Elective EVAR conversion, although technically challenging may be done with mortality similar to primary open repair. Mortality for conversion for infected grafts and ruptured aneurysms remains high. EVAR is associated with continued risk of conversion, and surveillance may identify late complications that require removal, justifying lifelong monitoring. Aggressive management of late complications and elective conversion may minimize the mortality associated with this procedure.

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The rate of EVAR late explants has increased during the past decade at our institution. Survival is higher when the explant is done electively compared with emergent repair. Difficulty in obtaining a seal at the initial EVAR often leads to failure ≤1 year, whereas progression of aneurysmal disease is the primary reason for failure >5 years.

Increasing rates of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections have also affected the microbial profile of breast abscesses.Objective: To update the decade-old bacteriologic description of breast abscesses to improve the choice of initial antibacterial drug therapy.Design: Retrospective case series.Setting: County hospital emergency department.Patients: Forty-four women (mean age, 41 years; age range, 20-63 years) with breast abscesses.Methods: All cultures from the breast abscesses of patients were reviewed. Main Outcome Measures:The microbiologic features and sensitivities of breast abscesses.Results: Of 46 specimens only 28 showed bacterial yield (61%). Of these, 11 (39%) were polymicrobial, for an average of 1.4 isolates per specimen. The most common or-

Obese patients had no greater delay in diagnosis, had no greater need for CT scan, gained no additional benefit from laparoscopy, and did not incur significantly worse outcomes after appendectomy except for an increased LOS among those with perforation.

Malperfusion in any territory at the time of presentation in patients with type B dissections can be treated with endovascular intervention with acceptable outcomes. Opposed to branch vessel intervention alone, increased aortic intervention with regard to proximal coverage may signify more serious disease is associated with worse outcome.

Objective: To determine the influence of computed tomography (CT) scans on diagnosis and management of patients with suspected appendicitis. Methods: Retrospective 2-year review of 1,630 patients with suspected appendicitis, categorized into three groups based on the likelihood (Alvarado scores) of having appendicitis. Group 1: low likelihood (Alvarado score ≤4); group 2: intermediate likelihood (Alvarado scores 5–7), and group 3: high likelihood (Alvarado score ≧ 8). CT scan utilization, hospital course, and final pathology were retrospectively reviewed. Results: More patients received a CT scan in 2006 as compared with 2005 (60 vs. 52%; p = 0.001). The overall appendectomy rate was similar between the 2 years (57% in 2005 vs. 57% in 2006; p = 0.995). The overall appendectomy rate in patients with a CT was significantly higher as compared with those without (60 vs. 53%; p = 0.002). The appendectomy rate in patients with Alvarado scores ≤4 and no CT scan was significantly lower than in those with a CT scan (12 vs. 48%; p < 0.0001). The overall negative appendectomy rate in patients with a CT scan was similar to that in those without: 31/546 (6%) vs. 23/383 (6%). Conclusions: CT scan utilization increased the appendectomy rate only in patients with a low clinical suspicion for appendicitis. Preoperative CT scans did not decrease the negative appendectomy rate.

Patients with advanced PAD that require lower extremity amputation have diminished survival and significant contralateral amputation rates. Elderly patients on dialysis are particularly prone to dying or losing the other leg after a major amputation. These data support strategies to enhance limb preservation and optimize medical comorbidities in these patients.