Journal of vascular surgery
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Multicenter Study
A regional quality improvement effort to increase beta blocker administration before vascular surgery.
To determine if a regional quality improvement effort can increase beta-blocker utilization prior to vascular surgery and decrease the incidence of postoperative myocardial infarction (POMI). ⋯ Our regional quality improvement effort successfully increased perioperative beta blocker utilization. However, this was not associated with reduced rates of POMI or resting heart rate. While this demonstrates the effectiveness of regional quality improvement efforts in changing practice patterns, further work is necessary to more precisely identify those patients who will benefit from beta blockade at the time of vascular surgery.
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Thoracic endograft collapse after thoracic endovascular aortic repair (TEVAR) is a potentially devastating complication. This study evaluates the management of thoracic stent graft collapse. ⋯ Endograft collapse can be successfully managed by endovascular techniques in most cases. Redo-TEVAR using high radial force devices should be considered the initial treatment of choice. Late endograft-related complications after treatment of collapsed endografts are not uncommon and can be safely managed by open conversion.
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Our aim was to identify important microRNAs (miRNAs) that might play an important role in contributing to aortic dissection by conducting a miRNA profile comparison between thoracic aortic dissection (TAD) and normal thoracic aorta. ⋯ Our results indicate that miRNAs expression profiles in aortic media from TAD were significantly changed. These results may provide important insights into TAD disease mechanisms. This study also suggests that the focal adhesion and MAPK signaling pathways might play important roles in the pathogenesis of TAD.
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The chief of surgery at a large private hospital read a paper reporting that implementation of a comprehensive surgical checklist greatly improved mortality and morbidity. The hospital has agreed to cover the cost of implementation. A special meeting of the surgical staff on implementing the checklist did not go well. ⋯ Start a pilot study with volunteer surgeons. E. Move to a new hospital where the staff is more progressive.
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Decisions regarding deep venous thrombosis (DVT) prophylaxis are complicated in neurosurgical patients because of the potential for catastrophic bleeding complications. Screening with venous duplex ultrasound (VDUS) may improve outcomes, but can strain hospital resources. Since there is little data to guide VDUS surveillance, we investigated the utility of a comprehensive VDUS screening program in neurosurgical patients. ⋯ Despite the uniform application of mechanical DVT prophylaxis and the use of chemoprophylaxis in a majority of patients, we found a 23% incidence of DVT in these hospitalized, nonambulatory, neurosurgical patients. No patients with isolated calf DVT had an embolic complication but 13.3% progressed proximally in short-term follow-up. While chemical prophylaxis significantly reduced DVT risk, no factor was sufficiently predictive to exclude patients from screening. These data substantiate the importance of full leg VDUS screening and maximizing DVT prophylaxis in this high risk population.