Inflow Can Be Enough: A Limited Approach to Revascularization in Critical Limb Ischemia

Abstract

Objectives: Provoked deep vein thrombosis (DVT) is precipitated by a specific event. In this study, the characteristics of provoked DVT in patients with a reversible risk (RR) factor were compared with patients with constant risk (CR) factors.Methods: A retrospective review of the records of all consecutive patients diagnosed with DVT between January 2013 and August 2014 was performed. Patients with provoked DVT were included in the RR group if the provoking event resolved and they did not have an ongoing risk of thrombosis. Patients in the CR group had a provoked DVT with an ongoing risk of thrombosis due to individual factors deemed as ongoing risks of thrombosis, such as cancer, on record review. Demographics, risk factors, association with pulmonary embolism and its severity, risk of recurrent venous thromboembolism (VTE), and mortality were compared between the two groups. SAS 9.3 software was used for analysis.Results: A total of 838 patients were diagnosed with DVT and 425 (50.7%) were provoked. There were 127 patients (29.9%) with RR and 298 (70.1%) with CR. RR patients were younger (60.4 6 16.3 vs 65.9 6 16.0 years; P ¼ .001). DVTs in RR patients were more likely to be provoked by surgery (70.9% vs 55.4%; P ¼ .0028), whereas DVTs in CR patients were more likely to be provoked by immobilization (21.5% vs 12.6%; P ¼ .032). CR patients were affected by cancer (48.7%) and hypercoagulable disorders (4.4%). RR patients were more likely to have calf DVTs (36.2% vs 26.2%, P ¼ .0468). There was a trend towards lower association with PE upon presentation in RR (17.3% vs 21.1%, P ¼ .072), but that did not reach statistical significance. However, RRs were more likely to be associated with a low-risk pulmonary embolism compared with CRs (54.6% vs 30.2%, P ¼ .04). After mean follow-up of 7.2 months, CR patients had higher risk of recurrent VTE (14.0% vs 6.8%, P ¼ .045) and mortality (23.5% vs 7.1%, P < .0001).Conclusions: Provoked DVT with CR affects older patients and is associated with high recurrence of VTE and mortality compared with provoked DVT with RR.Objectives: Patients presenting with delayed rupture after endovascular repair of their abdominal aortic aneurysm (EVAR) were identified, and medical records and imaging were reviewed to identify their anatomic characteristics.Methods: This was a retrospective study of all patients with abdominal aortic aneurysms presenting with delayed ruptures after EVAR from January 2002 to December 2014. Demographics, comorbidities, preoperative imaging, and perioperative and long-term outcomes were analyzed.Results: Identified were 54 among 3081 patients (1.8%) with delayed rupture after EVAR. The primary EVAR in 47 (87%) was performed in our facility and in seven (13%) in another hospital. The mean time between the initial repair and rupture was 44.2 months. Ruptures were related to an endoleak in 45 (83%) and to infection in nine (17%). Twenty-eight patients (52%) had an open repair for their delayed rupture, and 26 (48%) had secondary endovascular repair. Mean follow-up wa...