European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
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Eur J Vasc Endovasc Surg · Nov 2009
ReviewThe value of near-infrared spectroscopy measured cerebral oximetry during carotid endarterectomy in perioperative stroke prevention. A review.
Transcranial Doppler (TCD) for identification of patients at risk for cerebral hyperperfusion syndrome (CHS) following carotid endarterectomy (CEA) cannot be performed in 10-15% of patients because of the absence of a temporal bone window. Near-infrared spectroscopy (NIRS) may be of additional value in these patients. We aimed to (1) compare the value of NIRS related to existing cerebral monitoring techniques in prediction of perioperative cerebral ischaemia and (2) compare the relation between NIRS and the occurrence of CHS. ⋯ NIRS seems a promising monitoring technique in patients undergoing CEA. Yet the evidence to define clear cut-off points for the presence of perioperative cerebral ischaemia or identification of patients at high risk of CHS is limited. A large prospective cohort study addressing these issues is urgently needed.
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Eur J Vasc Endovasc Surg · Nov 2009
ReviewPerioperative blood glucose monitoring and control in major vascular surgery patients.
Diabetes mellitus (DM) is an independent predictor for morbidity and mortality in the general population, which is even more apparent in patients with concomitant cardiovascular risk factors. As the prevalence of DM is increasing, with an ageing general population, it is expected that the number of diabetic patients requiring surgical interventions will increase. Perioperative hyperglycaemia, without known DM, has been identified as a predictor for morbidity and mortality in patients undergoing surgery. ⋯ In addition, concerns on the external validity of some studies are important barriers for widespread recommendation of intensive glucose control in the perioperative setting. We propose that guidelines recommending intensive glucose control should be re-evaluated. In addition, moderate tight glucose control should currently be regarded as the safest and most efficient approach to patients undergoing major vascular surgery.
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Eur J Vasc Endovasc Surg · Nov 2009
Case ReportsSuccessful endovascular repair of acute type B aortic dissection in undiagnosed Ehlers-Danlos syndrome type IV.
A 61-year-old man presented with an acute type B aortic dissection for which a stent-graft was introduced. He remains complication-free 4 years onwards and has since been diagnosed with Ehlers-Danlos syndrome type IV (EDS IV). His particular mutation is predicted to result in lesser levels of normal collagen and may explain his favourable outcome from endovascular intervention. Understanding the genotype-phenotype correlation may influence the choice of therapy offered to patients with EDS IV.
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The collateral function of the external carotid artery (ECA) for cerebral perfusion in cases of atherosclerotic occlusive disease of the internal carotid artery (ICA) is difficult to assess; for this reason, blood flow measurements were taken during carotid endarterectomy (CEA). ⋯ Increased blood flow in the ICA after CEA is accompanied by decreased ECA flow whereupon the absolute amount of this redistribution is relatively limited. A more profound evaluation of these haemodynamic conditions demands further study.