Cox regression was used to adjust for confounding factors. Primary outcomes were 30-day and 5-year mortality.RESULTS: Of 36,611 patients included, 2,668 (7.3%) were on ACEI preoperatively only, 1,891 (5.2%) postoperatively only, and 16,582 (45.3%) both preoperatively and postoperatively. Although continuous pre-and postoperative ACEI use was associated with 65% reduced odds of 30-day mortality (odds ratio [OR] 0.35; 95% CI, 0.28 to 0.45; p < 0.001) and isolated postoperative ACEI use associated with 48% reduced odds of 30-day mortality (OR 0.52; 95% CI, 0.29 to 0.91; p ¼ 0.023), isolated preoperative use of ACEI was associated with 2.8-fold increased odds of 30-day mortality (OR 2.78; 95% CI, 2.18 to 3.56; p < 0.001) compared with no ACEI use. Continuous ACEI use was associated with decreased risk of 1-year amputation or death (hazard ratio 0.81; 95% CI, 0.76 to 0.87; p < 0.001) and 5-year mortality (hazard ratio 0.77; 95% CI, 0.71 to 0.82; p < 0.001). Isolated postoperative ACEI use also decreased the risk of 5-year mortality (hazard ratio 0.87; 95% CI, 0.76 to 1.00; p ¼ 0.044).CONCLUSIONS: ACEI use in the pre-and postoperative periods and isolated postoperative use can improve 30-day and 5-year survival after lower extremity bypass in patients with peripheral artery disease.
In cases of complex aortic arch anatomy, it can be difficult to obtain wire access into the ascending aorta for deployment of a thoracic endograft (thoracic endovascular aortic repair [TEVAR]) using a transfemoral approach. This can result from tortuosity or patulous aneurysmal areas, making platform stability difficult. We report the case of a young adult man with a large proximal left subclavian aneurysm that made zone 0 TEVAR placement very difficult with transfemoral access alone. Direct ascending aortic access through the open chest allowed for a stable through-and-through platform for endograft delivery, highlighting the efficacy of this seldom-needed technique during debranching TEVAR procedures.
The IHC showed positive expression of both vWF and a-smooth muscle actin, indicating a developing smooth muscle layer within the scaffold. While the smooth muscle cells in the experimental scaffold appeared less organized than those in native tissue, the DAPI-stained nuclei appeared to be more consistent with native organization (Fig 3).
Conclusions:The experiments examining the use of acellular electro spun scaffolds in a rat carotid arterial interposition model suggest the described scaffold fabrication approach, as well as the employed surgical technique, are appropriate for this setting. Furthermore, the time points of 1 week and 3 weeks are suiTable for examining the formation of an endothelial monolayer on the surface of the implanted graft. Longer time points will be needed to assess smooth muscle tissue formation in scaffolds. Most importantly, time points between 3 and 8 weeks will be needed to further investigate the compromise of patency in this model at that time.
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