Annals of vascular surgery
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Multicenter Study
Axillary Artery Injury Associated with Proximal Humeral Fractures: Review of Long-Term Vascular, Orthopedic, and Neurologic Outcomes.
Fracture and dislocation of the proximal humerus is common. It is associated with a number of vascular, neurologic, and orthopedic complications; these include brachial plexopathy and avascular necrosis (AVN) of the humeral head. These complications are rare but can potentially cause severe disability to patients; however, they remain poorly described in the literature. To describe vascular, orthopedic, and neurologic outcomes after axillary artery repair, in patients with proximal humeral fractures or dislocations. ⋯ There was an unusually high rate of injuries to the first part of the axillary artery. Close clinical observation is recommended for such patients. AVN of the humeral head and brachial plexopathy remain significant and debilitating complications.
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Multicenter Study Observational Study
Long-Term Outcomes of Catheter-Directed Thrombolysis for Acute Lower Extremity Occlusions of Native Arteries and Prosthetic Bypass Grafts.
Catheter-directed thrombolysis is a well-accepted treatment for acute lower extremity occlusions of native arteries and bypass grafts. Several variables that affect outcomes of thrombolysis have been identified. The hypothesis of this study was that the long-term outcome after catheter-directed thrombolysis would be better for acute lower extremity occlusions of native arteries compared with prosthetic bypass grafts. ⋯ Despite initial promising results, long-term follow-up of catheter-directed thrombolysis for acute lower extremity occlusions showed a disappointing amputation-free survival. In multivariate analysis, no significant differences in amputation-free survival between native arteries and prosthetic bypass grafts were determined.
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Multicenter Study Comparative Study
Hemodynamic changes in patients undergoing carotid endarterectomy under cervical block and general anesthesia.
The objective of this study was to assess differences in hemodynamic stability for patients undergoing carotid endarterectomy (CEA) under general anesthesia (GA) as compared with cervical block anesthesia (CBA). ⋯ For patients undergoing CEA, CBA resulted in less hemodynamic fluctuations and fewer intraoperative vasoactive medication requirements as compared with GA.
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Multicenter Study Comparative Study
Predictors affecting in-hospital mortality of ruptured abdominal aortic aneurysms: a Greek multicenter study.
Endovascular aortic repair (EVAR) is being used with increasing frequency for the treatment of ruptured abdominal aortic aneurysms (rAAAs), although conflicting results have been reported concerning perioperative mortality. The aim of our study was to evaluate potential difference in mortality rates between EVAR and open surgical repair (OSR) and identify independent risk factors for in-hospital mortality in rAAAs. This study also aimed to evaluate the Glasgow Aneurysm Score (GAS) in predicting in-hospital mortality. A time-trend analysis of EVAR for ruptured AAAs was also performed. ⋯ EVAR is being used with increasing frequency for the treatment of rAAAs and it appears to be associated with lower in-hospital mortality compared with OSR, after adjustment for hemodynamic instability and known atherosclerotic risk factors. Preoperative predictors of in-hospital mortality such as GAS should be probably modified in these patients.
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Multicenter Study Comparative Study
Open versus endovascular repair of ruptured abdominal aortic aneurysms.
Management of ruptured abdominal aortic aneurysms (rAAA) remains one of the most challenging situations in vascular surgery. The aim of our study was to examine national trends and compare contemporary outcomes of open and endovascular repair (EVAR) for rAAA across a wide spectrum of hospitals in the United States. ⋯ EVAR is a safe and, in appropriately selected patients, superior approach to open surgery for the management of patients with rAAA. On multivariate analysis, patients who underwent open repair were at significantly increased risk of morbidity and mortality. In clinical settings where adequate resources, personnel, and surgical expertise are present, an endovascular approach should be strongly considered for all patients with acceptable anatomy.