Annals of vascular surgery
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Endovascular repair of thoracic aortic disease continues to evolve since FDA approval of the first thoracic endograft in the United States in March 2005. Certain anatomic characteristics, including adequacy of arterial access, remain a significant limiting factor in thoracic endovascular repair. In clinical trials evaluating thoracic endografts, vascular access complications occurred in >20% of cases. The purpose of this study is to evaluate the arterial access and the selective use of the ascending aorta for thoracic endograft placement. ⋯ Access selection is an important part of the preoperative planning of endovascular procedures. Choosing the most appropriate access for a patient will decrease the access-associated complication rate. In addition, selected patients with poor aortoiliac access and those that require debranching or elephant trunk procedures may benefit from antegrade access.
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Review Meta Analysis
Long-term use of different doses of low-molecular-weight heparin versus vitamin K antagonists in the treatment of venous thromboembolism.
We evaluated whether the incidence of recurrent venous thromboembolic events (VTEs) during and after therapy differs for patients treated with full or reduced doses of low-molecular-weight heparin (LMWH) used long term compared with vitamin K antagonists (VKAs). ⋯ Full-dose LMWH for 3-6 months is as safe as intermediate and prophylactic doses for the long-term treatment of deep vein thrombosis. In patients with cancer it appears that there is an excess of VTE recurrence after treatment with prophylactic doses that does not occur with full therapeutic doses.
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Little is known about the prevalence of abdominal aortic aneurysm (AAA) in patients with coronary heart disease. The aims of this prospective study were to evaluate the prevalence of AAA and of large abdominal aorta in patients hospitalized for acute coronary syndrome and coronary stenosis of 50% or greater. ⋯ AAA and large infrarenal aorta prevalence seems high in patients with acute coronary syndrome and proven coronary stenosis of 50% or greater. Previous coronary events and older age might be associated with higher risk of AAA, and age, male gender, and obesity are significantly associated with large infrarenal aorta. If these results are confirmed in larger studies, further guidelines concerning AAA screening in this well-defined population should be considered.
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Case Reports
Complete catheter disconnection and migration of an implantable venous access device: the disconnected cap sign.
The use of totally implantable venous access device has provided a solution to difficult venous access. Early reports have, however, recognized several complications with their use. Catheter disruption is a rare but important complication of these devices; it may be asymptomatic but can be fatal in some cases. We present a case of a patient who had a rare and serious complication secondary to catheter disconnection from its chamber.