Annals of vascular surgery
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Comparative Study
Point-of-Care Ultrasound Performed by a Medical Student Compared to Physical Examination by Vascular Surgeons in the Detection of Abdominal Aortic Aneurysms.
The use of point-of-care ultrasound (POCUS) has become increasingly prevalent in medical practice as a non-invasive tool for focused bedside diagnosis. Consequently, some medical schools have begun implementing POCUS training as a standard in their medical school curriculum. The feasability and value of introducing POCUS training at the medical student level to screen for abdominal aortic aneurysms (AAA) should be explored. Given this, the objective of our study was to determine the test characteristics of point-of-care ultrasonography performed by a medical student versus physical examination by vascular surgeons compared to a gold standard reference scan for the detection of AAAs. ⋯ Point-of-care ultrasonography performed by a medical student is highly accurate and more effective in detecting AAAs than physical examination by vascular surgeons. The introduction of POCUS training at the medical student level and its wide-scale implementation as an extension to physical examination may lead to improved detection of AAAs.
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Catheter-directed thrombolysis (CDT) is a therapeutic option with acceptable results in patients with acute limb ischemia (ALI) but with severe systemic or intracranial bleeding being the most significant clinical complication. The aim of the study is to collect and present direct results of CDT in patients treated for ALI. ⋯ Results confirm the high direct technical success rate of CDT and the high percentage of patients survived without amputation within 30 days, although major complications are a great disadvantage of the method.
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Comparative Study Observational Study
Nationally Representative Readmission Factors in Patients with Claudication and Critical Limb Ischemia.
Hospital readmissions are associated not only with increased mortality, morbidity, and costs but also, with current health-care reform, tied to significant financial and administrative penalties. Some studies show that patients undergoing vascular surgery may have higher than average readmission rates. The recently released Nationwide Readmission Database (NRD) is the most comprehensive national source of readmission data, gathering discharge information from 22 geographically dispersed states, accounting for 51.2% of the total U.S. resident population and 49.3% of all U.S. hospitalizations. The aim of this study is to use the power of the NRD and obtain nationally representative readmission information for patients admitted with claudication or critical limb ischemia (CLI) who underwent revascularization procedures. ⋯ Care management/epidemiological, level IV.
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Case Reports
Acute Renal Vein Thrombosis: A Case Report of Successful Treatment with Mechanical Thromboaspiration.
Treatment of renal vein thromboses has previously been limited to conventional anticoagulation. We describe a case of successful treatment of acute native renal vein thrombosis (RVT) in a 61-year-old fit-and-well female using mechanical thromboaspiration without the use of thrombolysis. The report demonstrates the computed tomographic appearances of an acute RVT, the venographic images taken before and after thromboaspiration, and the magnetic resonance imaging of the kidney performed 3 months later, showing complete resolution of the thrombus and normal appearances of the kidney. We believe this case to be the first published case of a safe and successful treatment of acute native RVT using the Penumbra Indigo® mechanical aspiration system, highlighting the importance of access to skilled interventional radiologists for treatment of this rare condition.
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Prior studies have shown that octogenarians have a higher risk of mortality than nonoctogenarians undergoing open aneurysm repair (OAR) and endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Fenestrated endovascular aneurysm repair (F-EVAR) was approved by the Food and Drug Administration (FDA) in 2012 and has been used as a less invasive approach to treat patients with suboptimal neck anatomy with favorable outcomes compared with traditional OAR. The aim of the study is to compare 30-day outcomes of F-EVAR versus OAR in octogenarians undergoing repair of AAA involving the visceral vessels in the United States. ⋯ In this large national cohort of octogenarians undergoing repair for complex AAA's, we showed that F-EVAR is associated with significantly lower postoperative morbidity and mortality than open repair. One of the main limitations of the study is the lack of anatomical data. However, despite that, our findings support the shifting paradigm toward minimally invasive approach in this frail population for treatment of complex AAA's. Further studies are needed to evaluate the long-term benefit of any repair in octogenarians.