Journal of vascular surgery
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Several reports in the literature have described the value of regional cerebral oximetry (rSO(2)) as a neuromonitoring device during carotid endarterectomy (CEA). The use of rSO(2) is enticing because it is simpler and less expensive than other neuromonitoring modalities. This study was performed to compare the efficacy of rSO(2) with electroencephalography (EEG) and median nerve somatosensory evoked potentials (SSEP) in determining when to place a shunt during CEA. ⋯ Relying on rSO(2) alone for selective shunting is potentially dangerous and might have led to intraoperative ischemic strokes in seven patients and the unnecessary use of shunts in at least 16 patients in this series. The use of rSO(2) adds nothing to the information already provided by EEG and SSEP in determining when to place a shunt during CEA.
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Comparative Study
The effect of implementation of an optimized care protocol on the outcome of arteriovenous hemodialysis access surgery.
The long-term patency of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) suffers from a high incidence of primary failure due to early thrombosis, myointimal hyperplasia at the venous access site, or failure to mature. A multidisciplinary meeting in vascular access surgery was initiated to optimize the timing, indication, type of intervention, and the logistics of AVFs/AVGs during the preoperative and postoperative period. This study evaluated the influence of the new optimized care protocol on the incidence of revisions (surgical and endovascular) and patency rates. ⋯ The new protocol outlined in a bimonthly multidisciplinary meeting for vascular access surgery of AVFs/AVGs for hemodialysis resulted in more effective logistics according to preoperative diagnostics and operation. More importantly, a significant increase in endovascular balloon angioplasties and a significant decrease in surgical revisions was observed, resulting in less patient morbidity. Also, higher primary and secondary patency was achieved after the introduction of the new optimized care protocol.
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This study was conducted to determine the results of left subclavian artery (LSA) coverage during thoracic endovascular aortic repair (TEVAR). ⋯ Zone 2 TEVAR with LSA coverage can be accomplished safely in both elective and emergency settings and with and without revascularization (with the exception of a patent LIMA-LAD bypass). Nevertheless, overall stroke rates are higher compared with all-zone TEVAR. Staged LSA revascularization and even urgent revascularization may be necessary but can be performed without long-term detriment to the left arm.
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Fusion of the spine is often performed from an anterior approach requiring mobilization of aorta, iliac artery, and vein. This study describes the preferred techniques and incidence of vascular complications at a spine center. ⋯ Exposure to the lumbar spine can be readily accomplished via a retroperitoneal approach. Minor vascular injuries during exposure, mostly venous, are not uncommon and are easily repaired. They are increased when L4-5 is part of the exposure and are lowest when L5-S1 alone is exposed. Major injuries occur in less than 2% of patients.