Journal of vascular surgery
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Review Comparative Study
Prevention of venous thromboembolism in North America: results of a survey among general surgeons.
The purpose of this study was to analyze current attitudes toward the prevention of postoperative venous thromboembolism among North American general surgeons. ⋯ North American surgeons who responded to this survey are well aware of the problem of venous thromboembolism and their approach to prevention has been significantly modified in the last 10 years. Compared with similar European surveys this survey reveals a higher implementations of physical methods such as intermittent pneumatic compression and elastic stockings. Because of the limited response rate and possibility of sampling bias, these findings should be interpreted with caution.
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Clinical Trial
Monitoring for spinal cord ischemia by use of the evoked spinal cord potentials during aortic aneurysm surgery.
This clinical study was to evaluate changes of evoked spinal cord potentials (ESCPs) elicited by direct spinal cord stimulation and to determine their relation to spinal cord ischemia during aortic aneurysm surgery. ⋯ Lumbar descending ESCP was the best method for the spinal cord ischemia during aortic aneurysm surgery. Spinal cord ischemia could be detected by diminution in the amplitude of the late negative wave of lumbar descending ESCP. The recovery amplitude of the late negative wave after declamping correlated with the neurologic outcome.
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Clinical Trial
Acute disruption of polytetrafluoroethylene grafts adjacent to axillary anastomoses: a complication of axillofemoral grafting.
Acute disruption at or adjacent to axillary anastomoses of axillofemoral grafts has been sporadically reported. We have recently reported the patency and limb salvage results of a large number of axillofemoral grafts. In this report we describe a series of axillary artery-graft disruptions that occurred in these patients. ⋯ We conclude that axillofemoral grafting includes the potential for disruption of the proximal anastomosis, which has occurred in 5% of our patients. Although multiple steps have been recommended to avoid this complication, occasional cases continue to occur despite observing all precautions.
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The purpose of this study was to determine whether postoperative intensive care unit care is necessary for all patients undergoing carotid endarterectomy and whether a subgroup of patients at low-risk not requiring treatment in the intensive care unit could be identified. ⋯ In preoperative scheduling of intensive care unit beds, patients with less than four risk factors can be stratified to monitoring beds and those with greater than or equal to four can be stratified to intervention beds. After 8 hours, if no interventions are necessary or adverse outcomes occur, then floor recovery is safe. Patients who satisfy this algorithm would save 50% of current intensive care unit charges.
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The high prevalence of clinically silent venous thrombosis and the presence of a patent foramen ovale (PFO) in up to 35% of the general population suggests that paradoxical emboli may be the cause of an ischemic stroke or a peripheral thromboembolic occlusion more often than is presently considered. This study was undertaken to review our experience with presumed paradoxical embolism. ⋯ The incidence of presumed paradoxical embolism has increased dramatically in the recent past as a consequence of our improved ability to unequivocally detect PFO with associated physiologic shunting. The suspicion of this heretofore "rare" event should be raised, particularly in the young or middle-aged adult diagnosed with an acute thromboembolic event. Until the risk of recurrent ischemic events in the presence of a PFO is better defined, we currently recommend closure of the foramen ovale after a significant or recurrent paradoxical embolus. Otherwise, the selective use of intracaval filters, antiplatelet therapy, and oral anticoagulation remain undefined.