Annals of vascular surgery
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Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease (PAD). Patients who are transferred to other hospitals have generally complex medical problems compared to those patients who are directly admitted from home. The purpose of this study is to identify factors associated with an interfacility transfer in patients with PAD and compare the postoperative outcomes of these patients to those who are directly admitted to the hospital. ⋯ Multiple factors affect an interfacility transfer of patients including advanced age, need for emergency procedure, contaminated wounds. Patients who are transferred from another institution for a lower extremity bypass surgery are at a substantially higher risk for postoperative morbidity and mortality.
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Ultrasound screening shows a clinical benefit in reducing abdominal aortic aneurysm (AAA)-related mortality. However, its cost-effectiveness remains unclear. Understanding the relationship between risk factors and AAA is important to maximize the benefit of AAA screening. However, risk factors for AAA have not been reported in Korea. The purpose of this study is to determine the prevalence of, and risk factors for, AAA among the Korean population. ⋯ The prevalence of AAA was 2.0% in men and 0.4% in women. Male sex, old age, smoking, alcohol use, and pulmonary disease are possible risk factors for AAA in the general Korean population. Smoking is the strongest risk factor for the development of AAA.
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Case Reports
Emergency Hybrid Approach to Ruptured Femoral Pseudoaneurysm in HIV-positive Intravenous Drug Abusers.
Chronic traumatism of the common femoral artery due to intravenous injection in drug abusers, in association with local infections and arterial wall weakening caused by human immunodeficiency virus (HIV), can lead to the development of pseudoaneurysms (PSAs). Rupture of PSA is a dramatic event in such patients, and its correction is difficult and controversial. Most of the cases reported describe open surgical elective options, which consist in ligation, repair, or substitution of the damaged arterial segment, using when possible biological grafts. In literature, few cases describe an endovascular repair with covered stent deployment. ⋯ The favorable results and progressive healing of wound and local infections persuaded us not to perform any further surgical correction. The absence of recurrences and late complications, after 3 years in the first case and 1 year in the second one, lead us to consider this hybrid endovascular approach as a valuable alternative to open surgery in HIV intravenous injection in drug abuser patients, in particularly when emergency conditions occur.
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These last years, considerable attention has been given to renal issues following endovascular aortic repair but acute kidney injury (AKI) also remains one of the most frequent complications following open repair (OR). Since AKI definition has evolved, our aim was to review the etiology, incidence, classifications, and consequences of AKI after OR for intact abdominal aortic aneurysm (AAA). ⋯ AKI is a common but generally transient complication after OR for AAA. Its incidence depends on definitions used, and few studies were found to use recent consensual AKI criteria. In the future, large prospective studies using consensual AKI definitions will facilitate comparison between repair strategies.
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Medical care in the United States has evolved into a more cost-conscious value-based health care system that necessitates a comparison of costs when there are alternative interventions considered to be acceptable in the treatment of a disease. This study compares the cost differences between regional anesthesia (RA) and general anesthesia (GA) for carotid endarterectomy (CEA). ⋯ Decreased cost, operating room expenses, postoperative resources, and overall LOS were observed for individuals who underwent RA for CEA as compared with GA. In summary, RA is more cost-effective and should be the optimal choice when clinically appropriate.