Long-term mortality after f-EVAR is high, but most patients die from nonaneurysmal causes. Aneurysm-related mortality is associated with technical complications that can be reduced with increased experience. Reinterventions are common, and most complications are detected on routine follow-up.
Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.
eTAAA has low peri-operative mortality, but SCI incidence is high albeit that it decreased with increasing experience. More extensive repair and use of larger volumes of contrast were associated with higher risk of SCI. Acute repair does not significantly increase SCI risk. A standardized protocol for early diagnosis and treatment of SCI leads to a higher recovery rate with a greater likelihood of regaining ambulatory capacity.
Our study confirms that tumor cells can be released into the circulation during transurethral bladder tumor resection. It is currently unknown whether this will increase the risk of metastatic disease.
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