This multicenter experience has shown that laparoscopic diaphragm motor point mapping, electrode implantation, and pacing can be safely performed both in SCI and in ALS. In SCI patients it allows freedom from ventilator and in ALS patients it delays the need for ventilators, increasing survival.

PGF insertion in selected patients at high risk who had trauma effectively prevented both fatal and nonfatal PE. The lower incidence of fatal PE in the PGF group may have contributed to a reduction in the overall mortality rate. Patients who have trauma with high risk for PE should be considered for PGF placement.

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Therapeutic study, level V.

Standard thickness ePTFE is the graft of choice when placing ePTFE arteriovenous grafts for hemodialysis.

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Background Cervical spinal cord injury (SCI) can lead to dependence on mechanical ventilation (MV) with significant morbidity and mortality. The diaphragm pacing system (DPS) was developed as an alternative to MV. Methods We conducted a prospective single‐arm study of DPS in MV‐dependent patients with high SCI and intact phrenic nerves. Following device acclimation, pacing effectiveness to provide ventilation was evaluated. The primary endpoint was the number who could use DPS to breathe for 4 continuous hours without MV. Secondary endpoints included the number of patients that could use DPS 24 h/day free of MV and the ability of DPS to maintain clinically acceptable tidal volume (Vt). In addition, we conducted a meta‐analysis that included the prospective study along with data from four recently published studies to evaluate DPS hourly use. Results Fifty‐three patients were implanted in the prospective study. Most were male (77.4%) with a median time from injury to treatment of 28.3 (IQR: 12.1, 83.3) months. Four‐ and 24‐h use occurred in 96.2% (95% CI: 87.0%, 99.5%) and 58.5% (95% CI: 44.1%, 74.9%), respectively. Four and 24‐h results in the meta‐analysis cohort (n = 196) exhibited similar results 92.2% (95% CI: 82.6%, 96.7%) and 52.7% (95% CI: 36.2%, 68.6%) using DPS for 4 and 24 h, respectively. DPS use significantly exceeded the calculated basal tidal volume requirements by a mean of 48.4% (95% CI: 37.0, 59.9%; p < 0.001). Conclusions This study demonstrates that in most ventilator‐dependent patients, diaphragm pacing can effectively supplement or completely replace the need for MV and support basal metabolic requirements.

Carotid endarterectomy in very elderly patients remains controversial. We report our experience with this operation on 101 very elderly patients at the Baptist Heart Institute, a community hospital in Lexington, Kentucky. Ages ranged from 80 to 93 years with an average age of 86.5 years. There are 7 nonagenarians in this study. The indications included asymptomatic severe carotid artery stenosis in 29 (29.7%) patients and symptomatic disease in 72 patients (71.3%). Sixty eight percent of the patients had significant co-morbidity that included hypertension, diabetes mellitus, lipid disorders, previous stroke, previous carotid endarterectomy, coronary artery disease and previous myocardial infarctions. Thirty two percent of the patients had no significant past medical history. Two deaths occurred during hospitalizations (1.98%). One of these patients had carotid endarterectomy in conjunction with coronary artery bypass grafting. This patient suffered a stroke. The second death occurred as the result of respiratory failure. There was 1 perioperative infarct. From this study, we conclude that carotid endarterectomy can be performed safely in very elderly patients in a community hospital.