Annals of vascular surgery
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We present a case of external iliac vein patch venoplasty to accommodate rescue vascular access via a polytetrafluoroethylene loop arteriovenous fistula graft (AVG) for a patient with multiple central venous stenoses. ⋯ Central venous stenosis can be treated successfully with patch venoplasty to accommodate AVF/AVG formation for rescue vascular access; this is a potentially lifesaving intervention for patients requiring dialysis.
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Comparative Study
Endovascular Repair of Ruptured Abdominal Aortic Aneurysm Is Associated with Lower Incidence of Post-operative Acute Renal Failure.
Acute renal failure (ARF) after surgical treatment of ruptured abdominal aortic aneurysm (AAA) is an independent predictor of post-operative mortality. Open repair for ruptured AAA has been the gold standard treatment; however, there has been a recent trend in increased utilization of endovascular repair (EVAR) for treatment of ruptured AAA. The purpose of this study was to retrospectively review and compare the incidence of ARF among patients treated with open versus endovascular repair of ruptured AAA. ⋯ Incidence of mortality and post-operative ARF for ruptured AAA is significantly higher when treated with open repair, as compared to EVAR. Totally dependent functional status was associated with post-operative mortality and ARF.
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Observational Study
Frailty and Geriatric Syndromes in Vascular Surgical Ward Patients.
Preoperative frailty is an important predictor of poor outcomes but the relationship between frailty and geriatric syndromes is less clear. The aims of this study were to describe the prevalence of frailty and incidence of geriatric syndromes in a cohort of older vascular surgical ward patients, and investigate the association of frailty and other key risk factors with the occurrence of one or more geriatric syndromes (delirium, functional decline, falls, and/or pressure ulcers) and two hospital outcomes (acute length of stay and discharge destination). ⋯ Frailty and geriatric syndromes were common in elderly vascular surgical ward patients. Frail patients and nonelective admissions were more likely to develop geriatric syndromes, have a longer length of stay, and be discharged to a higher level of care.
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Patient-centered quality outcomes such as disposition after surgery are increasingly being scrutinized. Preoperative factors predictive of nonhome discharge (DC) may identify at-risk patients for targeted interventions. This study examines the association among preoperative risk factors, frailty, and nonhome DC after elective vascular surgery procedures in patients living at home. ⋯ Frail home-dwelling patients undergoing elective vascular procedures are at high risk of not returning home after surgery. Preoperative frailty assessment appears to hold potential for counseling regarding postsurgery disposition and DC planning.
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This study sought to identify vascular injury patterns among combat-specific cavalry scout personnel within the Iraq and Afghanistan Wars. ⋯ The high rates of KIA and extremity amputation among cavalry scout soldiers with a vascular injury denotes the lethality of these combat injuries. Uniformly equipping soldiers with battlefield tourniquets and educating them on their prehospital use might improve the survivorship of those servicemembers sustaining a compressible vascular injury.