Annals of vascular surgery
-
Cardiovascular complications, such as death, myocardial infarction, or heart failure, are the leading causes of morbidity and mortality in adult patients undergoing major noncardiac surgery. ⋯ These data suggest a significant benefit of an intensive cardiac preoperative evaluation in reducing the incidence of perioperative and postoperative cardiac morbidity and mortality.
-
In response to economic and societal pressures, a new integrated model of vascular surgery training has emerged that will condense training into 5 years. These new requirements challenge educators to develop innovative training programs that produce competent surgeons despite time constraints. Surgical skills simulation is a proven effective method to teach and evaluate learners in surgery residency programs. ⋯ Our needs assessment identified vascular procedures where simulation may be beneficial to improve the skill level of vascular trainees in Southern California. With economic and logistical constraints for simulation at each individual training facility, a potential approach to this educational challenge is a regional Southern California vascular surgery skills simulation center.
-
Conventional repair of aortic arch pathology is associated with significant mortality and stroke rates of 6-20% and 12%, respectively. Because endografting has excellent results for descending thoracic aortic disease, extension of thoracic endovascular repair (TEVAR) to the arch is a consideration. ⋯ TEVAR can effectively treat aortic arch pathology in high-risk patients with low morbidity and mortality. TEVAR and branch vessel revascularization techniques may be extended to the more proximal arch without increased complications compared with patients with subclavian only involvement. Stroke remains the most significant drawback of arch interventions. Indications for intervention, graft selection, and revascularization choices may all affect outcome. LSA sacrifice is associated with increased SCI and may predispose left-handed patients to symptomatic weakness.
-
Superior mesenteric artery (SMA) syndrome is a rare condition, which results in compression of the third portion of the duodenum by a narrow-angled SMA against the aorta. We report a case of a patient treated for chronic mesenteric ischemia, who developed an SMA-like syndrome as a result of the compression of the duodenum between an SMA stent and an inferior mesenteric artery (IMA) stent. ⋯ To our knowledge, this is the first report of duodenal obstruction caused as a result of the complications caused by multiple stent placements, which gave an impression of SMA-like syndrome.
-
Comparative Study
Massive and submassive pulmonary embolism: experience with an algorithm for catheter-directed mechanical thrombectomy.
The role of catheter-directed mechanical thrombectomy (CDMT) for the treatment of massive pulmonary embolism (MPE) and submassive pulmonary embolism (SMPE) is not clearly defined. We report our experience with an algorithm for CDMT as a primary treatment in patients with MPE and SMPE. ⋯ CDMT as primary treatment of MPE and SMPE has a high rate of technical and clinical success in a high-risk patient population. Experience and strict patient selection criteria may improve therapeutic outcomes.