Annals of vascular surgery
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Intravascular ultrasound (IVUS) examination may provide useful information during endovascular procedures. However, its actual clinical utility for carotid stenting remains unclear. We evaluated the usefulness of IVUS as a complementary tool during endovascular procedures in the carotid arteries and its impact on the modification of the therapeutic strategy. ⋯ IVUS examination provides complementary information to that obtained using conventional diagnostic procedures. It may be useful for characterizing the composition and measurement of the target lesion, choosing the type and size of the stent, and evaluating the results after the procedure.
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Randomized Controlled Trial
Effect of N-acetylcysteine in attenuating ischemic reperfusion injury in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.
Ischemic reperfusion injury due to oxidative stress remains one of the challenging problems during cardiac surgeries. The imbalance in the production of free radicals and antioxidants in vivo determines the extent of oxidative stress. The use of antioxidants in cardioplegia has become an important strategy to salvage the myocardium from the attack of these radicals. ⋯ The use of NAC in patients undergoing coronary artery bypass grafting using cardiopulmonary bypass decreased oxidative stress substantially. However, it did not lead to improvement in the level of cardiac troponin I, a marker of myocardial injury, in our study. Hence, the cardioprotective effect of NAC and the adaptation of the myocardium to oxidative stress should be extensively studied.
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The placement of central catheters is a common procedure. It is also associated with multiple known complications. One of the potential complications that carry high morbidity and morality is arterial puncture and cannulation. Herein, we describe five case reports of a central line that was inadvertently placed in the subclavian artery and successfully removed using a StarClose device (Abbott Laboratories, Redwood CA). ⋯ Based on our limited experience, we feel that this method can be performed safely and expeditiously not only in the operating room but also at the bedside.
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Gluteal artery aneurysms are rare and mostly secondary to blunt or penetrating trauma. As an absolute rarity, we report an exceptional presentation of bilateral mycotic aneurysm of the superior gluteal artery in a 16-year-old boy associated with bacterial endocarditis. The left pseudoaneurysm was ruptured and treated using open surgery; 1 week later, the right location was successfully treated by embolization.
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The management of blunt descending thoracic aortic injury remains controversial. Despite emerging evidence touting the advantage of endovascular repair in civilian trauma, there have been no reports on the application of this management strategy in the austere environment of war. We provide a case report from the 332nd EMDG/Air Force Theater Hospital, Balad Air Base, Iraq. ⋯ This report details the first endovascular treatment of blunt aortic injury in wartime and represents a sustained commitment to advance innovative endovascular capability closer to the time of injury. Although controversial, this less invasive approach is appealing in patients with high injury severity scores, making its availability in wartime especially germane.