Journal of vascular surgery
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There has been much discussion in the literature of factors that affect the mortality rate of patients who undergo repair of ruptured abdominal aortic aneurysms. Some studies have suggested restricting patient selection for repair on the basis of certain preoperative factors including age, increased creatinine level, low hemoglobin level, loss of consciousness, electrocardiographic changes, and preoperative cormorbid medical conditions. A retrospective review of 96 patients who underwent repair of a ruptured abdominal aortic aneurysm was performed to determine whether these factors would necessarily be applicable to all populations. ⋯ These findings suggest that the factors (loss of consciousness, creatinine level, hemoglobin level) that are predictive of death may be a reflection of shock in this patient population. Further studies should be directed to optimizing preoperative resuscitation. Patients who have a ruptured abdominal aortic aneurysm should not be denied therapy on the basis of any specific set of preoperative factors.
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To review delayed and guidewire-induced morbidity associated with vena cava filters. ⋯ Delayed complications of vena cava filters should be considered whenever unusual patient signs or symptoms cannot be easily explained, even in the absence of a history of filter placement. To prevent guidewire ensnarement of filters, simple techniques should modify endovascular procedures when vena cava filters are present.
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Randomized Controlled Trial Clinical Trial
Is intermittent claudication improved by percutaneous transluminal angioplasty? A randomized controlled trial.
Percutaneous transluminal angioplasty (PTA) is an increasingly popular invasive treatment for peripheral arterial disease, but there have been very few controlled trials to justify its use. This randomized controlled clinical trial was performed to determine in patients with mild and moderate intermittent claudication differences in outcome between PTA and conventional medical treatment after 2 years. ⋯ Two years after PTA, patients had less extensive disease than medically treated patients, but this did not translate into a significant advantage in terms of improved walking or quality of life. There are important implications for patient management and future clinical research.
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Critical limb ischemia (CLI) is equated with a need for limb salvage. Arterial reconstruction and major amputation are the therapies ultimately available to such patients. We studied whether measurements of skin perfusion pressure (SPP) can be used to accurately identify those patients with CLI who require vascular reconstruction or major amputation and distinguish them from patients whose foot ulcer would heal with local wound care or minor amputation. ⋯ We conclude that SPP measurement is an objective, noninvasive method that can be used to diagnose critical limb ischemia with approximately 80% accuracy.
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To investigate the associations between specific preoperative 12-lead electrocardiogram (ECG) abnormalities, perioperative ischemia, and postoperative myocardial infarction or cardiac death in major vascular surgery. ⋯ Left ventricular hypertrophy and ST segment depression on preoperative 12-lead ECGs are important markers of increased risk for myocardial infarction or cardiac death after major vascular surgery.