Journal of vascular surgery
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Abdominal aortic aneurysm (AAA) is defined as a localized dilatation of an aortic vessel. Though predominantly asymptomatic, it is a chronic degenerative condition associated with life-threatening risk of rupture. The early diagnosis of AAA, ie, before it ruptures, is therefore important; a simple, effective diagnostic method is ultrasound examination. To assess the benefit of screening in Italy, we developed a cost-effective Markov model comparing screening vs nonscreening scenarios. ⋯ As in economic evaluations developed in other countries, such as the UK, Canada, and The Netherlands, setting up a screening program for AAA can be considered cost-effective from the Italian NHS perspective.
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Comparative Study
Carotid revascularization outcomes comparing distal filters, flow reversal, and endarterectomy.
Contradictory outcomes exist for different methods of carotid artery revascularization. Here we provide the comparative rates of adverse events in patients after carotid endarterectomy (CEA), carotid artery stenting (CAS) with a distal embolic protection device (EPD), and CAS with a proximal flow reversal system (FRS) from a single institution by various specialists treating carotid artery disease. ⋯ We have established a similar and low incidence of MI, CVA, and death among patients undergoing CEA and CAS, of whom approximately 40% were symptomatic. FRS provided superior results in this series; however, its use was limited to 20% of the CAS procedures. Still, zero adverse events in this cohort make FRS an exciting technology that warrants a large-scale prospective comparative study.
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Case Reports
Primary aortoenteric fistula following endovascular aortic repair due to type II endoleak.
An 84-year-old female was lost to follow-up after endovascular aneurysm repair at another hospital with known type II endoleak. She later presented with presyncope and hematemesis. A referral center esophagogastroduodenoscopy showed possible duodenal diverticulum. ⋯ At our center, she underwent stent graft explantation and axillofemoral reconstruction for a primary aortoenteric fistula. She was discharged and is doing well 5 months postoperatively. A high degree of suspicion for aortoenteric fistula is imperative in any patient with upper gastrointestinal hemorrhage after open or endovascular abdominal aortic aneurysm repair.
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Operative treatment of celiac trunk aneurysms has traditionally involved open repair using simple ligation, interposition graft, resection, and direct repair or antegrade bypass from the aorta; recently, endovascular techniques have been proposed in selected cases. We report a 60-year-old man presenting with a celiac trunk aneurysm that we treated with a new multilayer stent with the aim of preserving the parent vessels arising from the aneurysm. Computed tomography angiography at the 12-month follow-up visit confirmed the patency of the stents, the complete thrombosis of the sac without impairment of the main branches, and the regular perfusion of the liver and spleen.
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Nowadays, as a result of more liberal selection criteria, dialysis-dependent patients have become substantially older, more likely to be female and diabetic, and have more comorbidity. The 1-year primary patency rates of arteriovenous fistulas (AVFs) are poor. To improve these results, several secondary interventions can be performed. The aim of this study was to evaluate the results after secondary interventions in patients with an upper extremity AVF. ⋯ The primary patency rate of AVFs is disappointing. However, due to mostly endovascular secondary interventions, 2-year primary assisted and secondary patency rates of more than 70% can be obtained.