best strategy, because it is associated with significantly worse morbidity than regional techniques.
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Comparative Study
A comparison of renal function between open and endovascular aneurysm repair in patients with baseline chronic renal insufficiency.
Endovascular aneurysm repair (EVAR) is rapidly becoming the predominant technique for repair of abdominal aortic aneurysms. Results from current studies, however, are conflicting on the effect of EVAR on renal function compared with standard open repair. Furthermore, data for open repair in patients with baseline renal insufficiency suggests worse outcomes, including renal function. This analysis compared the effects of open repair vs EVAR on renal function in patients with baseline renal insufficiency. ⋯ Open and endovascular repair of abdominal aortic aneurysms in patients with pre-existent renal insufficiency can be performed safely with preservation of renal function. In contrast to previous reports, no significant differences existed between open repair and EVAR in postoperative alterations in renal function. Although a significant increase in serum creatinine develops in patients with renal insufficiency postoperatively with open repair, this appears to be transient, and preoperative renal dysfunction alone should not exclude either approach. After EVAR, patients with pre-existing renal insufficiency continue to be at risk for progressive renal dysfunction, and protective measures should be taken to preserve renal function in this patient population.