Annals of vascular surgery
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Chronic stump and phantom limb pain after amputation for critical ischemia significantly affect patients' quality of life and pose challenging clinical problems. Pre-emptive analgesia attempts to prevent chronic postoperative pain by minimizing painful stimuli before and during surgery. ⋯ There is no robust evidence supporting the use of pre-emptive analgesia to minimize the risk of chronic pain after amputation for critical ischemia of peripheral vascular disease. The methods used are, however, effective in treating acute postoperative pain.
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Review Case Reports
Retrograde type A dissection after endovascular repair of a "zone 0" nondissecting aortic arch aneurysm.
Retrograde type A dissection (RTAD) is not so uncommon after thoracic endovascular aortic repair of type B dissections, especially in the presence of connective tissue disorders. Risk of RTAD after thoracic endovascular aortic repair of nondissecting aneurysms has still to be clarified, mainly if proximal arch involvement requires hybrid repair with ascending aortic side clamping, supra-aortic trunks proximal re-routing and endograft landing in ascending aorta. We report a mid-term RTAD after hybrid repair of a proximal arch nondissecting aneurysm without connective tissue disorders. The technique for ascending aortic replacement without arch endograft removal and literature review about this poorly known complication are presented.
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Despite the publication of recent guidelines for management of the left subclavian artery (LSA) during endovascular stenting procedures of the thoracic aorta, specific management for those presenting with dissection remains unclear. This systematic review attempts to address this issue. ⋯ In patients undergoing endovascular stenting for thoracic aortic dissection, in cases where LSA coverage is necessary, revascularization should be considered before the procedure to avoid complications such as left arm ischemia, stroke, and endoleak, and where feasible, an appropriate preoperative assessment should be carried out.
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Review Meta Analysis
Long-term use of different doses of low-molecular-weight heparin versus vitamin K antagonists in the treatment of venous thromboembolism.
We evaluated whether the incidence of recurrent venous thromboembolic events (VTEs) during and after therapy differs for patients treated with full or reduced doses of low-molecular-weight heparin (LMWH) used long term compared with vitamin K antagonists (VKAs). ⋯ Full-dose LMWH for 3-6 months is as safe as intermediate and prophylactic doses for the long-term treatment of deep vein thrombosis. In patients with cancer it appears that there is an excess of VTE recurrence after treatment with prophylactic doses that does not occur with full therapeutic doses.
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Review Case Reports
Neutrophil gelatinase associated lipocalin as a biomarker for acute kidney injury in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.
Acute kidney injury (AKI) is a significant cause of morbidity and mortality following cardiac surgery throughout the world. The paucity of early biomarkers has hampered early therapeutic intervention. Our aim was to evaluate plasma neutrophil gelatinase associated lipocalin (NGAL) levels as a predictor of renal injury in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) along with markers of oxidative stress. ⋯ Measurement of plasma NGAL in patients in the first few hours after CPB is predictive of AKI. Oxidative stress as measured by the level of MDA and antioxidants has no substantial role in the progression of AKI during CABG with CPB.