Annals of vascular surgery
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Angioedema is a localized swelling of sudden onset, often associated with angiotensin-converting enzyme (ACE) inhibitor use, that most commonly occurs in the face and neck. We present the case of a patient on long-term ACE inhibitor therapy for hypertension, who developed postoperative angioedema after carotid endarterectomy (CEA). The patient was initially misdiagnosed with an expanding cervical hematoma and underwent a surgical wound reexploration. Angioedema is a rare cause of neck swelling and upper airway distress occurring after CEA in patients treated with ACE inhibitors and should be considered in the differential diagnosis.
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Multicenter Study Comparative Study
Elective versus ruptured abdominal aortic aneurysm repair: a 1-year cost-effectiveness analysis.
Abdominal aortic aneurysm (AAA) is a life-threatening condition with an overall mortality of 80%. It predominantly affects men 65-74 years of age and is caused by focal distension of the main blood vessel in the abdomen. Most patients go undetected until their aneurysm ruptures. ⋯ The total costs of emergency AAA repair were pounds sterling 96,700.69, with a cost per life saved of pounds sterling 24,175.17. The total cost of elective AAA repair was pounds sterling 76,583.22, with a cost per life saved of pounds sterling 5,470.23. Emergency intervention for AAA was found to cost five times more than a planned intervention per life saved per year.
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Transluminal arterial stenting reduces vessel compliance and may alter accurate interpretation of flow velocities. We reviewed duplex ultrasonography (DUS) following carotid stenting to identify criteria indicative of severe recurrent stenosis. This is a single-center retrospective review of 158 carotid stenoses treated with carotid angioplasty and stenting (CAS) from April 2001 to December 2004. ⋯ Presumed restenosis and occlusion detected by DUS were confirmed in all cases with angiography. Restenosis or occlusion after CAS at our institution can reliably be detected by carotid duplex using cut-off values of 170 cm/sec PSV, 120 cm/sec EDV, and >50% increase over immediate postoperative values. While these criteria are applied to patients undergoing CAS at our institution, they serve only as suggested guidelines for patient populations at other centers and must be customized to each Intersocietal Commission for the Accreditation of Vascular Laboratories-accredited vascular laboratory.
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Comparative Study
Endovascular aneurysm repair versus open aneurysm repair: comparison of treatment outcome and procedure-related reintervention rate.
We conducted a retrospective study to compare treatment outcome and procedure-related reintervention rates of endovascular aneurysm repair (EVAR) with those of open repair. Clinical and radiological data of patients treated at the Rijnstate Hospital (Arnhem, The Netherlands) for nonsymptomatic aortic abdominal aneurysm during October 1998-January 2004 were reviewed and analyzed for demographic data, aneurysm specifics, comorbid condition status, and perioperative outcome. There were 99 patients treated with EVAR and 116 patients treated with open repair. ⋯ Follow-up of the EVAR group showed a decrease (mean 10 mm, 95% CI 7-14 mm) of aneurysm diameter in 15% of cases during follow-up (mean 18 months, range 1-66). Despite higher age and more comorbidity of patients undergoing EVAR, 30-day mortality, postoperative pulmonary infection rate, and length of hospital stay were lower than for those undergoing open repair. Both EVAR and open repair can be performed on a subset of patients with low mortality, complication, and reintervention rates.
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Historical Article
1992: Parodi, Montefiore, and the first abdominal aortic aneurysm stent graft in the United States.
In 1990 Juan C. Parodi performed the first endovascular abdominal aortic aneurysm (AAA) repair in Buenos Aires. ⋯ Since then the Montefiore/Einstein vascular group has performed 1522 endovascular grafts in 674 patients for many types of vascular lesions using a variety of both surgeon-made and industry-made devices. The purpose of the present article is to describe the events that surrounded the performance of the first seminal endovascular AAA repair at our institution on November 23, 1992.