Annals of vascular surgery
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Randomized Controlled Trial Comparative Study
The effect of beta-blocker dosing strategy on regulation of perioperative heart rate and clinical outcomes in patients undergoing vascular surgery: a randomized comparison.
The optimal dosing strategy for perioperative beta-blockers to safely achieve recommended target heart rates (HRs) by current guidelines is not well defined. An HR-titrated perioperative beta-blocker dosing regimen versus a fixed-dose regimen was assessed by clinical outcomes, postoperative heart rate, and beta-blocker-related complications. Patients (n = 64) scheduled to undergo moderate- to high-risk vascular surgery and without contraindications to beta-blockade were randomized to either a fixed-dose or HR-titrated beta-blocker dosing schedule. ⋯ There were no significant differences in the occurrence of asymptomatic hypotension between the two study arms, and no beta-blocker-related adverse events occurred in either study arm. An aggressive, HR-titrated perioperative beta-blocker dosing strategy was associated with more consistent maintenance of postoperative HRs within the range recommended by current guidelines and did not result in increased drug-related adverse events. The question of what is the best perioperative beta-blocker dosing regimen warrants further evaluation in a large-scale clinical trial.
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Review Case Reports
Congenital jugular vein phlebectasia: a case report and review of the literature.
Fusiform dilation of the jugular vein, or jugular venous phlebectasia, is a rare clinical entity, with an etiology of cervical swelling. We present a case of a 15-year-old male with no antecedent history of trauma and an enlarging right neck mass. Pertinent literature and relevant diagnostic and therapeutic modalities are reviewed. While conservative management is usually prescribed, ligation and resection may be performed safely when intervention is warranted.
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Review Case Reports
Endovascular stent graft repair of a thoracic aortic gunshot injury.
Endovascular treatment approaches offer minimally invasive alternative strategies for the management of vascular injuries. While endovascular stent graft repair of blunt injury to the thoracic aorta is well described, there are few reports of its application for treatment of penetrating injuries of the thoracic aorta. We report the successful treatment of a through-and-through gunshot injury of the thoracic aorta and review how this technology may be applied for the treatment of penetrating thoracic aortic injury.
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The National Kidney Foundation Dialysis Outcomes and Quality Initiative (DOQI) recommends autogenous fistulae as the preferred access for new dialysis procedures. Unfortunately, despite superior patency rates compared to prosthetic grafts, even autogenous access durability is often undermined by venous stenosis due to intimal hyperplasia at the outflow vein or by central venous stenosis due to long-standing central venous catheters. Salvage interventions, in the form of endovascular treatments such as percutaneous transluminal angioplasty (PTA) and/or stenting, are increasingly utilized for access salvage and maintenance. ⋯ Central venous and venous outflow interventions extended overall access patency by 38.5 and 33 months, respectively (p < 0.0001). Endovascular interventions are the mainstay of treatment for the malfunctioning dialysis access. Despite the need for multiple reinterventions and close surveillance, catheter-based interventions positively contribute to dialysis access durability in accordance with DOQI guidelines.