Journal of vascular surgery
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Comparative Study
Anticoagulation with enoxaparin versus intravenous unfractionated heparin in postoperative vascular surgery patients.
The use of postoperative anticoagulation is not uncommon for patients undergoing vascular procedures, whether for adjunctive therapy to the surgical procedure or for resumption of preoperative anticoagulation. We investigated whether low-molecular-weight heparin, specifically enoxaparin, was an effective replacement for intravenous heparin during the postoperative period until achievement of a therapeutic international normalized ratio, together with the impact on postoperative length of stay. ⋯ In this series, use of enoxaparin appears to be safe and effective for vascular postoperative anticoagulation. At the same time, its use can significantly reduce the average postoperative length of stay for patients undergoing vascular procedures. Further prospective data are needed before this protocol can be accepted as an alternative for postoperative anticoagulation in this set of patients.
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The purpose of this study was to evaluate and compare the attitudes, practices, technique utilizations, and barrier perceptions of smoking cessation counseling (SCC) in general surgery (GS) and primary care (PC) residents. ⋯ In this study, many GC residents agreed that physicians were responsible for SCC, but few followed through by arranging SCC follow-up visits compared with their PC resident counterparts. Behavior does not appear to change as residents mature, despite greater exposure to smoking-related diseases. In every dimension of SCC studied, GS residents played a less assertive role when compared with PC residents. GC residents should be more proactive in SCC because the diseases they treat are often related to cigarette smoking.
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By using transcranial Doppler (TCD) it is possible to measure blood flow velocities within the circle of Willis. In this study, TCD was performed before and after carotid endarterectomy (CEA) with the aim to describe cerebral hemodynamics after normalization of the carotid artery blood flow. ⋯ Soon after surgery, blood flow velocity increases often bilaterally in the MCA. However a contralateral flow velocity increase did not occur in patients with very severe contralateral stenosis or occlusion if the late follow-up investigation was chosen as a reference value. The clinical significance of bilateral flow velocity increases is uncertain, but very high blood flow velocities might be a signal for cerebrovascular hyperperfusion. In those patients, increased postoperative surveillance is recommended.
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Arterial dissection commonly affects the thoracic aorta and is associated with high morbidity and mortality rates. Although dissection of the abdominal aorta is considered rare, liberal use of diagnostic computed tomographic scan imaging for evaluation of abdominal pain has identified this process with increasing frequency. Because the clinical features and therapeutic options of isolated abdominal aortic dissection are not well characterized, we reviewed our recent experience and provide an algorithm for treatment. ⋯ Although the natural history of isolated abdominal aortic dissection has not been well defined, our experience adds to the understanding of this rare process. Because aneurysmal degeneration can occur, close surveillance is indicated if definitive treatment is not used initially. Patients with ischemic symptoms and those with intractable pain need intervention, the nature of which should be based on risk profile and aortoiliac anatomy.
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The purpose of this study was the report of the results of a consecutive series of carotid endarterectomy (CEA), performed by one surgeon and independently assessed by a neurologist, in which the achievability of selective early control of the distal internal carotid artery (ICA) was prospectively recorded. ⋯ Early selective distal ICA control is highly achievable during CEA without apparently compromising clinical results. Its use is relevant when selective methods of shunting that do not need initial control of the common and external carotid arteries (eg, local cervical block anesthesia, electroencephalography/other monitoring) are used. Further evaluation with transcranial Doppler scan monitoring is suggested to substantiate the theoretic potential of this method in the reduction or elimination of particulate plaque embolism.