Journal of vascular surgery
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Endovascular aortic repair (EVAR) has gained wide acceptance for the elective treatment of abdominal aortic aneurysms (AAA), leading to interest in similar treatment of ruptured abdominal aortic aneurysms (RAAA). The purpose of this study was to evaluate national outcomes after EVAR for RAAA and to assess the effect of institutional volume metrics. ⋯ In the United States, for RAAA, EVAR had a lower postoperative mortality than open repair. Higher elective open repair as well as RAAA volume increased this mortality advantage for EVAR. These results support regionalization of RAAA repair to high volume centers whenever possible and a wider adoption of endovascular repair of RAAA nationwide.
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Multicenter Study Comparative Study
Predicting 1-year mortality after elective abdominal aortic aneurysm repair.
Benefit of prophylactic abdominal aortic aneurysm (AAA) repair requires sufficient survival to overcome operative risk. Since death within 1 year of elective open or endovascular (EVAR) infrarenal AAA repair likely indicates ineffective treatment, we developed a prediction model for 1-year mortality to aid clinical decision-making. ⋯ Predictors of 1-year mortality can identify patients less likely to benefit from elective AAA repair. These factors differ for open repair vs EVAR and should be considered in individual patient decision-making. Our EVAR model had less impact on 1-year survival, even if CHF and large AAA diameter were present. However, a combination of age, COPD, renal insufficiency, and need for suprarenal clamping have significant impact on 1-year mortality after open AAA repair. Consideration of these variables should assist decision-making for elective AAA repair, especially in borderline cases.
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Cerebral hyperperfusion syndrome is a rare, serious complication of carotid revascularization either after carotid endarterectomy or carotid stent placement. Impaired cerebral autoregulation and post-revascularization changes in cerebral hemodynamics are the main mechanisms involved in the development of the syndrome. ⋯ This article reviews the literature, intending to make a synthesis of all new data concerning the clinical manifestations of hyperperfusion syndrome, the pathophysiologic pathways involved in its development, the prediction, and the appropriate management. Also, a review of the most recent series of hyperperfusion syndrome following carotid revascularization, both with classic open endarterectomy and carotid artery stenting has been performed.
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This study tested the hypothesis that silent embolic infarcts on computed tomography (CT) brain scans can predict ipsilateral neurologic hemispheric events and stroke in patients with asymptomatic internal carotid artery stenosis. ⋯ The presence of silent embolic infarcts can identify a high-risk group for ipsilateral hemispheric neurologic events and stroke and may prove useful in the management of patients with moderate asymptomatic carotid stenosis.
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Comparative Study
Suprarenal aortic cross-clamp position: a reappraisal of its effects on outcomes for open abdominal aortic aneurysm repair.
With the increasing use of endovascular aneurysm repair, a greater proportion of open aneurysm repairs in the future are expected to be more complex and require suprarenal cross-clamping. We sought to evaluate the effects of suprarenal (SR) vs infrarenal (IR) aortic cross-clamp position in abdominal aortic aneurysm (AAA) repair in an updated single center series. ⋯ Suprarenal cross-clamping is associated with low mortality and significant but acceptable morbidity, including postoperative decline in renal function. The results from this series may serve as relevant background data when evaluating emerging branched and fenestrated endograft technologies.