Journal of vascular surgery
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Meta Analysis
Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair.
Thoracic endovascular aortic repair (TEVAR) of various pathologies has been associated with peri-interventional neurologic complication rates of up to 15%. The objective of this study was to determine the influence of the management of the left subclavian artery (LSA) on neurologic complications and to define subgroups that might benefit from LSA revascularization. ⋯ Coverage of the LSA without revascularization is an important modifiable risk factor for stroke in patients undergoing TEVAR for a thoracic aortic aneurysm. Prior revascularization appears to protect against posterior circulation territory stroke.
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We previously showed that duplex ultrasound (DU) imaging is beneficial in the diagnosis of failing vein and prosthetic grafts performed for arterial occlusive disease. The purpose of this study was to evaluate whether DU imaging can reliably diagnose failing stent grafts (ie, covered stents) placed for arterial occlusive disease. ⋯ These findings suggest that follow-up DU surveillance can predict failure of stent grafts placed for lower extremity occlusive disease. Focal PSVs >300 cm/s, Vr >3.0, and most importantly, uniform PSVs <50 cm/s throughout the stent graft were statistically reliable markers for predicting stent graft thrombosis.
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Comparative Study Observational Study
Care of patients undergoing vascular surgery at safety net public hospitals is associated with higher cost but similar mortality to nonsafety net hospitals.
This study compared in-hospital mortality and resource utilization among vascular surgical patients at safety net public hospitals (SNPHs) with those at nonsafety net public hospitals (nSNPHs). ⋯ Patients undergoing vascular surgery at SNPHs, despite being younger, had higher comorbidities, presented more urgently with more advanced disease, and incurred higher costs than the SNPH cohort despite similar adjusted odds of in-hospital mortality. Delayed presentation and higher comorbidities are most likely related to poor access to routine and preventive health care for the SNPH patients.
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Despite poor long-term patency, acceptable limb salvage has been reported with cryopreserved saphenous vein bypass (CVB) for various indications. However, utility of CVB in patients with critical limb ischemia (CLI) remains undefined. The purpose of this analysis was to determine the role of CVB in CLI patients and to identify predictors of successful outcomes. ⋯ In CLI patients with no autologous conduit and prior failed infrainguinal bypass, CVB outcomes are disappointing. CVB performs best in patients with rest pain, particularly those who can be anticoagulated with warfarin. However, it may be an acceptable option in patients with minor tissue loss or concurrent graft infection, but consideration should be weighed against the known natural history of nonrevascularized CLI and nonbiologic conduit alternatives, given potential cost implications.
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The Society for Vascular Surgery (SVS) recently established the Lower Extremity Threatened Limb Classification System, a staging system using Wound characteristic, Ischemia, and foot Infection (WIfI) to stratify the risk for limb amputation at 1 year. Although intuitive in nature, this new system has not been validated. The purpose of the following study was to determine whether the WIfI system is predictive of limb amputation and wound healing. ⋯ The theoretical framework for risk stratification among patients with critical limb ischemia provided by the SVS expert panel appears valid. Further validation of the WIfI classification system with multicenter data is justified.