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https://www.readbyqxmd.com/read/28925651/exercise-stress-testing-indications-and-common-questions
#1
Kathryn K Garner, William Pomeroy, James J Arnold
Exercise stress testing is a validated diagnostic test for coronary artery disease in symptomatic patients, and is used in the evaluation of patients with known cardiac disease. Testing of asymptomatic patients is generally not indicated. It may be performed in select deconditioned adults before starting a vigorous exercise program, but no studies have compared outcomes from preexercise testing vs. encouraging light exercise with gradual increases in exertion. Preoperative exercise stress testing is helpful for risk stratification in patients undergoing vascular surgery or who have active cardiac symptoms before undergoing nonemergent noncardiac surgery...
September 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28919267/post-carotid-endarterectomy-hypertension-part-2-association-with-peri-operative-clinical-anaesthetic-and-transcranial-doppler-derived-parameters
#2
Jeremy E Newman, Mathew J Bown, Robert D Sayers, Jonathan P Thompson, Thompson G Robinson, Bryan Williams, Ronney Panerai, Peter Lacy, A Ross Naylor
OBJECTIVE/BACKGROUND: The first paper in this series observed that pre-operative baroreceptor dysfunction and poorly controlled hypertension were independently predictive for identifying patients who went on to require treatment for post-endarterectomy hypertension (PEH). The second paper examines the influence of intra-operative patient, transcranial Doppler (TCD) ultrasound, and anaesthetic variables on the incidence of PEH. METHODS: In total, 106 patients underwent carotid endarterectomy (CEA) under general anaesthesia...
September 14, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28893702/risk-factors-associated-with-perioperative-myocardial-infarction-in-major-open-vascular-surgery
#3
Danielle C Sutzko, Elizabeth A Andraska, Andrea T Obi, Peter K Henke, Nicholas H Osborne
BACKGROUND: Among patients undergoing non-cardiac surgery, major vascular surgery is associated with a high risk of perioperative myocardial infarction (MI). Currently there are no perioperative MI risk calculators accounting for intraoperative and postoperative risk factors in vascular surgery patients. We aimed to investigate specific risk factors for perioperative MI after major open vascular surgery to determine which patients are at highest risk of MI, and the association of perioperative MI with perioperative transfusion...
September 8, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28887250/analysis-of-patients-undergoing-major-lower-extremity-amputation-in-the-vascular-quality-initiative
#4
Joshua Gabel, Brice Jabo, Sheela Patel, Sharon Kiang, Christian Bianchi, Jason Chiriano, Theodore Teruya, Ahmed M Abou-Zamzam
BACKGROUND: Despite an aggressive climate of limb salvage and revascularization, 7% of patients with peripheral artery disease undergo major lower extremity amputation (LEA). The purpose of this study was to describe the current demographics and early outcomes of patients undergoing major LEA in the Vascular Quality Initiative (VQI). METHODS: The VQI amputation registry was reviewed to identify patients who underwent major LEAs. Patient factors, limb characteristics, procedure type, and intraoperative variables were analyzed by level of amputation...
September 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28887246/novel-morphological-features-for-prediction-of-distal-thoracic-aortic-enlargement-after-thoracic-endovascular-aortic-repair-of-debakey-iiib-aortic-dissection
#5
Yang Yang Ge, Yan Xue, Wei Guo, Hong Peng Zhang, Xiao Ping Liu, Jiang Xiong, Xin Jia, Xiao Hui Ma, Li Jun Wang
OBJECTIVE: To assess the novel morphological features for DeBakey IIIb aortic dissection in predicting distal thoracic aortic enlargement after thoracic endovascular aortic repair (TEVAR). METHODS: Sixty-seven patients who underwent TEVAR for DeBakey IIIb aortic dissection between January 2011 and December 2013 at our center were divided based on preoperative computer tomography angiography (CTA) features into 3 groups: I (n = 27) and III (n = 9), with true and false lumen, respectively, coursing closely along thoracic vertebral bodies; and II, spiral configuration (n = 31)...
September 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28887242/rapid-methods-for-routine-frailty-assessment-during-vascular-surgery-clinic-visits
#6
Luke G Mirabelli, Robert M Cosker, Larry W Kraiss, Claire L Griffin, Brigitte K Smith, Mark R Sarfati, Ragheed Al-Dulaimi, Benjamin S Brooke
BACKGROUND: Frailty assessment can help vascular surgeons predict perioperative risk and long term mortality for their patients. Unfortunately, comprehensive frailty assessments take too long to integrate into clinic workflow. This study was designed to evaluate 2 rapid methods for assessing frailty during vascular clinics-a short patient-reported survey and a provider-reported frailty scale. METHODS: We prospectively enrolled 159 patients presenting to an academic medical center vascular surgery clinic between May-November 2016...
