Journal of vascular surgery
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Perioperative beta-blocker therapy has been a heavily investigated and controversial topic during the past decade. Prior national consensus statements that recommended the routine use of these medications in patients undergoing high-risk surgical procedures have been called into question because of the results of recent clinical trials that involved heterogeneous groups of surgical patients. ⋯ However, there appears to be a concurrent risk of adverse events associated with these medications if patients are not monitored properly during the perioperative period. Perioperative beta-blockers should continue to occupy a prominent role in the therapeutic armamentarium for improving outcomes among high-risk patients undergoing major vascular surgery.
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Infrainguinal surgical bypass (BPG) is a durable method for lower extremity revascularization, but is accompanied by significant 30-day morbidity and mortality (MM). The goal of this study is to relate preoperative functional status, a defined metric in the National Surgical Quality Improvement Program (NSQIP) database, to perioperative MM. ⋯ Preoperative DEP is significantly correlated with all adverse 30-day outcomes in BPG patients. Furthermore, when combined in high-risk composites with specific preoperative clinical variables, DEP is associated with prohibitive MM, thereby identifying patient cohorts that may be unsuitable for BPG.
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Lower extremity arterial revascularization (LEAR) is the gold-standard for critical lower limb ischemia (CLI). The goal of this study was twofold. First, we evaluated the long-term functional status of patients undergoing primary LEAR for CLI. Second, prognostic factors of long-term functional status and survival after primary LEAR for CLI were assessed. ⋯ Nonambulatory patients suffer from extensive comorbid conditions. They are accompanied with an increased occurrence of AEs, unplanned reinterventions, and poor long-term survival rates. Successful LEAR did not improve their functional status after 6 years. This emphasizes that attempts for limb salvage must be carefully considered in these patients.
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Carotid endarterectomy is performed in high volume in the United States. Identifying patients with a higher risk of stroke and death after carotid endarterectomy can lead to modifications in care that would significantly reduce the occurrence of these events. This study evaluates whether atrial fibrillation is significantly associated with an increased risk of death or stroke for patients undergoing carotid endarterectomy. ⋯ Patients with atrial fibrillation have a substantially higher risk of stroke and death after carotid endarterectomy.