Perspectives in vascular surgery and endovascular therapy
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Perspect Vasc Surg Endovasc Ther · Mar 2007
The bedside insertion of inferior vena cava filters using ultrasound guidance.
Since the introduction of inferior vena cava (IVC) filters more than 30 years ago, there has been a steady improvement in the design, ease, and safety of the delivery systems. Today, all of the commonly used filters can be placed via a peripheral vein by using standard percutaneous Seldinger technique. However, this typically requires fluoroscopy, intravenous contrast agents, radiation exposure, and transport of the patient to the interventional or operating suite. ⋯ Vena caval interruption can be safely performed under ultrasound guidance in a monitored, intensive care unit environment. In selected intensive care unit or multiply injured trauma patients, this will reduce the risk, complexity and cost of transport for these critically ill patients. Duplex-guided IVC filter placement also reduces procedural costs compared to an operating room or interventional suite, and eliminates intravenous contrast material exposure.
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Perspect Vasc Surg Endovasc Ther · Dec 2006
Randomized Controlled Trial Multicenter StudyThe Coronary Artery Revascularization Prophylaxis (CARP) Trial: results and remaining controversies.
A high percentage of patients requiring elective vascular surgery also has indications for coronary artery revascularization, leading to varied opinions as to whether to undertake coronary artery revascularization first, to use risk stratification, or to do no coronary intervention before elective vascular surgery. The Coronary Artery Revascularization Prophylaxis (CARP) Trial determined the long-term benefit of coronary artery revascularization in patients with stable coronary artery disease undergoing elective infra-renal aortic or infra-inguinal vascular surgery. Following application of inclusion/exclusion criteria, those patients who did not require urgent vascular surgery or have significant co-existing conditions underwent cardiac evaluation and angiography. ⋯ The remaining 1190 patients underwent coronary angiography following which 680 were excluded for clinical or other reasons. The remaining 510 were randomized to coronary artery revascularization (258) before vascular surgery and no coronary intervention before vascular surgery (252). Coronary artery revascularization neither improves long-term survival nor does it improve short-term outcomes for elective aortic or infra-inguinal vascular surgery.
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Perspect Vasc Surg Endovasc Ther · Dec 2006
ReviewVagus nerve stimulation therapy for treatment of drug-resistant epilepsy and depression.
Vagal nerve stimulation therapy is a new adjunctive treatment for drug-resistant epilepsy and depression. It consists of a pulse generator that transmits impulses to the left vagus nerve via an implantable electrode and can be performed by surgeons familiar with the anatomy of the cervical vagus nerve. The minimum age for vagal nerve stimulation therapy for epilepsy is 12 years, and for depression, 18 years. ⋯ If used as adjunctive therapy, vagal nerve stimulation has shown better control of seizures or depression at smaller doses of antiepileptic or antidepressive medications and also results in decreased dose-dependent side effects. Vagal nerve stimulation therapy appears safe as an adjunctive treatment for drug-resistant epilepsy and depression. Long-term data are needed to better define its ultimate role in various subsets of patients.
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Perspect Vasc Surg Endovasc Ther · Sep 2006
Case ReportsHybrid endovascular and open surgical repair of a Crawford type III thoracoabdominal aneurysm in a high-risk patient.
Open thoracoabdominal aortic aneurysm repair carries a risk of significant morbidity and mortality. Thoracic endovascular aortic repair is an alternative, less invasive approach with lower morbidity and mortality but is not an option for thoracoabdominal aortic aneurysm because of visceral artery involvement. The authors describe the treatment of a 61-year-old high-risk male with an enlarging Crawford type III thoracoabdominal aneurysm using simultaneous aortic visceral debranching and thoracoabdominal endovascular aortic repair. A hybrid approach may be a safe alternative treatment option in high-risk surgical patients with thoracoabdominal aortic aneurysm.
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Perspect Vasc Surg Endovasc Ther · Jun 2006
Review Historical ArticleUpper extremity arterial combat injury management.
Traumatic hemorrhage and vascular injury management have been concerns for both civilian and military physicians. During the 20th century, advances in technique allowed surgeons to focus on vascular repair, restoration of perfusion, limb salvage, and life preservation. ⋯ The current generation of providers is challenged with applying contemporary care while expanding upon the lessons taught by our predecessors. The objective of this report is to review the historical experience with managing military upper extremity arterial injuries and compare that experience with current management.