Journal of vascular surgery
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Randomized Controlled Trial
Randomized clinical trial of negative pressure wound therapy for high-risk groin wounds in lower extremity revascularization.
The surgical site infection (SSI) rate in vascular surgery after groin incision for lower extremity revascularization can lead to significant morbidity and mortality. This trial was designed to study the effect of negative pressure wound therapy (NPWT) on SSI in closed groin wounds after lower extremity revascularization in patients at high risk for SSI. ⋯ This study demonstrated a nonsignificant lower rate of groin SSI in high-risk revascularization patients with NPWT compared with standard dressing. Owing to a lower than expected infection rate, the study was underpowered to detect a difference at the prespecified level. The NPWT group did show significantly shorter mean hospital duration of stay compared with the standard dressing group.
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Accurate and convenient methods for assessing a patient's risk of postoperative morbidity and mortality comprise important tools in clinical decision-making. Whereas some aspects of the patient's fitness for surgery can be easily quantified, measurement of the patient's frailty is often difficult or time-consuming. Previous research in the context of multiple types of major surgical procedures has reported psoas-L4 vertebral index (PLVI) to be a useful predictor of postoperative morbidity and mortality. ⋯ PLVI did not predict AFS after intervention for peripheral arterial occlusive disease. This is contrary to the ability of PLVI to predict perioperative and midterm survival after abdominal aortic aneurysm repair and other major abdominal surgery.
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Multicenter Study Comparative Study Observational Study
Prediction of major cardiac events after vascular surgery.
Predicting cardiac events is essential to provide patients with the best medical care and to assess the risk-benefit ratio of surgical procedures. The aim of our study was to evaluate the performance of the Revised Cardiac Risk Index (Lee) and the Vascular Study Group of New England Cardiac Risk Index (VSG) scores for the prediction of major cardiac events in unselected patients undergoing arterial surgery and to determine whether the inclusion of additional risk factors improved their accuracy. ⋯ The Lee and VSG scores have low accuracy and underestimate the risk of major perioperative cardiac events in unselected patients undergoing vascular surgery. The Lee score's accuracy can be increased by adding preoperative anemia. Underestimation of major cardiac complications may lead to incorrect risk-benefit assessments regarding the planned operation.
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Type II endoleak after endovascular aneurysm repair (EVAR) is frequently caused by persistent flow from the inferior mesenteric artery (IMA). The aim of this study was to assess the perioperative and midterm efficacy of laparoscopic ligation of the IMA for treatment of endoleak. ⋯ Laparoscopic ligation of the IMA for treatment of type II endoleak after EVAR is a feasible and safe technique in specialized centers with high technical success rate and good midterm outcomes.
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Multicenter Study Comparative Study
Carotid artery revascularization in patients with contralateral carotid artery occlusion: Stent or endarterectomy?
The Centers for Medicare and Medicaid Services (CMS) considers that contralateral carotid artery occlusion puts the patients at high risk for carotid endarterectomy (CEA) and agrees to reimburse for carotid artery stenting (CAS) in these patients. However, there is a paucity of evidence that support the superiority of CAS compared with CEA in patients with contralateral carotid occlusion. ⋯ In this exclusive large cohort of patients with contralateral carotid artery occlusion, CAS did not perform better compared with CEA in asymptomatic patients and had significantly worse outcomes in symptomatic patients in the perioperative period. The 2-year stroke rate was similar between the two procedures, but the risk of stroke or death was consistently higher for CAS patients. CAS is not safer than CEA in patients with contralateral carotid artery occlusion, and refinement of current guidelines is warranted to provide appropriate surgical care specifically tailored for the patient's presentation.