Annals of vascular surgery
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We present the case of a 63-year-old woman who was admitted to the intensive care unit for altered mental status and hypotension 3 weeks after creation of an arteriovenous fistula (AVF). She was found to have high-output heart failure and evidence of acute hepatic failure. High-output heart failure is a known complication of AVF creation, but hepatic failure after AVF has not been previously described. We present such a case.
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Most recent Chest 2008 guidelines counsel at least 3 months of anticoagulation for acute upper-extremity deep venous thrombosis (UEDVT). These guidelines are inconsistently followed, perhaps owing to relatively limited information regarding clinical outcomes among patients with UEDVT. Our institution maintains an UEDVT registry of consecutively encountered patients with sonographically confirmed UEDVT. We analyzed patient characteristics, treatment, and outcomes among these patients. ⋯ Anticoagulation therapy is inconsistently used to treat UEDVT and most often used for patients with multiple vein segments involved and with sonographically acute UEDVT components. However, regardless of the decision to anticoagulate, the incidence of PE attributable to UEDVT is small (2%), regardless of treatment with anticoagulation. Given the observed mortality associated with anticoagulation in this fragile patient cohort, the risk-benefit analysis for anticoagulation does not favor routine anticoagulation among these patients.
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Aortoenteric fistulas are a rare but potentially lethal condition. Here we present an unusual case of a fistula between the excluded portion of an infrarenal aneurysm repaired by stent-grafting and the duodenum. The fistula was supplied by a type II endoleak. The patient was successfully treated by extra-anatomic bypass grafting and removal of the aneurysm sac and the stent-graft.