Annals of vascular surgery
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Aortoenteric fistulae require urgent definitive intervention and traditionally carry a high mortality. We describe a patient who suffered a traumatic aortic dissection following an auto versus pedestrian collision. He underwent open fenestration of his infrarenal aorta and visceral resection, complicated by abdominal sepsis and enterocutaneous fistulae. ⋯ Due to an impassable abdominal wall, a stent-graft repair was performed. This report describes the successful use of endovascular techniques to achieve immediate hemostasis in an actively hemorrhaging aortoduodenal fistula. An endovascular approach provides a valuable option in settings where a hostile abdomen precludes the traditional open technique and may serve as a bridge to later definitive repair.
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Case Reports
Primary pulmonary artery sarcoma: difficult differential diagnosis from chronic pulmonary thromboembolism.
Pulmonary artery sarcoma is a rare malignant tumor. The disease is frequently misdiagnosed as chronic pulmonary thromboembolism because of the similar clinical and radiologic findings. We present a case of primary pulmonary artery sarcoma that was misdiagnosed as chronic pulmonary thromboembolism, and discuss the clinical presentation, diagnosis, and outcome.
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Comparative Study
Efficacy and vasodilatory benefit of magnesium prophylaxis for protection against spinal cord ischemia.
Prevention of paraplegia remains an imperative issue in thoracoabdominal aortic surgery. The aim of this study was to assess the efficacy of a prophylactic magnesium infusion in a rat spinal cord ischemia model and to demonstrate spinal blood flow increase caused by the infusion. The study was conducted in two parts. ⋯ In conclusion, magnesium may have potential prophylactic benefits during ischemia by exerting a neuroprotective effect through vasodilation of the spinal cord vasculature. To our knowledge, this vasodilatory effect on the spinal cord has not previously been investigated. Optimization of the treatment regimen, however, is required.
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We present preliminary results and analysis of a screening program that has been offered at a community-based hospital since July 2004. The program includes a quick carotid ultrasound study, abdominal aortic ultrasound imaging, and measurement of bilateral ankle/brachial indices (ABI). From July 2004 through January 2006, 1,719 patients were screened, including 1,094 (64%) women and 652 (36%) men. ⋯ This nonselective vascular screening program attracted many new patients into the health-care system. The open/endovascular procedure yield was low, but early disease detection was significant, causing numerous patients to be referred for additional testing and risk factor modification programs. These preliminary data suggest that community-based vascular screening programs play a key role in early vascular disease detection and provide the potential for prevention of disease progression while, at the same time, building sustainable business for hospitals and physicians.