Annals of vascular surgery
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Observational Study
The chimney technique in endovascular aortic aneurysm repair: late ruptures after successful single renal chimney stent grafts.
The chimney graft technique has been proposed as an alternative endovascular treatment of juxtarenal aortic aneurysms, extending the landing zone and enabling successful exclusion of the aneurysm with standard endograft devices. ⋯ Proximal type I endoleak constitutes a weak point of chimney graft interventions. Increased vigilance in surveillance of such patients to prevent late aneurysm-related complications is required. Additional research to identify potential poor prognostic morphologic indicators is expected.
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Patients at risk of mortality after amputation have not been well identified. We sought to devise a clinical index predicting 30-day mortality after amputation that would allow stratification of intensity of postoperative care. ⋯ More than one-third of deaths within 30 days of major amputation occur after discharge from acute care. A novel index to predict 30-day mortality after major amputation is described. Patients receiving a score ≥5 face a substantial risk of mortality and should be held in the hospital longer or, if discharged, receive closer postoperative follow-up.
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Comparative Study
Neurocognitive changes after eversion carotid endarterectomy under local anesthesia.
The effects of carotid endarterectomy (CEA) on cognitive function have yet to be fully elucidated. The aim of our study was to administer a battery of cognitive tests to identify any cognitive changes occurring in a consecutive series of patients who underwent CEA using the eversion technique under local anesthesia. ⋯ The effects on cognitive function of carotid stenosis, particularly CEA, is still a much debated issue. The data reported in the literature vary considerably, preventing any final conclusions from being drawn. The mechanisms capable of inducing changes in cognitive status after CEA have yet to be precisely clarified. In our study, a suitable battery of tests were used to analyze the trend of cognitive function correlating with eversion CEA under local anesthesia. Our results demonstrate substantially improved cognitive function after CEA, which was statistically significant in 7 of 10 tests. We surmise that the CEA procedure, per se, can help to protect patients against cognitive deterioration, especially in those <75 years of age.
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Review Case Reports Comparative Study
A shift toward endovascular repair for vascular complications in lumbar disc surgery during the last decade.
The purpose of this study is to evaluate 2 patients who underwent endovascular repair directly after acute life-threatening vascular injury complicating lumbar disc surgery, and to update an overview of the literature from 2002 to gain insights into characteristics, diagnosis, treatment, and outcomes of this rare, life-threatening complication. ⋯ Publication bias might play a role in the literature of this area because all cases survived surgery, whereas mortality rates for this condition are high. However, early recognition, diagnosis, and prompt surgical repair are essential to prevent fatal outcomes in vascular injuries complicating lumbar disc surgery. Endovascular repair is a minimally invasive, fast, and efficient treatment modality that is increasingly and preferably used because of its low morbidity and mortality.
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Multicenter Study Comparative Study
Effect of ethnicity and insurance type on the outcome of open thoracic aortic aneurysm repair.
Mortality and complication rates for open thoracic aortic aneurysm repair have declined but remain high. The purpose of this study is to determine the influence of ethnicity and insurance type on procedure selection and outcome after open thoracic aneurysm repair. ⋯ A high percentage of open thoracic procedures (45%) are performed urgently or emergently in the United States, which is associated with increased morbidity and mortality. Both ethnicity and payer status were associated with significant differences in surgical outcomes, including mortality and frequency of complications after open thoracic aortic aneurysm repair.