Annals of vascular surgery
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Socioeconomic and geographic disparities in access to endovascular abdominal aortic aneurysm repair.
Within Southwestern Ontario, abdominal aortic aneurysm (AAA) surgery has been centralized to a single university-affiliated medical center. The referral area serves 1.9 million people and includes community hospitals with limited vascular surgery capabilities. We reviewed the role of patients' travel distance, geographic location, and socioeconomic status (SES) to determine if centralization of endovascular programs results in disparity in access to endovascular surgery. We hypothesized that patients would travel a longer distance to specifically seek elective endovascular surgery while having open and emergent surgery closer to home. ⋯ Despite the centralization of endovascular programs in Canada, patients do not appear to be traveling a longer distance for EVAR while having open repairs closer to home as we expected. We did note that higher SES was associated with increased odds of EVAR, which may suggest a health care access bias for EVAR for patients of higher SES. Larger, population-based studies at the provincial or national level could confirm these initial findings.
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Ulnar artery thrombosis and hypothenar hammer syndrome are rare vascular complications that could potentially occur with repeated blows or trauma to the hand. Although initially reported as an occupational hazard among laborers and craftsmen, it has been observed more recently among recreationalists and athletes. Until now, it has never been reported as a complication in ice hockey players. ⋯ The patient's symptoms resolved, and he was maintained on therapeutic anticoagulation for 3 months prior to returning to playing ice hockey professionally, but with a padded glove and no tape knob at the handle tip. This case highlights a unique presentation of hockey stick-handling causing ulnar artery thrombosis that was likely from repeated palmar hypothenar trauma. Appropriate diagnostic imaging, early intraarterial thrombolysis, and postoperative surveillance and follow-up were crucial for the successful outcome in this patient.
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Randomized Controlled Trial Multicenter Study Comparative Study
External support of a polytetrafluoroethylene graft improves patency for bypass to below-knee arteries.
Patency and limb salvage after synthetic bypass to the arteries below the knee are inferior to that which can be achieved with autologous vein. The use of external support of synthetic polytetrafluoroethylene (PTFE) grafts to the below-knee position has been suggested to improve patency and limb salvage, a problem analyzed in this randomized clinical trial. We examined whether external graft support improves patency and/or limb salvage in patients undergoing reconstruction with synthetic PTFE grafts to the below-knee arteries. ⋯ External support to a PTFE graft used for bypass to below-knee arteries improves primary and secondary patency but not limb salvage.
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In this report we describe a special method of using a pedicled latissimus dorsi muscle flap for a mycotic aneurysm. The method involves wrapping the flap around a prosthetic graft. Using this method, an in situ graft, which replaces an aneurysm, can help to avoid recurrence of local infection.
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The efficacy of inferior vena cava (IVC) filters in the prevention of pulmonary embolism in patients with lower extremity deep venous thrombosis (DVT) has been well described. What remains uncertain is the risk of insertion-site thrombosis of the femoral vein after filter placement. Historically, the risk was relatively high, most likely due to large delivery systems and therefore a need for longer compression at the insertion site to provide hemostasis. The purpose of this prospective study was to determine the incidence of thrombus formation at the femoral vein puncture site after percutaneous insertion of contemporary IVC filters. ⋯ Based on our study findings, the risk of femoral insertion-site thrombosis after percutaneous placement of contemporary IVC filters is negligible. Concern for femoral vein thrombosis should not be a reason for using the internal jugular vein to deploy IVC filters.