Journal of vascular surgery
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Review Meta Analysis
Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis.
Duplex ultrasound is widely used for the diagnosis of internal carotid artery stenosis. Standard duplex ultrasound criteria for the grading of internal carotid artery stenosis do not exist; thus, we conducted a systematic review and meta-analysis of the relation between the degree of internal carotid artery stenosis by duplex ultrasound criteria and degree of stenosis by angiography. ⋯ Clinicians need to be aware of the limitations of duplex ultrasound scanning when making management decisions.
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Semiquantitative dipyridamole myocardial perfusion scintigraphy may provide better estimates of perioperative cardiac risk than nonquantitative scintigraphy. ⋯ Reversible defects in less than 20% of myocardial segments do not significantly alter the risk of perioperative cardiac complications. Greater extents of reversibility on dipyridamole myocardial stress perfusion imaging increase the risk of perioperative complications after noncardiac vascular surgery, but the quality and amount of data regarding greater extents of reversibility are limited.
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We sought to determine the efficacy of antiplatelet therapy and oral anticoagulants in maintaining graft patency and preventing ischemic complications in patients after infrainguinal bypass surgery. ⋯ Antiplatelet therapy and oral anticoagulants reduce the risk of graft occlusion. Oral anticoagulant therapy appears to be the more effective treatment in high-risk patients. Data on the reduction of the risk of stroke, myocardial infarction, and death are inconclusive. Evidence for the beneficial effects of antiplatelet and oral anticoagulant therapy after infrainguinal bypass surgery is based on a small number of trials only. There is no proof as to which modality is the most effective in the prevention of graft occlusion and ischemic events in patients after infrainguinal bypass surgery, which is reason for a randomized comparison of aspirin with oral anticoagulants.