Annals of vascular surgery
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Multicenter randomized prospective trial comparing a pre-cuffed polytetrafluoroethylene graft to a vein cuffed polytetrafluoroethylene graft for infragenicular arterial bypass.
Poor patency of synthetic grafts for infragenicular revascularization has led to use of distal vein patches or cuffs. The aim of this study was to compare the distally widened Distaflo PTFE graft, which mimics a vein cuff, with a PTFE graft with distal vein modification. In this prospective, randomized, multicenter trial we compared use of a precuffed PTFE graft wit that of PTFE grafts with distal vein modification for infragenicular revascularization in patients with critical limb ischemia without saphenous vein. ⋯ At 1 year and 2 years, the limb salvage rate was 72% and 65% for the precuffed group and 75% and 62% in the vein cuffed group (p = 0.88). Although numbers are small and follow-up short, this midterm analysis shows similar results for the Distaflo precuffed grafts and PTFE grafts with vein cuff. A precuffed graft is a reasonable alternative conduit for infragenicular reconstruction in the absence of saphenous vein and provides favorable limb salvage.
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Comparative Study
Surveillance venous duplex is not clinically useful after total joint arthroplasty when effective deep venous thrombosis prophylaxis is used.
The early detection of deep venous thrombosis (DVT) and treatment with systemic anticoagulation to prevent pulmonary embolism (PE) are essential in the management of patients undergoing total joint arthroplasty (TJA). However, improvements in prophylactic measures have significantly decreased the occurrence of DVT in these patients. The purpose of this study was to determine whether routine postoperative duplex surveillance for DVT remains clinically useful. ⋯ These data demonstrate that routine postoperative venous duplex scans rarely found DVT (5 of 398 patients) after TJA when effective prophylaxis was used. Furthermore, surveillance scanning did not enable reliable prediction of PE. Therefore, we conclude that postoperative inpatient surveillance duplex scans for DVT provide very minimal benefit and that a routine screening program is not clinically useful for patients managed with effective DVT prophylaxis.
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Comparative Study
Management trends and early mortality rates for acute type B aortic dissection: a 10-year single-institution experience.
This study was undertaken to assess trends in management over time and to determine predictors of early mortality for acute type B aortic dissection. Fifty-three consecutive patients with acute type B aortic dissection over a 10-year period were reviewed. Baseline demographics as well as in-hospital data regarding symptoms, type of initial management, surgical indications, type of surgical intervention, and early mortality rates were collected. ⋯ Early mortality was 50% in 16 patients having open aortic surgery vs. 0% in 10 patients undergoing endovascular stent graft repair (p < 0.005). Independent predictors of early mortality included only renal dysfunction (odds ratio [OR] 7.39), aortic rupture (OR 8.72), and date of admission during the study period (OR 0.712). Despite improvements over time in early mortality that appear associated with the increasing use of endovascular stent grafts, patient-specific factors are still the most important independent predictors of early mortality in acute type B aortic dissection.
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Patients undergoing endovascular abdominal aortic aneurysm (AAA) repair have lower perioperative morbidity and leave the hospital earlier than patients undergoing open repair. However, potential complications require continuous surveillance of endografts and there are few data regarding their long-term fate. If an open operation were well tolerated, this might be a preferable alternative. ⋯ Their time in the operating room was less (3.5 vs. 4.5 hr, p < 0.0001), and they had less estimated blood loss (750 vs. 1500 cc, p < 0.001) and fewer transfusions (0.95 vs. 2.45 units, p < 0.0001). Patients without COPD and smaller AAAs that can be repaired via a retroperitoneal approach have a lower incidence of perioperative complications and a shorter hospital stay following open AAA repair. Until long-term results for endografts are available, our data suggest that these patients are well served with an open repair.
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Open repair of thoracic aortic aneurysms is associated with significant morbidity and mortality. The introduction of endovascular repair has reduced both the morbidity and mortality. However, endovascular stent repair can be complicated by endoleaks. We report here the successful treatment of a type 2 endoleak following endovascular repair of a thoracoabdominal aortic aneurysm, using transesophageal echocardiography to assist in the localization of the thoracic endoleak.