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 · Jun 2009
ReviewAtherosclerosis and disc degeneration/low-back pain--a systematic review.
Atherosclerosis can obstruct branching arteries of the abdominal aorta, including four paired lumbar arteries and the middle sacral artery that feed the lumbar spine. The diminished blood flow could result in various back problems. The aim of this systematic literature review was to assess associations between atherosclerosis and disc degeneration (DD) or low-back pain (LBP). ⋯ Aortic atherosclerosis and stenosis of the feeding arteries of the lumbar spine were associated with DD and LBP. Cardiovascular risk factors had weaker associations, being clearly apparent only in cohorts on elderly people or in large study samples. More prospective clinical studies are needed to further clarify the association of atherosclerosis and low-back disorders.
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Eur J Vasc Endovasc Surg · Jun 2009
ReviewPrevention of paraplegia during thoracoabdominal aortic aneurysm repair.
Paraplegia affects up to 22% of patients undergoing thoarcoabdominal aneurysm surgery, producing long-term morbidity and a significant burden to healthcare. This article discusses the mechanisms that may lead to paraplegia during open and endovascular repair from an anatomical and physiological perspective. There are many adjuncts that must be considered to reduce the risk of spinal cord injury, such as revascularisation of intercostal arteries, maintenance of high mean blood pressure, spinal cord drainage and cooling. These adjuncts are discussed, highlighting the evidence available for each method and the practical ways in which they may be used.
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Eur J Vasc Endovasc Surg · Jun 2009
Randomized Controlled Trial Comparative StudyLow molecular weight heparin significantly reduces embolisation after carotid endarterectomy--a randomised controlled trial.
The administration of unfractionated heparin (UFH) prior to carotid clamping during carotid endarterectomy (CEA) transiently increases the platelet aggregation response to arachidonic acid (AA) despite the use of aspirin. We hypothesized that this phenomenon might be reduced by using low molecular weight heparin (LMWH) resulting in fewer emboli in the early post-operative period. ⋯ Intravenous LMWH is associated with a significant reduction in post-operative embolisation without increased bleeding. The higher rate of embolisation seen with UFH may be mediated by increased platelet aggregation to ADP, rather than to AA.
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Eur J Vasc Endovasc Surg · May 2009
Randomized Controlled Trial Comparative StudyCombined aspirin and cilostazol treatment is associated with reduced platelet aggregation and prevention of exercise-induced platelet activation.
Cilostazol has proven efficacy in increasing walking distance in claudicants, but it has not been demonstrated to be more effective than placebo in secondary cardiovascular prevention. The direct effect of exercise on platelet function remains less well defined. We have investigated the effect of combination treatment with aspirin and cilostazol on platelet activity in claudicants subjected to repeated treadmill exercise. ⋯ Combination treatment with aspirin and cilostazol results in suppression of platelet activation and reduces the effect of exercise on platelets. The benefit seen may be a result of cilostazol enhancing the inhibitory effect of aspirin on the cyclo-oxygenase pathway.
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Eur J Vasc Endovasc Surg · May 2009
Randomized Controlled Trial Comparative StudyEffect of postoperative restrictive fluid therapy in the recovery of patients with abdominal vascular surgery.
To compare the outcome of the postoperative administration of a restricted or standard intravenous fluid regimen in patients who underwent elective abdominal vascular surgery. The primary end point was postoperative hospital stay. ⋯ The use of a restrictive postoperative fluid protocol significantly reduces the duration of hospital stay in patients who have undergone major elective abdominal vascular surgery.