Journal of vascular surgery
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Randomized Controlled Trial Multicenter Study
Randomized trial of a dry-powder, fibrin sealant in vascular procedures.
Topical hemostats are important adjuncts for stopping surgical bleeding. The safety and efficacy of Fibrocaps, a dry-powder, fibrin sealant containing human plasma-derived thrombin and fibrinogen, was evaluated in patients undergoing vascular surgical procedures. ⋯ Fibrocaps, a ready-to-use, dry-powder fibrin sealant, was well-tolerated and reduced TTH in patients undergoing vascular procedures, including those receiving antiplatelet agents and/or anticoagulants, demonstrating its safety and usefulness as an adjunct to hemostasis.
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Optimal patient selection for lower extremity revascularization remains a clinical challenge among the hemodialysis-dependent (HD). The purpose of this study was to examine contemporary real world open and endovascular outcomes of HD patients to better facilitate patient selection for intervention. ⋯ Overall survival and AFS among HD patients remains poor, irrespective of revascularization strategy. Mortality remains the primary driver for these findings and justifies a prudent approach to patient selection. Focus for improved results should emphasize predictors of survival to better identify those most likely to benefit from revascularization.
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Comparative Study
Cost analysis of vascular readmissions after common vascular procedures.
This study analyzed readmissions and their associated hospital costs after common vascular surgeries at a single institution. ⋯ We found that vascular surgery readmissions occur at a rate of 17% at 30 days and 27% at 90 days. When including the costs of readmission for a wide variety of common vascular cases, there is no significant difference in total costs between endovascular and open procedures at 90 days.
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A recent investigation has documented an increased risk of aneurysm-related complications after endovascular aneurysm repair (EVAR) of familial abdominal aortic aneurysms (fAAAs). We hypothesized that fAAA patients are not at increased risk for complications following open AAA repair or EVAR when compared with sporadic abdominal aortic aneurysm (spAAA) patients. To this end, we performed a single institution retrospective review. ⋯ The current study shows that patients with fAAA do not have increased perioperative morbidity following open or endovascular AAA repair. However, patients with fAAA do have an increased risk of endoleak and secondary intervention following EVAR. These findings suggest that EVAR and open AAA repair are both safe and effective for fAAA patients. The increased rate of endoleak and secondary intervention in patients with fAAA suggests that this subpopulation may benefit from closer post-EVAR surveillance or open surgical repair in good risk patients.
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Comparative Study
Comparison of risk factors for length of stay and readmission following lower extremity bypass surgery.
Recent initiatives to improve health care quality have focused attention on length of stay (LOS) and readmission rates for surgical patients, yet these two outcomes may be inversely related. This study was designed to elucidate the risk factors for both outcomes and to clarify the relationship between them in patients undergoing lower extremity bypass (LEB). ⋯ In patients undergoing LEB, LOS is primarily associated with the occurrence of postoperative complications, whereas 30-day readmission is largely explained by underlying patient illness. Additionally, increased LOS is an independent risk factor for readmission. These findings suggest that efforts to reduce both LOS and readmission will be complementary. Furthermore, they support the notion that both LOS and 30-day readmission rates should be risk-adjusted.