Journal of vascular surgery
-
Precise, comprehensive imaging of the arterial circulation is the cornerstone of successful revascularization of the ischemic extremity in patients with diabetes mellitus. Arterial imaging is challenging in these patients because the disease is often multisegmental with a predilection for the distal tibial and peroneal arteries. Occlusive lesions and the arterial wall itself are often calcified and patients presenting with ischemic complications frequently have underlying renal insufficiency. ⋯ For patients in whom a catheter-based intervention is the likely treatment, a diagnostic DSA immediately followed by a catheter-based treatment in the same procedure is the preferred approach. In patients with pre-existing renal dysfunction, in which gadolinium-enhanced MRA is contraindicated, DSA or CTA can be performed. However, patients should have an infusion of intravenous normal saline solution or sodium bicarbonate before the procedure to reduce the incidence of contrast-induced nephropathy.
-
Axillosubclavian vein thrombosis, also known as Paget-Schroetter syndrome, is a rare presentation of thoracic outlet syndrome (TOS) representing approximately 5% of all cases. Conventional management consists of routine anticoagulation, operative decompression via first rib resection and scalenectomy (FRRS), and, recently, thrombolysis. The purpose of our study was to retrospectively review our experience with this condition and compare the effectiveness of preoperative endovascular intervention with thrombolysis and venoplasty to anticoagulation alone in those undergoing FRRS to preserve subclavian vein patency. ⋯ Preoperative endovascular intervention offered no benefit over simple anticoagulation prior to FRRS, since the use of thrombolysis prior to FRRS, regardless of need for postoperative venoplasty, had little impact on overall rates of patency. The optimal treatment algorithm may merely be routine anticoagulation for all effort thrombosis patients prior to FRRS followed by venography with venoplasty if needed. The role of thrombolysis for Paget-Schroetter syndrome should be further investigated in randomized trials.
-
Atherogenesis represents an active inflammatory process with leucocytes playing a major role. An elevated white blood cell count has been shown to be predictive of death in coronary artery disease patients. The aim of this study was to examine the predictive ability of neutrophil count and neutrophil/lymphocyte ratio for predicting survival in patients with critical lower limb ischemia (CLI). ⋯ This study suggests that an elevated NLR can identify a poor-risk subset of patients among those being treated for critical limb ischemia. This simple, inexpensive test may, therefore, add to risk stratification of these high-risk patients.
-
Patients who undergo surgery are at risk for venous thromboembolism (VTE), and a history of prior deep vein thrombosis (DVT) increases that risk. This study determined the incidence and risk factors for symptomatic perioperative VTE in patients with a prior diagnosis of DVT. ⋯ In patients with prior DVT, perioperative symptomatic recurrence is common and is associated with high-risk procedures. A longer time interval between a DVT episode and subsequent surgery may decrease the risk of recurrence, but large clinical trials are needed to confirm this. Further prospective evaluations are needed to identify and treat patients at greatest risk for recurrence.