Annals of vascular surgery
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Significantly reduced amputation rates for traumatic popliteal artery injuries have been achieved with improved revascularization and resuscitative techniques. Predictive scores have failed to accurately predict outcomes in patients who sustain popliteal artery damage. This study aimed to identify predictors of limb salvage in a civilian cohort after popliteal artery trauma. ⋯ Patients with traumatic popliteal artery injury are at high risk for amputation. Blunt injury, fractures, ISS >9, and MESS >7 were associated with an increased odds of amputation. Although in our data, MESS was the strongest predictor of amputation, we recognize that MESS was previously invalidated as a scoring system. New methods to determine limb viability in the mangled extremity are needed.
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Randomized Controlled Trial
Supervised exercise program improves aerobic fitness in patients awaiting abdominal aortic aneurysm repair.
Aerobic fitness is an important predictor of postoperative outcome in major surgery. In this study, we assess the effects of a period of preoperative exercise on aerobic fitness as measured by cardiopulmonary exercise testing (CPET) in patients scheduled for abdominal aortic aneurysm (AAA) repair. ⋯ This study shows that cardiopulmonary aerobic fitness improves after a period of supervised exercise in patients scheduled for AAA repair. This is justification for a randomized trial to assess whether this affects morbidity and mortality after AAA repair.
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Case Reports
Endovascular treatment of bilateral carotid artery pseudoaneurysms after blunt carotid injury.
The detection of blunt carotid artery injures has improved because of more aggressive screening protocols. Initial treatment depends on multiple factors; however, controversy exists with regard to the treatment of pseudoaneurysmal degeneration, especially in this age of endovascular treatment options. Current options include anticoagulation, open surgical repair, and endovascular repair. We report a rare case of bilateral carotid artery pseudoaneurysm degeneration after bilateral carotid artery dissection caused by blunt trauma.
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Simulation modules allow for the safe practice of certain techniques and are becoming increasingly important in the shift toward education for integrated vascular residents. There is an unquestionable need to standardize the evaluation of trainees on these simulation models to assure their impact and effectiveness. We sought to validate such an assessment tool for a basic open vascular technique. ⋯ Performance on an open simulation model evaluated by a standardized global rating scale correlated to trainee experience level. This initial work confirms the ease and applicability of the grading tool among multiple expert observers and different platforms, and supports additional; research into applications translating this performance into the operating room.
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Large randomized controlled trials have shown that carotid endarterectomy (CEA) is beneficial in the treatment of recent severe symptomatic carotid stenosis. Data are lacking concerning the risks of early CEA (<48 hours) for stroke in evolution (SIE) or crescendo transient ischemic attack (CTIA). The primary end point of this retrospective study was to evaluate the incidence of stroke, major adverse cardiac events (MACEs), and death within the first 30 days after early CEA performed within 48 hours in patients presenting with transient ischemic attack (TIA)/SIE. ⋯ CEA can be performed with an acceptable risk in properly selected symptomatic patients within 48 hours after TIA or SIE. The benefits of early CEA in symptomatic patients include the prevention of recurrent stroke.