The presence of persistent EL-2 after EVAR results in inferior AAA sac regression. A preoperatively patent IMA is associated with increased rates of EL-2 and inferior AAA sac regression. Consideration should be given to preoperative occlusion of a patent IMA before EVAR.
BackgroundBlunt carotid arterial injury (BCI) is a rare injury associated with motor vehicle collision (MVC). There are few population based analyses evaluating carotid injury associated with blunt trauma and their associated injuries as well as outcomes.MethodsThe Nationwide Inpatient Sample (NIS) 2003–2010 data was queried to identify patients after MVC who had documented BCI during their hospitalizations utilizing ICD-9-CM codes. Demographics, associated injuries, interventions performed, length of stay, and cost were evaluated.Results1,686,867 patients were estimated having sustained MVC; 1,168 BCI were estimated. No patients with BCI had open repair, 4.24 % had a carotid artery stent (CAS), and 95.76 % of patients had no operative intervention. Age groups associated with BCI were: 18–24 (27.8 %), 47–60 (22.3 %), 35–46 (20.6 %), 25–34 (19.1 %), >61 (10.2 %). Associated injuries included long bone fractures (28.5 %), stroke and intracranial hemorrhage (28.5 %), cranial injuries (25.6 %), thoracic injuries (23.6 %), cervical fractures (21.8 %), facial fractures (19.9 %), skull fractures (18.8 %), pelvic fractures (18.5 %), hepatic (13.3 %) and splenic (9.2 %) injuries. Complications included respiratory (44.2 %), bleeding (16.1 %), urinary tract infections (8.9 %), and sepsis (4.9 %). Overall mortality was 14.1 % without differences with regard to intervention (18.5 % vs. 13.9 %; P = 0.36). Stroke and intracranial hemorrhage was associated with a 2.7 times greater risk of mortality. Mean length of stay for patients with BCI undergoing stenting compared to no intervention were similar (13.1 days vs. 15.9 days) but had a greater mean cost ($83,030 vs. $63,200, p = 0.3).ConclusionBCI is a rare injury associated with MVC, most frequently reported in younger patients. Frequently associated injuries were long bone fractures, stroke and intracranial hemorrhage, thoracic injuries, and pelvic fractures which are likely associated with the force/mechanism of injury. The majority of patients were treated without intervention, but when CAS was utilized, it did not impact mortality and trended toward increased costs.
ObjectiveAngiotensin-converting enzyme inhibitors (ACEIs) have not been well evaluated in conjunction with lower extremity revascularization (LER). This study evaluated freedom from amputation in patients who underwent either an open (OPEN) or endovascular (ENDO) revascularization with and without utilization of an ACEI.Materials and methodsPatients who underwent LER were identified from 2007–2008 Medicare Provider Analysis and Review files. Demographics, comorbidities, and disease severity were obtained. Post-procedural use of an ACEI was confirmed using combining them with National Drug Codes and Part D Files. Outcomes were analyzed using chi-square analysis, Kaplan–Meier test, and Cox regression.ResultsWe identified 22,954 patients who underwent LER: 8,128 (35.4%) patients with claudication, 3,056 (13.3%) with rest pain, and 11,770 (51.3%) with ulceration or gangrene. More patients underwent ENDO (14,353) than OPEN (8,601) revascularization and 38% of the cohort was taking an ACEI. Overall, ACEI utilization compared to patients not taking ACEI was not associated with lower amputation rates at 30 days (13.5% vs. 12.6%), 90 days (17.7% vs. 17.1%), or 1 year (23.9% vs. 22.8%) (P>0.05 for all). After adjustment for comorbidities, ACEI utilization was associated with higher amputation rates for patients with rest pain (hazard ratio: 1.4; 95% confidence interval: 1.1–1.8).ConclusionACEI utilization was not associated with overall improved rates of amputation-free survival or overall survival in the vascular surgery population. However, an important finding of this study was that patients presenting with a diagnosis of rest pain and taking an ACEI who underwent a LER had statistically higher amputation rates and a lower amputation-free survival at 1 year. Further analysis is needed to delineate best medical management for patients with critical limb ischemia and taking ACEI who undergo vascular revascularization.
Objectives: Carotid plaque signal hyperintensity on T1-weighted magnetic resonance imaging (MRI) has been reported to represent intraplaque hemorrhage and to be associated with previous cerebral ischemic events. We applied this method as the preoperative assessment of aortic plaque to the patients undergoing arch replacement and compared the MRI findings with the resected pathologic samples.Methods: Ten patients who had aortic arch replacement for atherosclerotic aneurysm underwent plaque imaging using three-dimensional inversion recovery-based T1weighted MRI (magnetization-prepared rapid acquisition with gradient-echo [MPRAGE]) preoperatively. Aortic plaque with intensity on MPRAGE of >200% that of adjacent muscle was categorized as high signal intensity. Aortic samples were collected from 13 parts in the 10 patients that were >3 mm thick in preoperative computed tomography. Histopathologic evaluation was performed according to defect of fibrous cap or ulcer formation (0-3+) and presence of intraplaque erythrocytes (0-3+).Results: In the six parts corresponding to MPRAGE high signals, there was (1+) ulcer formation in 1, (2+) in 4, and (3+) in 1. As regard to presence of intraplaque erythrocyte, there were (1+) erythrocytes in 1, (2+) in 2, and (3+) in 3. In the remaining seven parts corresponding to MPRAGE no high signals, there was (1+) ulcer formation in five and (2+) in one, and there were (1+) intraplaque erythrocytes in six and (2+) in one. Dividing the severity of these findings into two categories (mild ¼ grade 0 and 1, and severe ¼ grade 2 and 3), there was more severe ulcer formation (P ¼ .016) and more accumulation of intraplaque erythrocytes (P ¼ .016) in the samples corresponding to MPRAGE high signals.Conclusions: MPRAGE high signal in aortic wall was associated with deficit of fibrous cap and ulcer formation resulting in accumulation of intraplaque erythrocytes. These findings would be useful to avoid embolic events in aortic surgery, especially in endovascular repair.
Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.In general, authors of case reports should use the Brief Report format.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.