Journal of vascular surgery
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Carotid endarterectomy is the most effective treatment for reducing the risk of stroke in patients with significant carotid stenosis. Few studies have focused on the failure rate of regional anesthesia. ⋯ In our practice, carotid endarterectomy under regional anesthesia is safe and associated with a very low rate of conversion to general anesthesia.
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Multicenter Study
Results of aberrant right subclavian artery aneurysm repair.
The objective of this multicenter registry was to review current treatments and late results of repair of aneurysm of aberrant right subclavian artery (AARSA). ⋯ Hybrid repair is the preferred therapeutic option for patients presenting with AARSA. Midterm results show high rates of clinical success with low risk of reintervention. Simple endografting presents high risk of related death; these findings underline the importance of achieving complete sealing to avoid treatment failures.
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The objective of this study was to introduce a novel strategy for thoracic endovascular aortic repair of Stanford B aortic dissection using two-stent graft implantation (TSI), in which the proximal stent and distal stent with different sizes are sequentially deployed, and to summarize our experience with this technique. ⋯ Short-term outcomes showed TSI to be a flexible and effective approach to accurately repair Stanford B aortic dissection that could potentially address the limitations of currently available stent grafts. Further prospective clinical studies are warranted to evaluate its long-term efficacy.
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Randomized Controlled Trial Comparative Study
Ultrasound-guided regional anesthesia for carotid endarterectomy induces early hemodynamic and stress hormone changes.
Locoregional anesthesia is an effective method for evaluating cerebral function during carotid endarterectomy (CEA). Landmark-guided regional anesthesia (RA) is currently used for CEA and can provoke substantial perioperative hypertension. Ultrasound-guided RA (US-RA) is a new method for performing RA in CEA; however, the effect on sympathetic activity and blood pressure is uncertain. This study assessed early sympathetic activity during CEA in US-RA compared with general anesthesia (GA). ⋯ The US-RA technique for CEA induces temporary intraoperative hypertension and an increase in stress hormone levels. Nevertheless, US-RA is a feasible, effective, and safe form of locoregional for CEA that enables targeted placement of low volumes of local anesthesia under direct visualization.
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Multicenter Study
Preoperative β-blockers do not improve cardiac outcomes after major elective vascular surgery and may be harmful.
Routine initiation β-blocker medications before vascular surgery is controversial due to conflicting data. The purpose of this analysis was to determine whether prophylactic use of β-blockers before major elective vascular surgery decreased postoperative cardiac events or mortality. ⋯ Exclusive of high-risk open AAA patients, preoperative β-blockers did not decrease rates of MACEs or mortality after LEB, AFB, or open AAA. Importantly, exposure to prophylactic preoperative β-blockers increased the rates of some adverse events in several subgroups. Given these data, the SVS-VQI cannot support routine initiation of preoperative β-blockers before major elective vascular surgery in most patients.