Annals of vascular surgery
-
Comparative Study
Comparison of POSSUM with P-POSSUM for prediction of mortality in infrarenal abdominal aortic aneurysm repair.
The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is a simple and valid scoring system in predicting mortality and morbidity rates. The Portsmouth predictor equation (P-POSSUM) has been shown to be a more accurate predictor of death than the POSSUM in vascular patients. The length of hospital stay (LOS) equation has been suggested to be of value in predicting total length of stay. ⋯ The LOS equation failed to predict significantly observed total hospital stay. POSSUM and P-POSSUM outcome risk equations are thus valid in predicting mortality for all cases and emergency AAA repairs. The POSSUM morbidity equation predicts complications quantitatively.
-
Comparative Study
EEG as a criterion for shunt need in carotid endarterectomy.
The efficacy of continuous intraoperative electroencephalographic (EEG) monitoring as a criterion for selective shunt use during carotid endarterectomy is evaluated in a group of 1661 operations in which the EEG was the sole criterion for shunt insertion. EEG monitoring is measured by the intraoperative stroke rate. Carotid stump pressure measurements were recorded as an additional observation in 1517 operations and represent a subset of the study group allowing comparison of this technique with EEG. ⋯ The EEG remained normal in 1295 operations including 75 operations with contralateral internal carotid artery occlusion. One minor intraoperative stroke (0.08%) which resolved in 1 week occurred in the absence of an EEG change with no intraoperative strokes in the 75 operations in which the contralateral internal carotid artery was occluded. Intraoperative EEG monitoring accurately (99.92%) identified patients who may safely have carotid endarterectomy without the need of a shunt.
-
Delivery of endovascular grafts via femoral access in patients with iliac arterial tortuosity or occlusive disease can be problematic. Aortomonoiliac grafts or arterial conduits sewn to proximal iliac arteries through an abdominal incision have been used as alternatives. ⋯ Hemostasis is achieved by use of a superficially placed concentric double purse-string suture. The technique has been employed successfully for placement of both thoracic and abdominal endografts.