查看更多>>摘要：Objectives "Enhanced recovery after surgery" (ERAS) protocols use a multisystem approach to target homeostatic physiology via opioid-minimizing analgesia. The aim of this study is to determine if an ERAS protocol for lower extremity bypass surgery improves pain control and decreases narcotics. Methods From July 2020 through June 2021, all patients that underwent infrainguinal lower extremity bypass procedures were subject to the ERAS protocol and compared to a "pre-ERAS" group between June 2016 through May 2020. Preoperatively, ERAS patients were given celecoxib, gabapentin, and acetaminophen while postoperatively they were given standing acetaminophen, gabapentin, ketorolac, and tramadol with as needed use of oxycodone. Pain scores were recorded using a numerical rating pain scale. Demographics, length of stay, 30-day complications, and disposition metrics were recorded. Results There were 50 patients in the ERAS group, compared to 114 before its implementation. The mean age was 70.5 (ERAS group) versus 68.7 (pre-ERAS group) and a majority were male (P > .05). Enhanced recovery after surgery patients were less likely to have chronic kidney disease (P = .01). Enhanced recovery after surgery patients had improved length of stay (3.6 +/- 2.3 days vs 4.8 +/- 3.2 days, ERAS vs pre-ERAS, P = .01). There was no significant difference between groups for the remaining demographics (P > .05). One patient (2%) in the ERAS group used patient-controlled analgesia, compared to 30 patients (26%) in the pre-ERAS group (P < .001). Cumulative pain control in the first 12 hours was significantly better in the ERAS group (P = .05). Pain control at discharge was similar between the 2 groups (3 pain score vs 3 pain score, pre-ERAS vs ERAS, P > .05) Conclusion Our study utilized a multisystem approach to optimize the physiologic stress response to vascular surgery while reducing high potency narcotic use. We show that an ERAS protocol provides noninferior pain control with less potent pain medication and improves the length of stay for patients undergoing infrainguinal bypass surgery.
Brouwers, Jeroen J. W. M.van Doorn, Louk P.Pronk, Laurievan Wissen, Rob C....
8页
查看更多>>摘要：Background In diagnosing peripheral arterial disease (PAD), medial arterial calcification (MAC) hampers arterial compression and could lead to unreliable ankle brachial index (ABI), toe brachial index (TBI) and toe pressure (TP). Doppler ultrasonography (DUS) derived maximal systolic acceleration (ACCmax) might be more accurate to diagnose PAD. In an in vitro study, a strong correlation between ACCmax and the severity of stenotic disease was determined. The aim of this study was to investigate the ACCmax in correlation with conventional non-invasive diagnostics in an in vivo setting. Methods: In twelve healthy individuals, an arterial stenosis was mimicked by compression on the common femoral artery by an ultrasounds probe, creating a local stenosis of 50%, 70% and 90%. The ABI, TBI, TP and several DUS parameters (including ACCmax) were assessed at the ankle during these different degrees of stenosis. All DUS parameters were measured separately by two observers to determine the interobserver variability. Results: Overall the ABI, TBI, TP, ACCmax, ACCsys and PSV decreased significantly when the degree of stenosis increased. The ACCmax showed the highest correlation with the degree of stenosis (r -.884), compared to ABI (r -.726), TBI (r -.716) and TP (r -.758). Furthermore, the interobserver variability of ACCmax was excellent, with an intraclass correlation coefficient (ICC) of .97. Conclusion: ACCmax is an accurate non-invasive DUS parameter to diagnose and assess the severity of a mimicked arterial stenosis in healthy individuals. Further prospective assessment of the clinical value of ACCmax and its potential benefits in patients with PAD is needed.
