Annals of vascular surgery
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Inadvertent subclavian artery catheterization during attempted central venous access is a well-known complication. Historically, these patients are managed with an open operative approach and repair under direct vision via an infraclavicular and/or supraclavicular incision. We describe our experience and technique for endovascular management of these injuries. ⋯ This minimally invasive endovascular approach to iatrogenic subclavian artery injury is a safe alternative to blind removal with manual compression or direct open repair.
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Randomized Controlled Trial Comparative Study
Early outcomes from a randomized, controlled trial of supervised exercise, angioplasty, and combined therapy in intermittent claudication.
To compare angioplasty (PTA), supervised exercise (SEP) and PTA + SEP in the treatment of intermittent claudication (IC) due to femoropopliteal disease. ⋯ SEP should be the primary treatment for the patients with claudication and PTA should be supplemented by an SEP.
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Multicenter Study
Body mass index: surgical site infections and mortality after lower extremity bypass from the National Surgical Quality Improvement Program 2005-2007.
Patients undergoing lower extremity bypass are at high risk for surgical site infections (SSI). We examined lower extremity bypasses by graft origin and body mass index (BMI) classification to analyze differences in postoperative mortality and SSI occurrence. ⋯ SSIs occur frequently after lower extremity bypass regardless of bypass origin and are associated with early graft failure and sepsis. Obesity predicts postoperative SSI. Mortality risk was greatest in the underweight, followed by morbidly obese and normal-weight patients, while overweight and mild to moderate obesity were associated with the lowest mortality.
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Since elements of the Dialysis Outcome Quality Initiative (K/DOQI) were implemented a decade ago, there has been a reduction in mortality for patients on hemodialysis. As patient longevity has increased, AV access site preservation by salvaging failed arteriovenous (AV) accesses has become increasingly important. However, efforts to salvage an AV access must be balanced against futile and expensive procedures. The Viabahn Endoprosthesis is a self-expandable stent graft (SG) that can be used to treat vein rupture or fibrotic lesions with significant elastic recoil following balloon angioplasty. The literature comprising the outcome of the use of SGs in salvaging failed AV accesses is limited. The purpose of this study is to determine the outcome of failed AV accesses treated with SGs and to identify patient or graft factors predictive of success. ⋯ Use of the SG to salvage AV accesses falls short of the current K/DOQI clinical outcome goals for successful surgical intervention in the majority of cases. Given these results and the cost of the SG, its use is indicated in cases where AV access salvage will have an impact on long-term survival such as for patients in whom there are few options for new access placement. Further studies are needed to compare the SG to less costly options, such as angioplasty alone or angioplasty with the use of bare metal stents.
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Renovascular disease is associated with left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction, both of which are associated with increased mortality and cardiovascular events. However, the effects of renal artery revascularization on cardiac morphology and function are poorly understood and largely based upon retrospective studies. In order to characterize changes in ventricular function and morphology following renal artery revascularization, we identified a cohort of patients with baseline preoperative echocardiograms and studied them with repeat echocardiography at 6-12 months postrevascularization. ⋯ Interval decreases in left ventricular mass were observed following renal artery revascularization, while diastolic function was largely unchanged. Regression of LVH has been associated with reduced mortality and cardiovascular morbidity, and further investigation is required to understand the long-term effects of renal revascularization on survival and ventricular function. Assessment of cardiac function in the setting of symptomatic renal artery stenosis should include evaluation for diastolic dysfunction, which may represent the predominant form of target organ damage in patients with this diagnosis.