Annals of vascular surgery
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The objective of this review is to provide surgeons basic knowledge regarding the Anti-kickback Statute (AKBS) and safe harbors available for legitimate business activities. The rising costs associated with fraudulent activities have led Congress to demand accountability, fiscal responsibility, and reduction of error rates. To deter and prosecute fraud and abuse, the government currently has available an array of civil and criminal remedies, supported by a number of statutes, investigated by multiple agencies and enforced by the Department of Justice. ⋯ This law makes it a crime to exchange any remuneration for patient referrals. Congress has also issued 23 "safe harbors", which are activities that are protected from prosecution and allow physicians to participate, invest, recruit, joint venture, and refer patients under certain conditions. It is necessary for surgeons to have some knowledge of the AKBS, as well as the various safe harbors provided by the legislature, for lawful business relationships.
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The objective of this study was to determine the incidence and timing of complications associated with ipsilateral transvenous pacemakers and hemodialysis access, including subclavian vein stenosis and occlusion, and assess their impact on dialysis access patency. All patients who had pacemakers placed at St. Francis Medical Center were reviewed during the 10-year period from 1988 to 1998. ⋯ The presence of pacemaker electrodes in the subclavian vein and the flow associated with hemodialysis may accelerate the occurrence of subclavian venous stenosis and occlusion. Patients who did not develop symptoms may have expired before venous outflow obstruction could develop. Vascular surgeons and cardiac surgeons/cardiologists need to coordinate their procedures to avoid ipsilateral transvenous pacemakers and hemodialysis access.
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Review Case Reports
Arterioesophageal fistula: a rare complication of retroesophageal subclavian arteries.
Formation of a fistula between a retroesophageal subclavian artery and the esophagus is a rare cause of hematemesis that is usually fatal. Several etiologies have been described. ⋯ Arteriography in the operating room confirmed the presence of a fistula and also allowed temporary hemostasis by tamponade. On the basis of a review of the literature, this case demonstrates the importance of screening patients requiring prolonged nasogastric intubation to rule out the possibility of an aberrant aortic arch system.
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Case Reports
Distal aortic arch replacement for aneurysmal disease: the value of preparatory carotid subclavian reconstruction.
Between November 2000 and January 2002, two patients with aneurysms that involved the distal part of the aortic arch including the left subclavian artery were treated at our institution. Patient 1 had an aneurysm of 5.8 cm extending to the proximal descending aorta. Patient 2 had a 6.8 cm type II thoracoabdominal aneurysm extending proximal to the aortic bifurcation. ⋯ Both patients remain alive and well at the time of last follow-up (7 to 20 months). Carotid subclavian reconstruction in preparation for distal aortic arch replacement facilitates the performance of the proximal anastomosis and attempts to maintain flow through the left vertebral system during aortic cross-clamping. This may reduce the risk of stroke during distal aortic arch replacement.
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Stingray envenomations usually result in minor injuries with localized symptoms. In some cases the injury incurred is more serious, resulting in significant morbidity if not adequately treated. ⋯ Stingray venom is known to have necrosing properties in human tissues and in this case this led to graft failure requiring surgical repair. This case emphasizes the insidious nature of stingray venom and the necessity of extensive surgical debridement for more significant envenomations.