Journal of vascular surgery
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Inflammation is likely a major contributor to spinal cord reperfusion injury after aortic reconstruction. Systemic 4-(3-[6-amino-9-(5-ethylcarbamoyl-3,4-dihydroxy-tetrahydro-furan-2-yl)-9H-purin-2-yl]-prop-2-ynyl)-cyclohexanecarboxylic acid methyl ester (ATL-146e), a selective adenosine A(2A) agonist, has been shown to reduce paralysis after spinal cord ischemia. We hypothesized that ATL-146e reduces cytokine production during spinal cord reperfusion, curtailing inflammation and decreasing spinal cord capillary platelet-endothelial cell adhesion molecule-1 (PECAM-1) expression. ⋯ ATL-146e, an adenosine A(2A) agonist, reduces spinal cord reperfusion injury. The mechanism of the protection may involve a reduction in circulating TNF-alpha during a critical 3-hour reperfusion interval and reduction in spinal cord endothelial PECAM-1 upregulation.
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The importance of diabetes mellitus (DM) as an independent risk factor for perioperative cardiac morbidity after vascular surgery is controversial. This study examined the impact of DM on perioperative outcomes and length of stay in patients who underwent major vascular surgery. ⋯ Patients with diabetes have a higher incidence rate of death and cardiovascular complications. However, after controlling for specific comorbid conditions, the only independent association was between patients with insulin treatment and the risk of cardiovascular complications. DM does not appear to be an independent risk factor for postoperative mortality. All patients with diabetes, regardless of insulin use, have a prolonged length of stay after major vascular surgery.
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Many studies have linked carotid plaque surface irregularities with stroke risk, but this relationship has been obscured by the limited ability of available imaging modalities to resolve plaque surface morphology. To address this issue, we performed a prospective study correlating the presenting neurologic symptoms of patients with high-resolution magnetic resonance imaging (MRI; 200 microm) studies of ipsilateral plaque surface invaginations and ledges, lumen shape, and the location of the plaque bulk creating the stenosis. ⋯ Surface irregularities were revealed by means of submillimeter resolution of the carotid plaques with MRI to be common, but only the presence of major irregularities correlated with the patient having TIA or stroke. Lumen shape and plaque location did not appear to predict stroke risk, but may effect imaging accuracy in determining the degree of stenosis. These data further define the relationship of plaque irregularity and cerebrovascular symptoms caused by atheroemboli.
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Post hoc analysis results of the North American Symptomatic Carotid Endarterectomy Trial and the Asymptomatic Carotid Atherosclerosis Study suggest that carotid endarterectomy (CEA) may not be as efficacious in women as it is in men. This study was undertaken for the evaluation of whether there is a difference between men and women in early postoperative outcome after CEA and whether such a difference is consistent across other predictors. ⋯ The combined TIA or stroke and stroke or mortality rates are higher in women as compared with men in the postoperative period, but these risks remain acceptable when CEA is performed for appropriate indications. The interaction between symptoms and gender suggests that, in patients who are asymptomatic, women are more likely than are men to have early complications. However, there is no gender difference in patients who are symptomatic. Therefore, despite a low postoperative complication rate, CEA is appropriate in both women who are asymptomatic and women who are symptomatic only if the postoperative TIA, stroke, and mortality rates are appreciably lower than in the natural history of medical management of these patients.
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Multicenter Study Comparative Study Clinical Trial
Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: The EUROSTAR experience.
The purpose of this study was to assess the incidence, risk factors, and consequences of endoleaks after endovascular repair of abdominal aortic aneurysm. ⋯ The presence of device-related endoleaks correlated with a higher risk of aneurysmal rupture and conversion compared with patients without type I or III endoleaks. Type II endoleak was not associated more often with these events. Consequently, intervention in type II endoleak should only be performed in case of increase of aneurysm size.