Journal of vascular surgery
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Open surgical repair of thoracoabdominal aortic aneurysms (TAAAs) is uncommon. Mortality rates of 20% are reported in studies using national data and are 5% to 8% in single-institution studies. Clinical trials are currently evaluating branched and fenestrated endografts. The purpose of this study is to establish a benchmark for future comparisons with endovascular trials using open repair of TAAAs in the National Surgical Quality Improvement Program (NSQIP) database. ⋯ In this study of NSQIP hospitals, the first to analyze open surgical repair of TAAAs, the 30-day mortality rate of 10.0% is similar to single-institution reports. However, morbidity and mortality after open TAAA repair remain high, confirming the need for less invasive procedures.
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The objectives of the present study are to estimate the incidence of postoperative acute kidney injury (AKI) after radical nephrectomy with inferior vena cava (IVC) thrombectomy for renal cell carcinoma (RCC) based on the Acute Kidney Injury Network (AKIN) criteria, to investigate the risk factors for postoperative AKI, and to define the association between postoperative AKI and clinical outcome in patients undergoing such a surgery. ⋯ The incidence of postoperative AKI in patients with RCC and IVC thrombus was considerable. Intraoperative management seems to influence the risk of AKI after surgery; particularly, the longer the IVC clamping time, the higher the risk of postoperative AKI. Postoperative AKI was associated with postoperative CKD (P = .031), prolonged hospitalization (P = .047), and increased long-term mortality (1 year after surgery).
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Comparative Study
Outcomes of endovascular aneurysm repair on renal function compared with open repair.
Recent studies have shown that progressive renal dysfunction may develop in patients after endovascular aneurysm repair (EVAR). Data are conflicting about the effect of EVAR on renal function compared with open repair (OR). The purpose of this study was to compare the effects of EVAR, both with transrenal fixation (TRF) and infrarenal fixation (IRF), vs OR on renal function detected with renal perfusion scintigraphy (RPS). ⋯ After EVAR, there is a continuous decline in renal function with respect to OR, regardless of fixation level and independently of pre-existing renal insufficiency. The risk of GFR impairment after EVAR should be taken into consideration in selecting patients with preoperative renal insufficiency.
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To explore the incidence, predictors, and outcomes of hemodynamic instability (HI) following carotid angioplasty and stenting (CAS). ⋯ HI represents a common occurrence following CAS. While the presence of periprocedural HI alone did not portend a worse clinical outcome, CS-HI was associated with increased risk of stroke. Expeditious intervention to prevent and manage CS-HI is of critical importance in order to minimize adverse clinical events following CAS.
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Comparative Study
Differentiating transmural from transanastomotic prosthetic graft endothelialization through an isolation loop-graft model.
In humans, transanastomotic endothelial outgrowth onto the surface of prosthetic vascular grafts is limited to the immediate perianastomotic region, even after years of implantation. In contrast, continual transanastomotic outgrowth together with short graft lengths has led to early endothelial confluence in most animal models pre-empting endothelialization through transmural capillary sprouting. We describe an isolation loop-graft model that clearly separates these distinctly different events. ⋯ Although the mode of graft deployment has changed over the years, the problem of an absent surface endothelium remains, whether small- to medium-diameter grafts are surgically implanted or placed endovascularly as “covered stents.” In contrast to humans, most animal models experience progressive transanastomotic endothelial outgrowth. Together with graft lengths that were too short, the clinically irrelevant transanastomotic endothelialization inadvertently led to early endothelial confluence in the vast majority of experimental vascular graft studies pre-empting or concealing alternative modes of endothelialization. The isolation loop-graft model we propose allows the long-term differentiation of the different modes of endothelialization in a small animal screening model.