Journal of vascular surgery
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Multicenter Study
Thrombolysis for lower extremity bypass graft occlusion.
Thrombolysis is a common method in the treatment of lower extremity bypass graft occlusion. The purpose of this study was to investigate the results of thrombolytic therapy in the management of acute bypass graft occlusion and to identify risk factors for technical failure and amputation. ⋯ Our findings support the use of thrombolysis in the treatment of acute bypass graft occlusion in the lower limb given its acceptable short- and long-term amputation-free survival rates. Technical failure and higher age were factors associated with major amputation. Synthetic grafts appeared to have a somewhat increased likelihood of technically successful thrombolysis compared with vein grafts, but on the other hand, they exhibited an increased risk of amputation during follow-up.
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Multicenter Study
Anticoagulation monitoring by an anticoagulation service is more cost-effective than routine physician care.
Vitamin K antagonists (VKAs) are the mainstay of long-term anticoagulation but require careful monitoring for effectiveness and safety. Physicians manage anticoagulation for most patients, although anticoagulation services are becoming increasingly popular. A new anticoagulation service (AS) run by nurses and overseen by a physician was established and its effectiveness vs usual physician care was independently assessed using costs of emergency department (ED) visits and hospitalizations resulting from failure or complication of anticoagulation. We report the results of this independent analysis of anticoagulation monitoring of patients treated with VKAs. ⋯ Management of long-term VKA therapy by an AS using established protocols appears to reduce anticoagulation morbidity and results in significant cost savings by reducing the number of ED visits and hospitalizations.
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Thoracic endovascular aortic repair (TEVAR), initially developed for the treatment of degenerative aneurysms of the descending thoracic aorta, has been applied to the entire spectrum of descending thoracic aortic pathology in both the elective and emergent settings. This single center study evaluates the effectiveness of TEVAR for the treatment of acute surgical emergencies involving the descending thoracic aorta, including traumatic aortic disruption (TAD), ruptured descending thoracic aneurysm (RDTA), and acute complicated Type B dissection (cTBD). ⋯ Emergent TEVAR has become the treatment of choice for acute surgical emergencies involving the descending thoracic aorta. Short-term morbidity and mortality compare favorably with historic results for emergent open surgical procedures on the descending thoracic aorta. Survival is highest in patients undergoing repair of TAD. Using current endograft technology, nearly all emergent conditions of the descending thoracic aorta can be successfully treated with TEVAR.
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Outcomes and predictors of acute surgical conversion during endovascular aortic aneurysm repair (EVAR) were examined using the American College of Surgeons-National Safety and Quality Improvement Project (ACS-NSQIP) Database (2005 to 2008). ⋯ Acute surgical conversion was a rare complication affecting 1.1% of EVAR cases, with no broadly identifiable at-risk population. When conversion did occur, morbidity and mortality rates paralleled those observed for elective open repair.
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The purpose of this study was to identify predictors of decreased survival after open abdominal aortic aneurysm (AAA) repair at a single university hospital. ⋯ Open AAA repair can be done with low morbidity and mortality in the era of endovascular aneurysm repair. Careful consideration should be given to preoperative optimization and perioperative care in patients with chronic obstructive pulmonary disease, chronic renal insufficiency, and cerebrovascular disease. Postoperative decrease in renal function and pulmonary complication portend decreased 5-year survival; strategies to ameliorate these factors should be sought.