Annals of vascular surgery
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The elderly represent a large percentage of patients seen in departments of vascular surgery. Delirium is a frequent perioperative complication in this population and contributes to increased morbidity and mortality. ⋯ The aging of our population implies management of increasing numbers of older patients who often have concomitant pathologies and, consequently, polypharmacy. Optimization of their management rests on collaboration between surgeons, anesthetists, and geriatrists.
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Case Reports
Endovascular management of radiotherapy-induced injury to brachiocephalic artery using covered stents.
Actinic vascular lesions tend to be stenotic-occlusive lesions. In this article, we present 2 exceptional cases of pseudoaneurysms caused by radionecrosis of the supra-aortic trunks. ⋯ Proper exclusion of the pseudoaneurysm was attained in both cases; the first patient remained asymptomatic 12 months later; the second patient died of mediastinitis. Compared with conventional surgery, endovascular management is a viable, less invasive alternative in select patients, especially in life-threatening cases.
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Multicenter Study
Multicenter audit of emergency endovascular repair of infrarenal aortic aneurysms.
Emergency endovascular aneurysm repair (eEVAR) for infrarenal abdominal aortic aneurysm has become widely accepted as an alternative to open repair, if the aortic anatomy is favorable and endovascular expertise is readily available. The aim of this study is to report the outcome of eEVAR in Hong Kong. ⋯ This audit shows that the results of eEVAR in Hong Kong are comparable to international standards. In the endovascular era, this may be an attractive alternative to emergency open aneurysm repair.
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Case Reports
Symptomatic obstruction of the brachiocephalic and left subclavian arteries obscured by aortic stenosis.
Stenosis or occlusion of the brachiocephalic artery represents an uncommon cause of cerebrovascular insufficiency. We report a patient with combined brachiocephalic and left subclavian obstruction with clinical manifestations of lightheadedness, syncope, and left-sided weakness who remained misdiagnosed essentially because of symmetrical pressures in the upper extremities. ⋯ Eventual stenting of the brachiocephalic trunk resolved the patient's symptoms. Our report highlights the diagnostic challenges in this case of bilateral supraaortic vessel disease and shows that equal upper extremity pressures do not rule out brachiocephalic artery obstruction.
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Comparative Study
Metabolic syndrome reduces the survival benefit of the obesity paradox after infrainguinal bypass.
Metabolic syndrome, having risen to epidemic proportions in the United States, is associated with future cardiovascular disease and mortality and increased postoperative complication rates. However, the impact of metabolic syndrome on outcomes after infrainguinal bypass surgery remains poorly defined. ⋯ Patients with metabolic syndrome are at an increased risk of postoperative complications after infrainguinal bypass. Despite increased morbidity, metabolic syndrome was not associated with inferior 30-day mortality, but did diminish the survival benefit of the obesity paradox.