First-degree male relatives of AAA patients have wider aortas and a twofold higher prevalence of AAA compared with the age adjusted background population. The prevalence of AAA was markedly higher in participants related to female, rather than male, patients with AAA.
Objective: Few studies have been published on the safety of carotid endarterectomy (CEA) after intravenous thrombolysis (IVT). Registry reports have been recommended in order to gather large study groups. Design: A retrospective, registry based, case controlled study on prospectively gathered data from Sweden, the capital region of Finland, and from Denmark, including 30 days of follow up. Methods: The study group was a consecutive series of 5526 patients who had CEA for symptomatic carotid artery stenosis during a 4.5 year period. Among these, 202 (4%) had IVT prior to surgery, including 117 having CEA within 14 days, and 59 within 7 days of thrombolysis. IVT as well as CEA were performed following established guidelines. The median time from index symptom to CEA was 12 days (range 0e130, IQR 7e21). Results: The 30 day combined stroke and death rate was 3.5% (95% CI 1.69e6.99) for those having IVT + CEA, 4.1% (95% CI 3.46e4.39) for those having CEA without previous IVT (odds ratio 0.84 [95% CI 0.39e1.81]), 3.4% (95% CI 1.33e8.39) for those having IVT + CEA within 14 days, and 5.1% (95% CI 1.74e13.91) for those having IVT + CEA within 7 days. Conclusion: Data on the time from symptoms to CEA in patients not having IVT, Rankin score, degree of stenosis, and cerebral imaging were not available. Despite its weaknesses, this study reasserts that CEA can be performed within the recommended 2 weeks of the onset of symptoms and IVT without increasing the risk of peri-operative stroke or death. Centres and vascular registries are recommended to continue monitoring changes in patient characteristics, lead times, and major complications after CEA in general, with a special focus on those who have undergone a prior thrombolysis.
Background: The aim of this study was to evaluate the clinical experience with 310 robot assisted vascular procedures. The da Vinci system has been used by a variety of disciplines for laparoscopic procedures but the use of robots in vascular surgery is still relatively uncommon. Methods: From November 2005 to May 2014, 310 robot assisted vascular operations were performed. Two hundred and twenty four patients were prospectively evaluated for occlusive disease, 61 patients for abdominal aortic aneurysm, four for a common iliac artery aneurysm, four for a splenic artery aneurysm, one for a internal mammary artery aneurysm, and after the unsuccessful endovascular treatment five for hybrid procedures, two patients for median arcuate ligament release and nine for endoleak II treatment post EVAR. Among these patients, 224 underwent robotic occlusive disease treatment (Group I), 65 robotic aorto-iliac aneurysm surgery (Group II) and 21 other robotic procedures (Group III). Results: A total of 298 cases (96.1%) were successfully completed robotically. In 10 patients (3.2%) conversion was necessary. The 30 day mortality was 0.3%, and two (0.6%) late prosthetic infections were seen. Targeted Group I and Group II patients were compared. Robotic iliofemoral bypass, aorto-femoral bypass, or aorto-iliac thrombo-endarterectomy with prosthetic patch (Group I) required an operative time of 194 (range, 127-315) minutes and robotic aorto-iliac aneurysm surgery (Group II), 253 (range, 185-360) minutes. The mean aortic cross clamping time was 37 minutes in Group I and 93 minutes in Group II. The mean blood loss was more significant in Group II (1210 mL) than in Group I (320 mL). Conclusion: From a practical point of view, the greatest advantage of the robot assisted procedure has been the speed and relative simplicity of construction of the vascular anastomosis. This experience with robot assisted laparoscopic surgery has demonstrated the feasibility of this technique in different areas of vascular surgery.
exclusion. Correct patient selection is both crucial and challenging, and the best diagnostic strategy is still debatable. Ultrasound (US) is a good and non-invasive method for visualization of mesenteric vessels. In contrast to computer tomographic angiography (CTA), US provides real-time imaging and hereby the possibility to demonstrate respiratory synchronous velocity changes in the trunk, considered to be diagnostic for the disease with a high positive predictive value. In comparison to CTA and angiography, which supply better anatomical details, US is noninvasive and does not require contrast, but does rely on experienced sonographers. A CTA-verified "hook shape" of the coeliac trunk, together with relevant symptoms, should lead to referral to a vascular centre with interest and experience in this rare but probably underdiagnosed condition. A MALS-team consisting of specialists in gastroenterological laparoscopy, endovascular interventionists, clinical physiologists and vascular surgeons has been established at Rigshospitalet and Hvidovre Hospital in order to optimise the management of MALS.
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