Annals of vascular surgery
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A 68-year-old man, having right-sided aortic arch (RAA), underwent thoracic endovascular aortic repair (TEVAR) to treat Stanford B type dissection with the chimney technique to extend the proximal landing zone between his right subclavian artery and left subclavian artery (LSA). Six-month follow-up showed that there was sufficient cerebral infusion and positive aortic remodeling, and the chimney stents were patent. The results show the safety and effectiveness of chimney TEVAR for Stanford type B dissection in patients having RAA with an aberrant LSA who have no sufficient proximal fixation zone.
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Traumatic injuries of the head and neck present a difficult diagnostic and therapeutic challenge when identified in a delayed manner. Pseudoaneurysm formation has been reported in the literature typically with regard to blunt mechanisms; however, a delayed presentation following penetrating injury is a rare finding, much less described. In this case report, we describe a pseudoaneurysm of the common carotid artery as a result of penetrating trauma to the thorax.
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Compared with other common chronic conditions, admissions for management of peripheral arterial disease (PAD) are associated with prolonged hospitalizations. Length of stay (LOS) is one of many metrics receiving increased attention in the current focus on efficient healthcare delivery. Our objective was to characterize LOS among patients with severe PAD, those undergoing surgical bypass for critical limb ischemia (CLI), and identify risk factors for protracted postoperative LOS. ⋯ Here, we identify preoperative risk factors for protracted postoperative LOS after infrainguinal bypass for CLI. These findings provide an important evidence basis for ongoing efforts to reduce healthcare spending and facilitate provision of efficient health care. Future efforts will include prospective identification of patients at high risk for protracted postoperative LOS and targeted multidisciplinary efforts to reduce associated costs without sacrificing healthcare quality.
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Review Meta Analysis
The influence of study design on the evaluation of ruptured abdominal aortic aneurysm treatment.
The best strategy in the treatment for ruptured abdominal aortic aneurysm (RAAA) is an ongoing matter of debate. Differently from several retrospective studies, recent randomized controlled trials (RCTs) failed to demonstrate the superiority of endovascular repair (EVAR) over open repair (OPEN). The aim of the present study was to compare 30-day mortality of EVAR and OPEN in RAAA according to different study designs through a systematic review and meta-analysis. ⋯ Only few studies are available to compare EVAR and OPEN in an "unbiased" cohort, with no significant differences between the 2 treatments. However, after the introduction of EVAR and OPEN protocols, the overall mortality for RAAA was reduced compared with the only OPEN option, suggesting a beneficial effect of EVAR in selected cases.
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Multicenter Study Comparative Study
Predictors affecting in-hospital mortality of ruptured abdominal aortic aneurysms: a Greek multicenter study.
Endovascular aortic repair (EVAR) is being used with increasing frequency for the treatment of ruptured abdominal aortic aneurysms (rAAAs), although conflicting results have been reported concerning perioperative mortality. The aim of our study was to evaluate potential difference in mortality rates between EVAR and open surgical repair (OSR) and identify independent risk factors for in-hospital mortality in rAAAs. This study also aimed to evaluate the Glasgow Aneurysm Score (GAS) in predicting in-hospital mortality. A time-trend analysis of EVAR for ruptured AAAs was also performed. ⋯ EVAR is being used with increasing frequency for the treatment of rAAAs and it appears to be associated with lower in-hospital mortality compared with OSR, after adjustment for hemodynamic instability and known atherosclerotic risk factors. Preoperative predictors of in-hospital mortality such as GAS should be probably modified in these patients.