Annals of vascular surgery
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Simulation modules allow for the safe practice of certain techniques and are becoming increasingly important in the shift toward education for integrated vascular residents. There is an unquestionable need to standardize the evaluation of trainees on these simulation models to assure their impact and effectiveness. We sought to validate such an assessment tool for a basic open vascular technique. ⋯ Performance on an open simulation model evaluated by a standardized global rating scale correlated to trainee experience level. This initial work confirms the ease and applicability of the grading tool among multiple expert observers and different platforms, and supports additional; research into applications translating this performance into the operating room.
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Large randomized controlled trials have shown that carotid endarterectomy (CEA) is beneficial in the treatment of recent severe symptomatic carotid stenosis. Data are lacking concerning the risks of early CEA (<48 hours) for stroke in evolution (SIE) or crescendo transient ischemic attack (CTIA). The primary end point of this retrospective study was to evaluate the incidence of stroke, major adverse cardiac events (MACEs), and death within the first 30 days after early CEA performed within 48 hours in patients presenting with transient ischemic attack (TIA)/SIE. ⋯ CEA can be performed with an acceptable risk in properly selected symptomatic patients within 48 hours after TIA or SIE. The benefits of early CEA in symptomatic patients include the prevention of recurrent stroke.
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Perioperative stroke is a devastating complication after cardiac surgery. In an attempt to minimize this complication, many cardiac surgeons routinely preoperatively order carotid artery duplex scans to assess for significant carotid stenosis. We hypothesize that the routine screening of preoperative cardiac surgery patients with carotid artery duplex scans detects few patients who would benefit from carotid intervention or that a significant carotid stenosis reliably predicts stroke risk after cardiac surgery. ⋯ The majority of postoperative strokes after cardiac surgery are not related to extracranial carotid artery disease and they are not predicted by preoperative carotid artery duplex scan screening. Consequently, universal carotid artery duplex scan screening cannot be recommended and a selective approach should be adopted.
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The adjunctive use of a preoperative cerebrospinal fluid (CSF) drain and/or left subclavian artery (LSA) bypass for thoracic endovascular aortic repair (TEVAR) to minimize neurologic complications remains controversial. ⋯ Our use of adjunctive procedures for TEVAR demonstrated better SCI results compared with those of prior reports of selective CSF drainage when SCI arises. Our approach was associated with improved 1-year survival. Preoperative CSF drain placement allows for rapid, intensive therapy for SCI and should be considered when clinically feasible.
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We sought to evaluate the incidence, epidemiology, and factors associated with surgical site infections (SSIs) after lower extremity revascularization procedures involving groin incisions and determine outcomes based on SSI status. ⋯ The incidence of postoperative surgical site complications after lower extremity revascularization procedures involving a groin incision was 31% and was significantly associated with blood transfusion, postoperative seroma or hematoma, dyslipidemia, and statin usage. After adjusting for differences in patient and operative variables, postoperative seroma or hematoma was an independent predictor of SSI. Patients with a SSI have a longer duration of hospitalization and higher reoperative rate. Additional prospective cohort studies are warranted to delineate ways to decrease the rate of SSI.