Journal of vascular surgery
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Comparative Study
Arterial cutdown reduces complications after brachial access for peripheral vascular intervention.
Factors influencing risk for brachial access site complications after peripheral vascular intervention are poorly understood. We queried the Society for Vascular Surgery Vascular Quality Initiative to identify unique demographic and technical risks for such complications. ⋯ Brachial access for peripheral vascular intervention carries significantly increased risks for access site occlusion or hematoma formation. Arterial cutdown and smaller sheath diameters are associated with lower complication rates and thus should be considered when arm access is required.
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Observational Study
Increased homocysteine and lipoprotein(a) levels highlight systemic atherosclerotic burden in patients with a history of acute coronary syndromes.
Strong evidence supports an association between high levels of homocysteine (Hcy) and lipoprotein(a) [Lp(a)] and an increased rate of ischemic vascular events. ⋯ The addition of evaluation of Hcy ≥15 μmol/L and Lp(a) ≥500 mg/L to the traditional CRF count does improve detection of systemic atherosclerotic burden of patients with acute coronary syndrome and can offer a new opportunity to optimize secondary prevention.
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This study reports our initial experience with the Gore Hybrid Vascular Graft (GHVG; W. L. Gore & Associates, Flagstaff, Ariz) for staged hybrid open renovisceral debranching and endovascular aneurysm repair in patients affected by thoracoabdominal aortic aneurysms and pararenal abdominal aortic aneurysms (PAAAs). ⋯ This limited series extracted from a more consistent hybrid procedure experience showed a mortality rate similar to most recent reports. Technical feasibility and the short-term patency rate of the GHVG for renovisceral debranching during staged hybrid open and endovascular procedures were satisfactory. Use of GHVGs may represent a useful revascularization adjunct to minimize visceral ischemia in these challenging patients.