Journal of vascular surgery
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Myocardial ischemia and infarction after surgery remain leading causes of morbidity and mortality in patients undergoing major vascular surgery. B-type natriuretic peptide has been shown to predict early postoperative cardiac events in patients undergoing major noncardiac surgery. We aimed to determine if N-terminal pro B-type natriuretic peptide (NT-pro-BNP), with its longer half-life and greater plasma stability, can predict postoperative myocardial injury in vascular patients. ⋯ Elevated preoperative plasma NT-pro-BNP levels independently predict postoperative myocardial injury, which is associated with adverse outcome in the short- and long-term regardless of the presence of symptoms of acute coronary syndrome.
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Endovascular stent graft repair of a traumatic thoracic aortic disruption (TTAD) is rapidly becoming an accepted alternative to open surgical repair. The use of currently approved thoracic stent grafts especially in younger patients with small, "steep," tapered aortas, remains a concern due to the acute thoracic endograft collapse and enfolding. The objective of this study, the largest report to date, was to evaluate the mid-term results of TTAD treated with abdominal aortic "stacked" extension cuffs, with follow-up extending to 41 months. ⋯ Stent-graft repair of TTAD is technically feasible. The technique of "stacked" aortic cuffs provides an acceptable option when urgent therapy is needed, when patients are deemed high-risk for open operative repair, or until thoracic endografts are designed which can safely treat focal, smaller aortic diameter injuries.
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Review Case Reports
Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm.
Percutaneous catheterization is a frequently-used technique to gain access to the central venous circulation. Inadvertent arterial puncture is often without consequence, but can lead to devastating complications if it goes unrecognized and a large-bore dilator or catheter is inserted. The present study reviews our experience with these complications and the literature to determine the safest way to manage catheter-related cervicothoracic arterial injury (CRCAI). ⋯ During central venous placement, prevention of arterial puncture and cannulation is essential to minimize serious sequelae. If arterial trauma with a large-caliber catheter occurs, prompt surgical or endovascular treatment seems to be the safest approach. The pull/pressure technique is associated with a significant risk of hematoma, airway obstruction, stroke, and false aneurysm. Endovascular treatment appears to be safe for the management of arterial injuries that are difficult to expose surgically, such as those below or behind the clavicle. After arterial repair, prompt neurological evaluation should be performed, even if it requires postponing elective intervention. Imaging is suggested to exclude arterial complications, especially if arterial trauma site was not examined and repaired.
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Although endovascular repair of thoracic aortic aneurysm has been shown to reduce the morbidity and mortality rates, spinal cord ischemia remains a persistent problem. We evaluated our experience with spinal cord protective measures using a standardized cerebrospinal fluid (CSF) drainage protocol in patients undergoing endovascular thoracic aortic repair. ⋯ Perioperative CSF drainage with augmentation of systemic blood pressures may have a beneficial role in reducing the risk of paraplegia in patients undergoing endovascular thoracic aortic stent graft placement. However, selective CSF drainage may offer the same benefit as mandatory drainage.
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To evaluate national outcomes after open repair of descending thoracic aortic aneurysm (DTA). ⋯ Mortality after open repair of DTA is high and complications are common. Mortality is dependent upon age, rupture status, and hospital surgical volume. Results of endovascular DTA repair should be compared using similar population-based data.