Journal of vascular surgery
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Randomized Controlled Trial Multicenter Study Comparative Study
Validation of three models predicting in-hospital death in patients with an abdominal aortic aneurysm eligible for both endovascular and open repair.
The Medicare, the Vascular Governance North West (VGNW), and the British Aneurysm Repair (BAR) models can be used to predict in-hospital death after an intervention for an asymptomatic abdominal aortic aneurysm (AAA). Validation of these models in patients with suitable aortic anatomy for endovascular repair and a general condition fit for open repair is lacking. We validated the Medicare, VGNW, and BAR models in patients from a randomized controlled trial comparing open and endovascular AAA repair. ⋯ In AAA patients eligible for endovascular and open repair, the predictions of in-hospital death by the Medicare, VGNW, and BAR models were sufficiently accurate. Therefore, these models can be used to support deciding between endovascular and open repair.
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Randomized Controlled Trial Comparative Study
Comparison of a novel real-time SonixGPS needle-tracking ultrasound technique with traditional ultrasound for vascular access in a phantom gel model.
Ultrasound-guided percutaneous vascular access for endovascular procedures is well established in surgical practice. Despite this, rates of complications from venous and arterial access procedures remain a significant cause of morbidity. We hypothesized that the use of a new technique of vascular access using an ultrasound with a novel needle-guidance positioning system (GPS) would lead to improved success rates of vascular puncture for both in-plane and out-of-plane techniques compared with traditional ultrasound. ⋯ Use of the novel SonixGPS needle-tracking ultrasound system (UltraSonix, Richmond, BC, Canada) was not associated with a higher success rate of vascular puncture compared with the traditional ultrasound-guided technique. Assessment of mental task load significantly favored the use of the ultrasound GPS over the traditional ultrasound technique.
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Randomized Controlled Trial Comparative Study
Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins.
Many case series have been published on treatments of varicose veins, but comparative randomized controlled trials remain sparse. ⋯ After 1-year follow-up, EVLA is as effective as CS and superior to UGFS according to occlusion on ultrasound duplex. Quality of life improves after treatment in all groups significantly.
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Randomized Controlled Trial Multicenter Study Comparative Study
Economic analysis of endovascular repair versus surveillance for patients with small abdominal aortic aneurysms.
The Positive Impact of EndoVascular Options for Treating Aneurysms Early (PIVOTAL) trial enrolled individuals with small (4.0- to 5.0-cm diameter) abdominal aortic aneurysms (AAA) and reported no difference in rupture or aneurysm-related death for patients who received early endovascular repair (EVAR) vs surveillance with serial imaging studies. We evaluated resource use, medical cost, and quality of life outcomes associated with the PIVOTAL treatment strategies. ⋯ A treatment strategy involving early repair of smaller AAA with EVAR is associated with no difference in total medical costs at 48 months vs surveillance with serial imaging studies. Longer follow-up is required to determine whether the late medical cost increases observed for surveillance will persist beyond 48 months.
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Randomized Controlled Trial Multicenter Study Comparative Study
Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years.
This is the first randomized controlled trial with a 5-year follow-up comparing endovenous laser ablation (EVLA) with high ligation and pin-stripping in patients with great saphenous vein (GSV) incompetence. ⋯ Five-year follow-up of our randomized controlled trial comparing EVLA with open surgery in patients with GSV incompetence did not show any significant difference between the two groups in primary or secondary end points, perhaps because of the small sample size. EVLA seems to be a valid alternative to open surgery.