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 · Jan 2010
Re-interventions, readmissions and discharge destination: modern metrics for the assessment of the quality of care.
To determine whether administrative data can be used to determine metrics to inform the quality agenda. To determine the relationship between these metrics and the method of abdominal aortic aneurysm (AAA) repair undertaken. ⋯ Administrative data can be used to identify metrics other than mortality and length of stay. These metrics might be used to inform service provision. In particular for AAA repair, differences in these outcomes were identified between open repair and EVAR and between octogenarians and younger patients.
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Eur J Vasc Endovasc Surg · Jan 2010
Asymptomatic low ankle-brachial index in vascular surgery patients: a predictor of perioperative myocardial damage.
This study evaluated the prognostic value of asymptomatic low ankle-brachial index (ABI) to predict perioperative myocardial damage, incremental to conventional cardiac risk factors imbedded in cardiac risk indices (Revised Cardiac index and Adapted Lee index). ⋯ In total, 148 (23%) patients had asymptomatic low ABI (mean 0.73, standard deviation+/-0.13). Perioperative myocardial damage was recorded in 107 (18%) patients. Multivariate regression analyses demonstrated that asymptomatic low ABI was associated with an increased risk of perioperative myocardial damage (odds ratio (OR): 2.4, 95% CI: 1.4-4.2) CONCLUSIONS: This study demonstrated that asymptomatic low ABI has a prognostic value to predict perioperative myocardial damage in vascular surgery patients, incremental to risk factors imbedded in conventional cardiac risk indices.
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Eur J Vasc Endovasc Surg · Dec 2009
Management of inadvertent arterial catheterisation associated with central venous access procedures.
This study aims to describe the clinical management of inadvertent arterial catheterisation after attempted central venous catheterisation. ⋯ Inadvertent arterial catheterisation during central venous cannulation is associated with obesity, emergency puncture and lack of ultrasonic guidance and should be suspected on retrograde/pulsatile catheter flow or local haematoma. If arterial catheterisation is recognised, the catheter should be left in place and the patient be referred for percutaneous/endovascular or surgical management.
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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.