Annals of vascular surgery
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Intraoperative monitoring of cerebral ischemia with shunting during carotid endarterectomy (CEA) remains controversial. Our objective was to evaluate the sensitivity and specificity of BIS changes during carotid clamping in relation to shunted patients in awake CEA. ⋯ BIS monitoring during carotid clamping is an easy, noninvasive method which correlates with cerebral ischemia in patients undergoing CEA. A decrease>or=14% from the basal BIS value presents a high negative predictive value, and ischemia is unlikely without a decrease. Nonetheless, a decrease may not always indicate cerebral ischemia with a low positive predictive value.
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In patients with ruptured abdominal aortic aneurysm (RAAA) and shock, the time lag between the onset of the symptoms due to RAAA and the presence of a full developed shock syndrome was evaluated to assess its prognostic meaning. This time lag was called time before shock (TBS). ⋯ TBS seems to complete the information given by the parameter "presence of shock," and its evaluation allows a more effective judgment of the risk of death, at emergency admission of patients with RAAA.
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Randomized Controlled Trial Comparative Study
Retroperitoneal approach to abdominal aortic aneurysm repair preserves splanchnic perfusion as measured by gastric tonometry.
We investigated if minimizing bowel manipulation and mesenteric traction using the retroperitoneal approach in open abdominal aortic aneurysm (AAA) repair preserves splanchnic perfusion, as measured by gastric tonometry, and reduces the systemic inflammatory response and dysfunction of the various organs. ⋯ The retroperitoneal approach for open AAA repair is associated with gastric tonometric evidence of better splanchnic perfusion compared to the transperitoneal approach.
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Comparative Study
The impact of isolated tibial disease on outcomes in the critical limb ischemic population.
Most patients with critical limb ischemia (CLI) have multilevel infrainguinal peripheral arterial disease (M-PAD). One-third of CLI patients will have isolated tibial disease (ITD). The treatments for multilevel disease or ITD differ depending on whether open or endovascular procedures are used, but we questioned whether outcomes from these procedures differ. We evaluated outcomes of CLI patients after open and/or endovascular revascularization for CLI and assessed the impact of disease distribution. ⋯ After revascularization for CLI, ITD carries a worse prognosis (amputation-free survival, limb salvage, survival, maintenance of ambulation, and independent living status) compared with patients with M-PAD, despite the "greater" disease burden in M-PAD patients. ITD patients are more likely to have confounding factors such as diabetes mellitus, renal disease, and worse ischemia at presentation than those with M-PAD. The recognition of ITD may be helpful in identifying high-risk patients but is not an independent risk factor for poor outcomes.
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Case Reports
Duplication of superficial femoral artery: an uncommon variation of the lower limb arterial system.
The most common anatomical variation of the superficial femoral artery (SFA) is hypoplasia or aplasia, associated with persistent sciatic artery. Duplication of SFA remains uncommon. We report a case of SFA duplication discovered on an angiogram performed for critical limb ischemia, in an 80-year-old man.