Annals of vascular surgery
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Since elements of the Dialysis Outcome Quality Initiative (K/DOQI) were implemented a decade ago, there has been a reduction in mortality for patients on hemodialysis. As patient longevity has increased, AV access site preservation by salvaging failed arteriovenous (AV) accesses has become increasingly important. However, efforts to salvage an AV access must be balanced against futile and expensive procedures. The Viabahn Endoprosthesis is a self-expandable stent graft (SG) that can be used to treat vein rupture or fibrotic lesions with significant elastic recoil following balloon angioplasty. The literature comprising the outcome of the use of SGs in salvaging failed AV accesses is limited. The purpose of this study is to determine the outcome of failed AV accesses treated with SGs and to identify patient or graft factors predictive of success. ⋯ Use of the SG to salvage AV accesses falls short of the current K/DOQI clinical outcome goals for successful surgical intervention in the majority of cases. Given these results and the cost of the SG, its use is indicated in cases where AV access salvage will have an impact on long-term survival such as for patients in whom there are few options for new access placement. Further studies are needed to compare the SG to less costly options, such as angioplasty alone or angioplasty with the use of bare metal stents.
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We evaluated national outcomes after open repair of abdominal aortic aneurysms (AAAs) with visceral or renal bypass (VRB). ⋯ VRB repair volume decreased per year similarly to open IRA repair volume and may be related to increasing use of endovascular therapy. Mortality after VRB is high and dependent upon age, renal failure, and congestive heart failure. Overall, VRB repair was associated with worsened outcomes; however, this study cannot conclude that avoiding such a repair will improve outcomes. This should be factored into surgical decision making for these patients.