Journal of vascular surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
The efficacy of a new portable sequential compression device (SCD Express) in preventing venous stasis.
It has been previously shown that the SCD Response Compression System, by sensing the postcompression refill time of the lower limbs, delivers more compression cycles over time, resulting in as much as a 76% increase in the total volume of blood expelled per hour. Extended indications for pneumatic compression have necessitated the introduction of portable devices. The aim of our study was to test the hemodynamic effectiveness of a new portable sequential compression system (the SCD Express), which has the ability to detect the individual refill time of the two lower limbs separately. ⋯ Flow velocity and volume flow enhancement by the SCD Response and SCD Express were essentially similar. The latter, a portable device with optional battery power that detects the individual refill time of the lower limbs separately, is anticipated to be associated with improved overall compliance and therefore optimized thromboprophylaxis. Studies testing its potential for improved efficacy in preventing deep vein thrombosis are justified.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Carotid Revascularization Using Endarterectomy or Stenting Systems (CaRESS) phase I clinical trial: 1-year results.
Current clinical trials evaluating carotid stenting have focused on high-risk patients and may not reflect the broad population of patients with carotid stenosis who undergo treatment to prevent stroke. The Carotid Revascularization Using Endarterectomy or Stenting Systems (CaRESS) phase I study is a multicenter, prospective, nonrandomized trial designed to address the question of whether carotid stenting (CAS) with cerebral protection is comparable to carotid endarterectomy (CEA) in patients with symptomatic and asymptomatic carotid stenosis. ⋯ The CaRESS phase I study suggests that the 30-day and 1-year risk of death, stroke, or MI with CAS is equivalent to that with CEA in symptomatic and asymptomatic patients with carotid stenosis.
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Intercostal artery pseudoaneurysm is extremely rare, and only six cases have been reported in the English literature. We describe a case of intercostal artery pseudoaneurysm due to a stab wound, review the literature, and discuss therapeutic modalities. Intercostal artery pseudoaneurysm is at risk for early rupture, and diagnosis before rupture is mandatory. Although embolization is considered to be a feasible therapeutic method, we would emphasize the significance of the anatomic features of the intercostal arteries: multiple blood supplies into the pseudoaneurysm, such as the anterior and posterior intercostal arteries, and musculophrenic artery.
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Neurologic deficit after endovascular treatment of the thoracic aorta is a complication reported with variable frequency that may be associated with severe morbidity and mortality. The mechanism of spinal cord ischemia appears to be multifactorial and remains ill-defined. We reviewed our experience to investigate the determinants of paraplegia after stent-graft repair of the thoracic aorta, identify patients at risk, and assess the effectiveness of ancillary techniques. ⋯ Perioperative hypotension (MAP <70 mm Hg) was found to be a significant predictor of spinal cord ischemia; hence, careful monitoring and prompt correction of arterial pressure may prevent the development of paraplegia. When the latter occurred, reduction of the CSF pressure by drainage was useful. Patients with a previous or synchronous abdominal aortic repair may also benefit from CSF drainage as a perioperative adjunct.
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Review Meta Analysis
Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis.
Duplex ultrasound is widely used for the diagnosis of internal carotid artery stenosis. Standard duplex ultrasound criteria for the grading of internal carotid artery stenosis do not exist; thus, we conducted a systematic review and meta-analysis of the relation between the degree of internal carotid artery stenosis by duplex ultrasound criteria and degree of stenosis by angiography. ⋯ Clinicians need to be aware of the limitations of duplex ultrasound scanning when making management decisions.