Annals of vascular surgery
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Comparative Study
S-100B release during carotid endarterectomy under local anesthesia.
The neuronal protein S-100B has been found to be an indicator of cellular brain damage. The aim of the study was to evaluate whether cross-clamping of the carotid artery for carotid endarterectomy (CEA) under local anesthesia is associated with the same S-100B release pattern as during general anesthesia, where an increase in S-100B concentration in the jugular vein blood of 120% has been reported. In 45 consecutive patients undergoing CEA under local anesthesia, serum S-100B samples were drawn before surgery (T1), before carotid cross-clamping (T2), before cerebral reperfusion (T3), after reperfusion but before the end of surgery (T4), and 6 hr postoperatively (T5). ⋯ S-100B release did not differ at any time point between patients who needed and patients who did not need a shunt, in either the arterial or the venous blood samples. During uncomplicated CEA under local anesthesia, there is no relevant increase of S-100B. These results are different from those reported when CEA is done under general anesthesia.
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Reported in-hospital complications following rib resections for neurogenic thoracic outlet syndrome.
While brachial plexus injury has been described as the most common complication following thoracic outlet syndrome (TOS) operation and case series have been reported, the exact incidence rate has not been described. We conducted a retrospective analysis of 5 years (1999-2003) of the Nationwide Inpatient Sample database. Neurogenic TOS patients, rib resections, brachial plexus injuries, and vascular injuries are identified by ICD-9 diagnosis codes or procedure codes. ⋯ On hospital discharge, brachial plexus injury following rib resection for TOS occurs in <1% of cases, while vascular injuries occur in 1-2% of cases. The low complication rates suggest that the operation can be performed safely in all patients, especially at teaching hospitals, which had significantly lower rates of vascular injuries, shorter hospital lengths of stay, and lower hospital charges. The low incidence rates of these traditional clinical measures of outcome in TOS patients suggest that the appropriate measure for TOS patient outcome would be patient-reported quality of life or functional outcomes.
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Our aim was to determine whether organizational changes could improve the outcome after ruptured abdominal aortic aneurysm (RAAA). Regional centralization and quality improvement in the in-hospital chain of treatment of RAAA included strengthening of the emergency preparedness and better availability of postoperative intensive care. During the reorganization, all patients with RAAA were admitted to Helsinki University Central Hospital (HUCH) from Helsinki and Uusimaa district. ⋯ During the study period, population-based mortality decreased from 77% to 56% (P < 0.001) and 90-day mortality, from 54% to 28% (P = 0.002). Operative 30-day mortality was 19% during the third period and lower than previously (P = 0.001). Our results seem to argue in favor of centralization of emergency vascular services with adequate manpower and operative expertise in the first line and with availability of closed-unit postoperative critical care to achieve better results as these measures were associated with a positive impact on survival.
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Aortoenteric fistulae require urgent definitive intervention and traditionally carry a high mortality. We describe a patient who suffered a traumatic aortic dissection following an auto versus pedestrian collision. He underwent open fenestration of his infrarenal aorta and visceral resection, complicated by abdominal sepsis and enterocutaneous fistulae. ⋯ Due to an impassable abdominal wall, a stent-graft repair was performed. This report describes the successful use of endovascular techniques to achieve immediate hemostasis in an actively hemorrhaging aortoduodenal fistula. An endovascular approach provides a valuable option in settings where a hostile abdomen precludes the traditional open technique and may serve as a bridge to later definitive repair.