查看更多>>摘要：Objectives Heavy cannabis use has been associated with the development of acute myocardial infarction and stroke. The objective of this study was to determine if heavy, chronic cannabis use is associated with the development of acute limb ischemia (ALI) or critical limb ischemia (CLI). Methods We conducted a retrospective cohort study within the National Inpatient Sample (2006-2015). Patients without cannabis use disorder (CUD) were matched to patients with CUD in a 2:1 ratio using propensity scores. Our primary outcomes were incidence of ALI and CLI. Secondary outcomes included incidence of acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), frequency of open or endovascular interventions, length of stay, and total costs. Sensitivity analyses were performed with alternative models, including in the entire unmatched cohort with regression models utilizing survey weights to account for sampling methodology. Results We identified a cohort of 46,297 857 unmatched patients. Patients with CUD in the unmatched cohort were younger, with less cardiovascular risk factors, but higher rates of smoking and substance abuse. The matched cohort included 824,856 patients with CUD and 1,610,497 controls. Those with CUD had a higher incidence of ALI (OR 1.20 95% CI: 1.04-1.38 P=.016). Following multiple sensitivity analyses, there was no robust association between CLI and CUD. We observed no robust association of CUD with AMI, CMI, procedures performed, frequency of amputation, costs, or total length of stay. Conclusions Cannabis use disorder was associated with a significantly higher incidence of admission for acute limb ischemia. CUD was not associated with an increased risk of critical limb ischemia following sensitivity analysis. Given CUD is often seen in younger, less co-morbid patients it provides an important target for intervention in this population.
查看更多>>摘要：Background and Purpose Carotid artery stenting has become widespread as a revascularization method and has increasingly replaced carotid endarterectomy for treating internal carotid artery stenosis with contralateral carotid occlusion. Hence, this study aimed to establish the clinical characteristics and perioperative outcomes of carotid artery stenting for internal carotid artery stenosis in patients with contralateral carotid occlusion using a combined protection method. Methods This retrospective single-center study assessed 218 patients with internal carotid artery stenosis who underwent carotid artery stenting using the dual protection (simultaneous flow reversal and distal filter) and blood aspiration method. We distinguished 2 patient groups: contralateral carotid occlusion (n = 11) and no contralateral carotid occlusion (n = 207). We evaluated the patients' characteristics, intraoperative transient neurological symptoms, hypotension, bradycardia, major adverse events (major stroke, myocardial infarction, and death within 90 days), minor stroke, hyperintensities on diffusion-weighted images after carotid artery stenting, captured visible debris, and restenosis. Results In this cohort, 5% of patients with internal carotid artery stenosis had contralateral carotid occlusion. No statistically significant differences in patient characteristics existed between the groups. The success rate of carotid artery stenting was 100%. There were no statistically significant differences in intraoperative complications, postoperative major adverse events, or other outcomes between both groups. Conclusions In this cohort, carotid artery stenting using dual protection combined with blood aspiration was safe and effective in preventing distal embolism in patients with internal carotid artery stenosis and contralateral carotid occlusion.
查看更多>>摘要：Popliteal arteriovenous fistulae (PAF) are anomalous communications between the arterial and venous systems of the lower extremity. They are usually secondary to trauma and are rarely associated with additional vascular defects. The coexistence of a PAF and a venous aneurysm is rare and usually occurs in patients with connective tissue disorders. Evidence regarding the management of this type of anomaly is scarce. However, both open and endovascular approaches seem feasible alternatives for treating this condition. Here, we describe a spontaneous popliteal arteriovenous fistula associated with a venous aneurysm in a 42-year-old male patient who presented with a popliteal mass. Satisfactory endovascular closure of the fistula and exclusion of the venous aneurysm were achieved using an Amplatzer (TM) Vascular Plug II.
查看更多>>摘要：The co-occurrence of abdominal aortic aneurysm (AAA) and colorectal malignancy creates a significant surgical dilemma over which entity should be addressed first. A 73-year-old male was referred to our hospital due to a painful pulsatile abdominal mass. Computed tomographic angiography revealed an infrarenal aortic aneurysm measuring 5.8 cm in diameter and incidentally, a synchronous mass lesion in the sigmoid colon. The patient underwent an emergency EVAR using a Gore Excluder endograft. Postoperative CT staging for colon cancer revealed a type 2 endoleak on the grounds of a patent wide inferior mesenteric artery. The patient underwent a standard laparoscopic left colectomy with high ligation of the inferior mesenteric artery in order to simultaneously address the ongoing type 2 endoleak. Follow-up examinations with computed tomographic angiography were performed confirming the resolution of the endoleak. Synchronous laparoscopic sigmoidectomy and high ligation of inferior mesenteric artery for type 2 endoleak treatment appears to be applicable with hopeful results.
