Annals of vascular surgery
-
Review Meta Analysis
The impact of carotid artery stenting on cognitive function in patients with extracranial carotid artery stenosis.
The effect of carotid artery stenting (CAS) on cognitive function in patients with extracranial carotid artery stenosis is equivocal. The aim of this study was to examine the impact of CAS on various domains of cognitive function. ⋯ CAS may be associated with improvement in global cognition, memory, and attention/psychomotor speed. There was no positive effect on executive function, language, and functional ability, but CAS was not associated with a decline in any area of cognitive function. Future studies in larger groups of patients are probably needed to fully investigate the long-term effect of CAS on cognition in patients with carotid artery stenosis.
-
Randomized Controlled Trial
Prospective study of a single treatment strategy for local tumescent anesthesia in Muller phlebectomy.
Ambulatory Muller phlebectomy for varicose veins can be performed under local anesthesia. However, subcutaneous injection of local tumescent anesthetics may cause discomfort because of acidity of the solution. Addition of sodium bicarbonate lowers the acidity of anesthetic solutions, which might cause less pain. The objective of this study was to study whether alkalinization of the local anesthetic solution with sodium bicarbonate 1.4% decreases perioperative pain during Muller phlebectomies. ⋯ Alkalinization of local anesthetic solution with sodium bicarbonate 1.4% significantly improves patient comfort during injection of local tumescent anesthesia.
-
Observational Study
The impact of perioperative red blood cell transfusions on postoperative outcomes in vascular surgery patients.
Red blood cell (RBC) transfusions are common in vascular surgery and aim to reduce tissue ischemia. However, the evidence that transfusions are beneficial is contradictory. This study evaluates the impact of perioperative transfusion (transfusion within 3 days of surgery) on 30-day postoperative outcomes in elective vascular surgery patients. ⋯ Perioperative transfusion is associated with a strongly increased risk of both 30-day CV events and mortality in elective vascular surgery patients.
-
Case Reports
Limitation of imaging in identifying iatrogenic aortic coarctation following thoracic endovascular aortic repair.
A 21-year-old male suffered blunt trauma from a motor vehicle accident causing thoracic aorta tear. The smallest available stent graft was deployed. Definitive repair was later performed using a 22 × 22 × 116 mm Talent Thoracic Stent Graft. ⋯ This case report demonstrates a need for wider availability and selecting appropriate stent graft in treating traumatic aortic injuries in young patients. It is the first case report of the inability of current imaging modalities in confirming stent collapse. Pressure gradient is a useful tool in confirming stent collapse when clinical scenario does not match CT findings.
-
Multidisciplinary amputation prevention teams decrease the frequency of major amputations by increasing the use of revascularization procedures and minor amputations. The outcomes of wound healing, wound recurrence, and ambulatory status are assumed to be improved but are not routinely reported. This study investigates the midterm outcomes of neuroischemic wounds treated by our multidisciplinary team. ⋯ Multidisciplinary limb salvage teams effectively heal wounds and maintain ambulatory status in patients with limb-threatening neuroischemic wounds. Patient specific factors, such as hindfoot or ankle wounds, can adversely influence the outcome. Even with aggressive care, healing can be prolonged and a substantial proportion of patients can be expected to have a recurrence, making subsequent surveillance mandatory. Our data also suggest that a coordinated amputation prevention program may help to minimize hospital readmissions in this high-risk population.