Annals of vascular surgery
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Frailty syndrome is an established predictor of adverse outcomes after carotid surgery. Recently, a modified 5-factor National Surgical Quality Improvement Program frailty index has been used; however, its utility in vascular procedures is unclear. The aim of our study was to compare the 5-factor modified frailty index (mFI-5) with the 11-factor modified frailty index (mFI-11) regarding value and predictive ability for mortality, postoperative infection, and unplanned 30-day readmission. ⋯ The mFI-5 and mFI-11 are equally effective predictors of postoperative outcomes in patients undergoing carotid endarterectomy. mFI-5 is a strong predictor of postoperative complications, mortality, and 30-day readmission.
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Multicenter Study Comparative Study
Operative Treatment and Clinical Outcomes in Peripheral Vascular Trauma: The Combined Experience of Two Centers in the Endovascular Era.
Arterial traumas of the extremities are quite rare in civilian records; nevertheless, patients with trauma of limbs are admitted daily in emergency departments worldwide. The up-to-date information about epidemiology and treatment (open vs. endovascular surgery) comes from war records and it is not always easy getting data on mortality and morbidity in these patients. The aim of this study is to analyze the approach (open or endovascular) and the outcome of patients with vascular trauma of upper limbs (from the subclavian artery) and/or lower limbs (distal to the inguinal ligament), in the greater Milan area. ⋯ Isolated arterial trauma of the extremities are rare, usually they occur in the setting of multiple trauma patients. Despite progresses in surgical techniques, there are still controversies in diagnosis and treatment of these patients. We treated most cases with open surgery (n = 46), choosing endovascular approach (embolization performed mainly by interventional radiologists) in difficult anatomic districts. We believe that, during decision-making of the surgical strategy, it is important to consider the anatomical site of lesions and the general condition of the patients. Moreover, in case of multiple trauma, we suggest a multidisciplinary approach to provide the best medical care to the victims.
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Comparative Study Observational Study
Analysis of Limb Outcomes by Management of Concomitant Vein Injury in Military Popliteal Artery Trauma.
Despite aggressive limb salvage attempts, military popliteal artery injuries are associated with high amputation rates. Combined arterial and venous injuries present a management dilemma for military surgeons in austere settings, and the impact of vein injury management strategy on limb outcomes is not clear. ⋯ Type of management of concomitant popliteal vein injury was not associated with early or late amputation in this series of military popliteal artery injuries. Vein injury management may have had implications for the development of arterial graft and limb complications, however. Surgical decision-making regarding popliteal vein treatment should balance short-term contingencies with long-term limb salvage issues.
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Same-day cancellation of vascular surgical procedures is an undesirable occurrence with multifaceted implications into the patient's health care. Numerous factors play a role in same-day cancellations, ranging from medical causes, patient factors, or administrative and scheduling conflicts. ⋯ At our institution, same-day cancellations of vascular surgical procedures were infrequent (2%). Most cancellations were due to medical reasons. Although most cancellations were determined to be nonforeseeable, emphasizing foreseeable cancellations may provide opportunities to improve patient care, enhance satisfaction, and reduce future cancellations.
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The optimal surgical approach and treatment algorithm for thoracic outlet syndrome (TOS) remain controversial. We sought to examine the outcomes of patients treated at a military medical treatment facility (MTF) for TOS. ⋯ Despite a variety of surgical approaches and often delayed presentation, we identified a high percentage of postoperative vein patency and return to AD status in our population. The debate over surgical approach remains; however, a multimodal approach individualized to the patient's presentation and meticulous surgical technique led to successful outcomes in our healthy military population.