Annals of vascular surgery
-
Comparative Study
Management of upper extremity arterial injuries at an urban level I trauma center.
Although relatively uncommon, upper extremity arterial injuries are serious and may significantly impact the outcome of the trauma patient. Management of upper extremity arterial injuries at an urban level I trauma center was reviewed to determine incidence, assess the current management strategy, and evaluate hospital outcome. Upper extremity trauma patients with arterial injury who presented between January 2005 and December 2006 were included in this retrospective review. ⋯ No patients expired and all were discharged home. Equivalent demographics, mechanisms of injury, surgical management approaches, and successful hospital outcomes were demonstrated between penetrating and blunt injuries as well as between proximal and distal arterial injuries. The current management approach, including use of angiography and prompt surgical management, results in successful outcomes after upper extremity arterial injuries and will continue to be utilized.
-
Comparative Study
Open surgical repair of descending thoracic aortic aneurysms in the endovascular era: a 9-year single-center study.
The purpose of this study was to present a single center's experience with elective treatment of descending thoracic aortic aneurysms (DTAAs) in the endovascular era. From July 1997 to May 2005, we operated on 173 patients for DTAA. A total of 52 patients (30.1%) underwent endovascular stent-graft repair (group I). ⋯ The findings of this study show that open surgical repair achieves excellent results when high-risk surgical candidates are recommended for endovascular repair. However, since preoperative spinal cord arteriography was a selection criterion for endovascular repair, the improvement in mortality was accompanied by a concentration of spinal cord ischemic complications in the patients having open surgical repair. The high mortality associated with endovascular repair in our series should decrease as deployment skill and endovascular technology improve.
-
Comparative Study
Superiority of thoracoscopic sympathectomy over medical management for the palmoplantar subset of severe hyperhidrosis.
Severe hyperhidrosis is a disabling disorder whose management is controversial. Medical treatment consists of topical aluminum chloride, oral anticholinergics, ionotophoresis, and botulinum toxin A (Botox) injections. Despite the minimally invasive nature of thoracoscopic sympathectomy, there is a common perception that surgery is only a "last resort." The palmoplantar subtype of hyperhidrosis is particularly problematic for patients professionally and socially. ⋯ There were no other significant operative complications. The safety and overwhelming efficacy of BTS compared to medical management of severe palmoplantar hyperhidrosis is demonstrated. Rather than being a "last resort," BTS can be confidently recommended as first-line treatment for the typical, severe form of palmoplantar hyperhidrosis.
-
Superior vena cava (SVC) hemorrhage due to iatrogenic injury is an infrequent but important event. We report the case of a 56-year-old woman with a history of right pneumonectomy for lung cancer with iatrogenic SVC injury and hemorrhage. After unsuccessful attempts at suture repair of the defect, an endovascular approach using a stent graft succeeded in controlling hemorrhage while maintaining vessel patency. To our knowledge, this is the third report of SVC hemorrhage control using this technique, and it supports the experience of other authors that endovascular stenting is an effective means of treating emergent venous hemorrhage.
-
Internal carotid artery (ICA) flow reversal is an effective means of cerebral protection during carotid stenting. Its main limitation is that in the absence of adequate collateral flow it may not be tolerated by the patient. The purpose of this study was to determine if preoperative identification of intracranial collaterals with computerized tomographic (CTA) or magnetic resonance (MRA) angiography can predict adequate collateral flow and neurological tolerance of ICA flow reversal for embolic protection. ⋯ No EEG changes were present with common carotid artery occlusion and ICA flow reversal. One patent intracranial collateral provides sufficient cerebral perfusion to perform carotid occlusion and flow reversal with absence of EEG changes. Continued progress in noninvasive imaging modalities is becoming increasingly helpful in our understanding of cerebral physiology and selection of patients for invasive carotid procedures.