Annals of vascular surgery
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Multicenter Study Comparative Study
Open versus endovascular repair of ruptured abdominal aortic aneurysms.
Management of ruptured abdominal aortic aneurysms (rAAA) remains one of the most challenging situations in vascular surgery. The aim of our study was to examine national trends and compare contemporary outcomes of open and endovascular repair (EVAR) for rAAA across a wide spectrum of hospitals in the United States. ⋯ EVAR is a safe and, in appropriately selected patients, superior approach to open surgery for the management of patients with rAAA. On multivariate analysis, patients who underwent open repair were at significantly increased risk of morbidity and mortality. In clinical settings where adequate resources, personnel, and surgical expertise are present, an endovascular approach should be strongly considered for all patients with acceptable anatomy.
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Endovascular repair of thoracic aortic pathology has become increasingly common over the last decade. We highlight the case of an intentionally occluded left subclavian artery stump acting as a source of emboli after thoracic endovascular aneurysm repair (TEVAR) for type B dissection. ⋯ Consideration should be given to ligating the subclavian artery immediately proximal to the vertebral artery origin when performing adjunctive carotid subclavian bypass during TEVAR. If this is not done, surveillance computed tomography scans should monitor for the development of propagating thrombus in the subclavian stump.
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To prevent ischemia during carotid endarterectomy, a routine or selective shunt can be set up in cases of insufficient cerebral perfusion during the carotid clamping. The aim of this study was to analyze predictive factors for shunting under locoregional anesthesia and to validate a risk index to predict shunt. ⋯ We have established the first version of a score that predicts the need for a shunt by studying factors associated with intolerance to clamping. The relevance of this score, validated in our series, must be confirmed and adjusted by studies based on a larger sample size.
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A case of successful total endovascular repair of a right-sided descending thoracic aorta aneurysm (r-DTAA) with Kommerell diverticulum and aberrant left subclavian artery (ALSA) was reported. Few cases of this very rare pathology were reported, mostly describing a hybrid treatment, with only 2 cases of total endovascular repair performed to date. ⋯ Endovascular repair can be a safe and effective treatment for aortic disease with challenging anatomy, avoiding the need for a complex open surgery procedure.
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Patients undergoing major lower extremity amputation (MLEA) for peripheral arterial disease are often elderly, debilitated, and fraught with medical comorbid conditions that place them at high risk for surgical intervention. Data from lower extremity revascularization surgeries are often extrapolated to determine which anesthetic modality to use for amputations, with preference given to regional anesthesia. However, there is little evidence to support the use of one mode of anesthesia over another. We conducted this study to determine the effect of anesthetic modality on the clinical outcomes of patients undergoing above- or below-knee amputations. ⋯ Regional anesthesia for patients undergoing MLEA is associated with a lower incidence of postoperative pulmonary complications and cardiac arrhythmias. It is also associated with lower resource use. As such, regional anesthesia should likely be the favored anesthetic modality for patients undergoing MLEA.