Journal of vascular surgery
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Peripherally inserted central catheters (PICCs) may be complicated by upper extremity (UE) superficial (SVT) or deep venous thrombosis (DVT). The purpose of this study was to determine current PICC insertion patterns and if any PICC or patient characteristics were associated with venous thrombotic complications. ⋯ The incidence of symptomatic PICC-associated UE DVT is low, but given the number of PICCs placed each year, they account for up to 35% of all diagnosed UE DVTs. Larger-diameter PICCs and malignancy increase the risk for DVT, and further studies are needed to evaluate the optimal vein of first choice for PICC insertion.
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Device-related complications in the thoracic aorta are partly due to the unavoidable proximal angulation and increased flow-related forces. The present study evaluated the incidence, predictors, and outcome of the complication of infolding with the GORE TAG thoracic endoprosthesis (TAG device) to better understand the factors that might help predict these events. ⋯ TAG device infolding appears to be an infrequent event, primarily occurring in young trauma patients secondary to excessive oversizing and severe proximal aortic angulation. However, there clearly exists a need for devices that treat such patients. As a result, future device designs should consider the compression failure mode when being designed in order to help prevent such events.
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Multicenter Study Clinical Trial
Prospective multicenter clinical trial (STABLE) on the endovascular treatment of complicated type B aortic dissection using a composite device design.
This study evaluates the safety and effectiveness of a unique composite thoracic endovascular aneurysm repair (TEVAR) construct (proximal stent graft and distal bare metal stent) for the treatment of patients with complicated type B aortic dissection (cTBAD). ⋯ Initial data with a composite TEVAR construct have demonstrated favorable clinical and anatomic results. Continued enrollment and long-term data are needed to assess the overall effectiveness of this treatment strategy.
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The use of fenestrated and branched stent graft technology for paravisceral abdominal aortic aneurysms (PAAA) is on the rise; however, its application is limited in the United States to only a few selected centers. Most PAAAs are currently repaired using an open approach. The objective of this study was to determine which patients are at highest risk with open PAAA repair and might benefit most from endovascular repair using fenestrated or branched stent grafts. ⋯ PAD, COPD, and female sex are major risk factors for postoperative mortality after open PAAA repair. Fenestrated or branched stent graft repair may be a more valuable alternative to open repair for patients with one or more of these characteristics who have suitable access vessels.
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Comparative Study
Duplex velocity criteria for native celiac/superior mesenteric artery stenosis vs in-stent stenosis.
Duplex velocity criteria (DVC) to identify in-stent celiac artery (CA) and superior mesenteric artery (SMA) stenosis is not well defined. Only one study has been published which concluded that DVC for native SMA stenosis overestimated stenosis in stented SMAs. The purpose of this study was to analyze DVC in detecting CA/SMA in-stent stenosis (ISS). ⋯ There is a tendency toward higher velocities in stented CA/SMAs in comparison to native arteries. Caution must be exercised in using duplex velocity cutoffs for native CA/SMA stenosis for stented CA/SMA. Further prospective validation studies are needed.