Annals of vascular surgery
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Patients undergoing open abdominal aortic aneurysm (AAA) repair are at risk of perioperative infections that can lead to subsequent complications. Our goal was to understand how an initial infectious complication influences the risk of subsequent complications in this cohort of patients. ⋯ A postoperative nosocomial infection after open AAA repair is significantly more likely to lead to serious subsequent complications. Prevention and early identification of infectious index complications and subsequent complications could allow for interventions that could decrease morbidity and mortality.
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Prophylactic open surgery is the standard practice in patients with connective tissue and thoracoabdominal aortic aneurysm (TAAA) and aortic arch disease. Branched and fenestrated devices offer a less invasive alternative but there are concerns regarding the durability of the repair and the effect of the stent graft on the fragile aortic wall. The aim of this study is to evaluate mid-term outcomes of fenestrated and/or branched endografting in patients with connective tissue disease. ⋯ The favorable mid-term outcomes in this series that demonstrate fenestrated and/or branched endografting should be considered in patients with connective tissue and TAAA and aortic arch disease, which are considered unfit for open surgery. All patients require close lifetime surveillance at a center specializing in aortic surgery, with sufficient experience in both open and endovascular aortic surgery, so that if endovascular treatment failure occurs it can be recognized early and further treatment offered.
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Case Reports
Thrombolytic Therapy of Acute Massive Pulmonary Embolism Using Swan-Ganz Pulmonary Artery Catheter.
Acute massive pulmonary embolism (PE) is associated with high fatality, and catheter-directed thrombolytic therapy has been shown to be an efficacious treatment for this condition. We herein report a patient who developed acute massive PE but could not undergo the conventional catheter-directed thrombolytic therapy. A Swan-Ganz pulmonary artery catheter was placed at bedside to initiate immediate thrombolytic infusion, which resulted in dramatic clinical improvement. This report underscores a potential role of thrombolytic therapy via a transjugular pulmonary artery catheter in patients with acute massive PE who could not undergo the conventional catheter-based thrombolytic intervention.
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Comparative Study
Reintervention Rate after Open Surgery and Endovascular Repair for Nonruptured Abdominal Aortic Aneurysms.
We aim to determine the reintervention rate after open aortic aneurysm repair (OAR) or endovascular aneurysm repair (EVAR) according to compliance or noncompliance with the instructions for use (IFU) for commercial endovascular stent grafts. ⋯ In contrast to IFU EVAR group, the RFS and OS rates of non-IFU EVAR group were lower than in the OAR group during mid-term follow-up. Final endoleak was more frequent, and reintervention was more commonly performed in the non-IFU group than in the IFU group. Therefore, performing EVAR in non-IFU situations should be planned carefully.
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Despite advances in endovascular surgery, lower extremity arterial bypass (LEB) remains the gold standard treatment for severe, symptomatic Peripheral Arterial Disease. With recent changes in health care, there has been an increasing emphasis on reducing the hospital length of stay (LOS). The purpose of this study was to identify the postoperative complications, which occur after discharge from hospital and to find risk factors for developing such complications. ⋯ Wound infection is the most common complication after LEB. Most of these complications occur after discharge from hospital. Patients with risk factors for developing wound infections should be followed and closely monitored after discharge from the hospital.