查看更多>>摘要：Objective: Persistence of the sciatic artery is a rare phenomenon in vascular surgery. It results from abnormal embryologic development, and where present in the absence of a femoral arterial system, it can have significant clinical implications for patients and can even be limb threatening. We present the case of a 69-year-old man with left-sided, short-distance claudication and rest pain, which caused concern for critical limb ischaemia. Methods: Computed tomography angiography revealed a persistent sciatic artery arising from the common iliac artery and resulting in an occluded popliteal artery. The patient underwent a double-bypass procedure to restore the arterial supply to the symptomatic limb. A left iliopopliteal Dacron graft bypass was performed, followed by a left iliopopliteal Dacron to posterior tibial bypass using the patient's great saphenous vein. The left sciatic artery was ligated proximally. Results:This allowed for restoration of arterial supply to the patient's left lower limb, relieving his claudication and rest pain. Conclusion: The key finding was the aneurysmal nature of the sciatic artery, reflecting the likely thromboembolic nature of the distal popliteal disease. Thus, our patient required not only a bypass procedure but also ligation of the native sciatic artery. Timely management is critical due to severity of consequences.
Hakkenbrak, Nadia A. G.Truijers, MaartenThomassen, Irene
3页
查看更多>>摘要：An 82-year-old male was referred to the emergency department for severe respiratory distress. Computed tomography angiography showed tracheal compression due to a large ruptured saccular aneurysm of the descending thoracic aorta. Emergency Thoracic Endovascular Aneurysm Repair (TEVAR) was performed. To reduce tracheal compression, an endotracheal stent was placed (silicone Dumon(C)). Following surgery, respiratory function improved. Two days after the surgery, the patient refused further invasive treatment, including mechanical mucus aspiration from the endotracheal stent, and palliative sedation was initiated. Conventional treatment to reduce tracheal compression by a saccular aortic aneurysm is open surgical aneurysm repair. If open repair is contraindicated because of patient age, comorbidity, or in case of severe hemodynamic instability following aneurysm rupture, TEVAR with endotracheal stent placement may serve as a bridge to definite surgery to reduce tracheal compression.
查看更多>>摘要：May-Thurner syndrome (MTS) is a known structural risk factor for deep vein thrombosis (DVT) and embolism. In patients with a patent foramen ovale (PFO), emboli originating from the deep veins are able to paradoxically reach the systemic circulation via the PFO, consequently resulting in transient ischemic attacks (TIA) or stroke. We report the case of a 31-year-old pregnant woman, with a recent history of TIA, who presented with chronic bilateral numbness, pain, and swelling in the lower extremities. On imaging, she was found to have a PFO and MTS. Her pregnancy was subsequently terminated. This decision was made independently by the patient. Her care team did not advise her to terminate her pregnancy as there was no specific medical reason to do so. However, the patient was in significant physical pain and distress and ultimately was not comfortable continuing with the pregnancy. This highlights the complex, multifactorial decision-making process that pregnant patients with comorbid health conditions undertake. The patient then underwent transcatheter PFO closure and stents were placed bilaterally in the left and right common iliac veins. Following the stent procedure, lower extremity symptoms swiftly resolved, allowing the patient to significantly improve her ability to ambulate. There have been no signs of TIA since her procedures, and her venous symptoms have been stable. In patients with TIA or stroke from a paradoxical embolism, MTS should be considered as a potential etiology. Endovascular intervention to treat the underlying MTS should also be considered to decrease the risk of recurrent DVT and embolism.
查看更多>>摘要：Purpose We report a case of revascularization for an occluded renal artery using endovascular renal thrombus aspiration followed by catheter-directed thrombolysis. Case Report A 56-year-old man presented with sudden onset severe left-sided abdominal and loin pain for 6 hours. Urgent computed tomography (CT) angiogram showed occlusion of left renal artery. Emergency selective left renal angiogram and thrombus aspiration using a 5-French Cobra catheter was performed. Catheter-directed thrombolysis with urokinase was initiated after aspiration thrombectomy. Angiogram 24 hours after thrombolysis showed the left renal artery and its segmental branches were successfully revascularized. Patient was put on anticoagulation after operation and his renal function recovered well. Conclusion Percutaneous aspiration thrombectomy with conventional catheters combined with intra-arterial local fibrinolysis could be used to salvage the renal function in case of complete renal artery thromboembolic occlusion.
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