Annals of vascular surgery
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Multicenter Study
Hypoalbuminemia Predicts Perioperative Morbidity and Mortality after Infrainguinal Lower Extremity Bypass for Critical Limb Ischemia.
Poor nutritional status has been associated with a higher risk of morbidity and mortality in general surgery patients; however, outcomes in vascular surgery patients are unclear. Our goal was to determine the effect of poor nutritional status on perioperative morbidity and mortality after lower extremity bypass (LEB). ⋯ Poor preoperative hypoalbuminemia is associated with morbidity and mortality after infrainguinal lower extremity bypass for critical limb ischemia. Evaluation and optimization of nutritional status should be performed preoperatively in this high risk population.
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Observational Study
Evaluation of the Bundle "Zero Surgical Site Infection" to Prevent Surgical Site Infection in Vascular Surgery.
To compare the incidence of surgical site infections (SSIs) before and after the implementation of a bundle of care called "Zero Surgical Site Infection." Secondary goals included estimating measures of association and their potential impact, determining care management indicators in vascular surgery, and evaluating the level of compliance with the bundle. ⋯ This bundle has demonstrated to be effective in reducing the incidence of SSI in vascular surgery. The publication of these initial results should encourage the implementation of this bundle at national level.
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Ultrasound screening shows a clinical benefit in reducing abdominal aortic aneurysm (AAA)-related mortality. However, its cost-effectiveness remains unclear. Understanding the relationship between risk factors and AAA is important to maximize the benefit of AAA screening. However, risk factors for AAA have not been reported in Korea. The purpose of this study is to determine the prevalence of, and risk factors for, AAA among the Korean population. ⋯ The prevalence of AAA was 2.0% in men and 0.4% in women. Male sex, old age, smoking, alcohol use, and pulmonary disease are possible risk factors for AAA in the general Korean population. Smoking is the strongest risk factor for the development of AAA.
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Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease (PAD). Patients who are transferred to other hospitals have generally complex medical problems compared to those patients who are directly admitted from home. The purpose of this study is to identify factors associated with an interfacility transfer in patients with PAD and compare the postoperative outcomes of these patients to those who are directly admitted to the hospital. ⋯ Multiple factors affect an interfacility transfer of patients including advanced age, need for emergency procedure, contaminated wounds. Patients who are transferred from another institution for a lower extremity bypass surgery are at a substantially higher risk for postoperative morbidity and mortality.
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Case Reports
A Rare Entity: Traumatic Thoracic Aortic Injury in a Patient with Aberrant Right Subclavian Artery.
Aberrant right subclavian artery is an uncommon entity incidence ranging from 0.5 to 2.5%. Management of thoracic aortic injury in the presence of such anomalies can be a challenge. We present here a case of traumatic aortic injury, which was incidentally found to have an asymptomatic aberrant right subclavian artery. The patient was managed by an endovascular repair of thoracic aortic injury with an endograft and a right carotid to subclavian artery bypass as a hybrid procedure. ⋯ In a trauma setting with multiple injuries, hybrid procedure with a thoracic endograft is associated with low mortality and morbidity; hence, it is the treatment of choice for thoracic aortic injury over open surgical repair. A hybrid suite can be life and time saving in situations which mandate simultaneous endovascular repair along with surgical revascularization when indicated, especially in cases with aberrant aortic arch anatomy.