Journal of vascular surgery
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Multicenter Study
Dual antiplatelet therapy reduces stroke but increases bleeding at the time of carotid endarterectomy.
Controversy persists regarding the perioperative management of clopidogrel among patients undergoing carotid endarterectomy (CEA). This study examined the effect of preoperative dual antiplatelet therapy (aspirin and clopidogrel) on in-hospital CEA outcomes. ⋯ Preoperative dual antiplatelet therapy was associated with a 40% risk reduction for neurologic events but also incurred a significant increased risk of reoperation for bleeding after CEA. Given its observed overall neurologic protective effect, continued dual antiplatelet therapy throughout the perioperative period is justified. Initiating dual therapy in all patients undergoing CEA may lead to decreased neurologic complication rates.
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Multicenter Study
The effect of congestive heart failure on perioperative outcomes in patients undergoing lower extremity revascularization.
As the management of peripheral arterial disease evolves, determining the factors affecting the outcome of lower extremity interventions is important. The presence of peripheral arterial disease is associated with a twofold increase in the prevalence of congestive heart failure (CHF), with reports of increased perioperative complications. This study evaluated CHF as a predictor of acute postoperative complications in patients undergoing lower extremity bypass. ⋯ Recently diagnosed or exacerbated CHF does not affect acute IIB graft patency. However, CHF may increase the complication rates for perioperative pneumonia, prolonged intubation, reintubation, sepsis, return to the operating room, extended length of stay, and mortality. Therefore, before pursuing lower extremity interventions in patients with a history of CHF, one should incorporate an individualized approach to optimize the success of the revascularization while minimizing medical comorbidities.
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Multicenter Study Comparative Study
Volume analysis of true and false lumens in acute complicated type B aortic dissections after thoracic endovascular aortic repair with stent grafts alone or with a composite device design.
This study compared the 12-month evolution of the aortic volume in patients who underwent thoracic endovascular aortic repair (TEVAR) with stent grafts alone or a composite device (Zenith TX2 stent graft and Zenith Dissection stent; Cook Medical, Bloomington, Ind) for acute (≤2 weeks from onset) complicated type B aortic dissection. ⋯ According to this volume analysis, thoracic endografting for acute complicated type B dissections promotes significant thoracic aortic remodeling. The use of bare-metal dissection stents leads to significant true lumen expansion and false lumen regression in the early follow-up and to subsequent continued true lumen expansion in the abdominal aorta; however, a definitive benefit in aortic remodeling over TEVAR alone was not demonstrated at 1 year.
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Randomized Controlled Trial Multicenter Study
Smoking cessation counseling in vascular surgical practice using the results of interviews and focus groups in the Vascular Surgeon offer and report smoking cessation pilot trial.
Although smoking cessation is a key priority emphasized by professional societies and multidisciplinary consensus guidelines, significant variation exists in the methods and efficacy of smoking cessation treatment practiced by vascular surgeons. We conducted a series of patient, surgeon, and nonpatient stakeholder focus groups to identify important domains for establishment of a successful smoking cessation program. ⋯ Differences in motivation and significance exist for patients, surgeons, and stakeholders when they considered the specific domains most important in building a successful smoking cessation program. Despite these differences, all parties involved agreed that a brief, standardized intervention can be successful delivered in a busy vascular clinic setting.
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Multicenter Study
In-hospital outcomes in patients with critical limb ischemia and end-stage renal disease after revascularization.
Analysis of in-hospital outcomes in patients treated for critical limb ischemia (CLI) and end-stage renal disease (ESRD) compared to CLI patients with normal renal function. ⋯ CLI patients on dialysis represent a challenging cohort prone to in-hospital death, amputation, and hemodynamic failure. Two-thirds of these high-risk patients are treated with EVT. Present data suggest that this modality is generally considered as the most favorable treatment option in this patient subgroup.