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 · Feb 2004
Visceral and renal tissue oxygenation during supraceliac aortic crossclamping and left heart bypass with selective organ perfusion.
Left-heart bypass (LHB) and selective organ perfusion (SOP) are used during thoracoabdominal aortic surgery to prevent ischemic damage to the kidneys and visceral organs after supraceliac aortic crossclamping. We studied the hypothesis, in a porcine model, that despite LHB and maximal SOP, visceral and renal ischemia still occurred during surgery. ⋯ LHB and SOP preserves renal but not visceral tissue oxygenation during supraceliac aortic crossclamping and does not induce hemolysis.
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Despite satisfactory results for surgery performed by trainees, vascular surgeons need to improve training methods to ensure that aspiring surgeons are adequately trained with less clinical exposure during fewer dedicated years of training. ⋯ Many methods are now available to allow focused training for particular skills in non-clinical settings. Objective tools are also available that allow assessment of trainees at many levels or practicing surgeons. These technical skills assessment methods are important for trainees and surgeons who, in the future, will increasingly need to demonstrate competence in vascular surgery.
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Hyperhomocysteinaemia has recently been identified as an important risk factor for atherosclerotic vascular disease. Screening for hyperhomocysteinaemia has been recommended, however, the incidence of hyperhomocysteinaemia in vascular patients is not known. ⋯ There is a high rate of hyperhomocysteinaemia in vascular patients with a higher incidence in patients with rest pain. There was also a high incidence of elevated homocysteine levels in patients with an abdominal aortic aneurysm. The rate of growth of these aneurysms is currently under review. Low folate or B12 concentrations is not the cause of raised homocysteine levels.
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Eur J Vasc Endovasc Surg · Oct 2003
von Willebrand factor and platelet count in ruptured abdominal aortic aneurysm repair.
von Willebrand factor (vWF) is essential for the formation of platelet aggregates at sites of vascular endothelial cell (EC) injury. Peri-operative thrombocytopenia is associated with poor outcome in ruptured abdominal aortic aneurysm (AAA) repair. This prospective study examines the relationship between vWF and platelet count (PC) in ruptured AAA repair. ⋯ these data demonstrate that EC activation, the acute phase protein response, operative blood loss and aortic clamp time all contribute to the peri-operative fall in PC in patients with ruptured AAA. The peri-operative fall in circulating levels of vWF and PC may represent consumption secondary to macro- and microvascular thrombus formation. The resultant procoagulant state may partly explain the association between low PC and poor outcome in ruptured AAA.
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Eur J Vasc Endovasc Surg · Sep 2003
Multicenter StudySpinal cord stimulation in the treatment of non-reconstructable stable critical leg ischaemia: results of the European Peripheral Vascular Disease Outcome Study (SCS-EPOS).
To determine the effect of spinal cord stimulation (SCS) on limb survival in patients with non-reconstructable critical leg ischaemia, and the value of patient selection on the basis of transcutaneous oxygen pressure (TcpO2) measurements and trial screening. ⋯ SCS treatment of non-reconstructable critical leg ischaemia provides a significantly better limb survival rate compared with conservative treatment. Patient selection based on TcpO2 and the results of trial screening further increase the probability of limb survival after SCS therapy.