Journal of vascular surgery
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Comparative Study
Comparison of outcomes following endovascular repair of abdominal aortic aneurysms based on size threshold.
Size threshold for operative repair of abdominal aortic aneurysms (AAAs) has been determined based on risks and outcomes of open repair vs surveillance. The influence of endovascular aneurysm repair (EVAR) on this threshold is less established. The purpose of this study is to determine whether long-term outcomes following EVAR are affected by maximum diameter at the time of treatment. ⋯ EVAR for small AAAs shows improved long-term outcomes than for age-matched patients with larger aneurysms.
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Comparative Study Clinical Trial
Discontinuation of preoperative clopidogrel is unnecessary in peripheral arterial surgery.
The optimal management of preoperative clopidogrel remains controversial, as vascular surgeons are increasingly encountering patients treated with clopidogrel as part of dual antiplatelet therapy. Current practice differs considerably, from cessation of the medication at least 5 days before surgery to proceeding with surgery without delay. The purpose of this prospective, nonrandomized, comparative study was to determine the effect of preoperative exposure to clopidogrel and aspirin on perioperative bleeding complications in patients undergoing open arterial surgery. ⋯ Combined therapy with clopidogrel and aspirin up to the day of surgery is not associated with increased bleeding complications or transfusion requirements. Data from this study do not validate the perceived higher risk of perioperative bleeding in clopidogrel patients and do support the strategy of continued clopidogrel use in patients undergoing peripheral arterial surgery.
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Randomized Controlled Trial Multicenter Study Comparative Study
Validation of three models predicting in-hospital death in patients with an abdominal aortic aneurysm eligible for both endovascular and open repair.
The Medicare, the Vascular Governance North West (VGNW), and the British Aneurysm Repair (BAR) models can be used to predict in-hospital death after an intervention for an asymptomatic abdominal aortic aneurysm (AAA). Validation of these models in patients with suitable aortic anatomy for endovascular repair and a general condition fit for open repair is lacking. We validated the Medicare, VGNW, and BAR models in patients from a randomized controlled trial comparing open and endovascular AAA repair. ⋯ In AAA patients eligible for endovascular and open repair, the predictions of in-hospital death by the Medicare, VGNW, and BAR models were sufficiently accurate. Therefore, these models can be used to support deciding between endovascular and open repair.
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As endovascular abdominal aortic aneurysm repair has become increasingly prominent in our vascular surgery practices, the discussion regarding long-term durability continues. The initial randomized trials that enrolled patients almost 10 years ago revealed a short-term survival advantage with endovascular abdominal aortic aneurysm repair at the expense of a higher reintervention rate and loss of that initial survival advantage in the longer term. Continuing and healthy debate over the practical importance of these findings has resulted in somewhat differing practice patterns on either side of the Atlantic. This debate explores the issues surrounding whether younger, good-risk patients with a long life expectancy should be treated with endovascular repair.