September 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28874329/outcome-after-turndown-for-elective-abdominal-aortic-aneurysm-surgery
#7
Joshua D Whittaker, Lewis Meecham, Virginia Summerour, Sheirin Khalil, Georgia Layton, Marianne Yousif, Adrian Jennings, Micheal Wall, Jeremy Newman
OBJECTIVES: The aim was to assess the survival of patients who had been turned down for repair of an abdominal aortic aneurysm (AAA) and to examine the factors influencing this. METHODS: This was a retrospective observational study of a prospectively maintained database of all patients turned down for AAA intervention by the Black Country Vascular Network multidisciplinary team (MDT) from January 2013 to December 2015. Data on AAA size, cardiopulmonary exercise testing (CPET) and cause of death were recorded...
September 2, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28833508/in-hospital-and-long-term-outcomes-of-percutaneous-balloon-aortic-valvuloplasty-with-concomitant-percutaneous-coronary-intervention-in-patients-with-severe-aortic-stenosis
#8
Marzena Daniec, Danuta Sorysz, Artur Dziewierz, Paweł Kleczyński, Łukasz Rzeszutko, Agata Krawczyk-Ożóg, Dariusz Dudek
BACKGROUND: Severe aortic stenosis (AS) often coexists with significant coronary artery disease. OBJECTIVE: To evaluate procedural complications and long-term outcomes of patients with severe AS undergoing balloon aortic valvuloplasty (BAV) and percutaneous coronary intervention (PCI). METHODS: A total of 97 patients with severe AS underwent 104 BAVs as palliative procedure, bridge to definitive treatment, or before urgent non-cardiac surgery...
August 22, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28821166/perioperative-acute-myocardial-infarction-associated-with-non-cardiac-surgery
#9
Nathaniel R Smilowitz, Navdeep Gupta, Yu Guo, Jeffrey S Berger, Sripal Bangalore
Aims: Acute myocardial infarction (AMI) is a significant cardiovascular complication following non-cardiac surgery. We sought to evaluate national trends in perioperative AMI, its management, and outcomes. Methods and results: Patients who underwent non-cardiac surgery from 2005 to 2013 were identified using the United States National Inpatient Sample. Perioperative AMI was evaluated over time. Propensity score matching was used to compile a cohort of AMI patients managed invasively (defined as cardiac catheterization or coronary revascularization) vs...
August 14, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28807383/prediction-of-major-cardiac-events-after-vascular-surgery
#10
Danielle M Gualandro, Christian Puelacher, Giovanna LuratiBuse, Gisela B Llobet, Pai C Yu, Francisco A Cardozo, Noemi Glarner, Andres Zimmerli, Jaqueline Espinola, Sydney Corbière, Daniela Calderaro, Andre C Marques, Ivan B Casella, Nelson de Luccia, Mucio T Oliveira, Andreas Lampart, Daniel Bolliger, Luzius Steiner, Manfred Seeberger, Christoph Kindler, Stefan Osswald, Lorenz Gürke, Bruno Caramelli, Christian Mueller
OBJECTIVE: Predicting cardiac events is essential to provide patients with the best medical care and to assess the risk-benefit ratio of surgical procedures. The aim of our study was to evaluate the performance of the Revised Cardiac Risk Index (Lee) and the Vascular Study Group of New England Cardiac Risk Index (VSG) scores for the prediction of major cardiac events in unselected patients undergoing arterial surgery and to determine whether the inclusion of additional risk factors improved their accuracy...
August 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28772186/an-evaluation-of-involving-family-caregivers-in-the-self-care-of-heart-failure-patients-on-hospital-readmission-randomised-controlled-trial-the-family-study
#11
Hiba Deek, Sungwon Chang, Phillip J Newton, Samar Noureddine, Sally C Inglis, Ghina Al Arab, Samer Kabbani, Wael Chalak, Nadim Timani, Peter S Macdonald, Patricia M Davidson
BACKGROUND: The prevalence of heart failure is increasing in Lebanon but to date there is no systematic evaluation of a disease management intervention. OBJECTIVE: The aim of this study was to evaluate the effect of involving family caregivers in the self-care of patients with heart failure on the risk of hospital readmission. DESIGN: A multi-site, block randomised controlled trial. SETTINGS: The study was conducted over a 13-month period in three tertiary medical centres in Beirut and Mount Lebanon, Lebanon...
July 25, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/28768786/posterior-spinal-fusion-for-adolescent-idiopathic-scoliosis-using-a-convex-pedicle-screw-technique-a-novel-concept-of-deformity-correction
#12
A I Tsirikos, G Mataliotakis, N Bounakis
AIMS: We present the results of correcting a double or triple curve adolescent idiopathic scoliosis using a convex segmental pedicle screw technique. PATIENTS AND METHODS: We reviewed 191 patients with a mean age at surgery of 15 years (11 to 23.3). Pedicle screws were placed at the convexity of each curve. Concave screws were inserted at one or two cephalad levels and two caudal levels. The mean operating time was 183 minutes (132 to 276) and the mean blood loss 0...
August 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28766692/truncal-varicose-vein-diameter-and-patient-reported-outcome-measures
#13
T R A Lane, L Varatharajan, F Fiorentino, A C Shepherd, L Zimmo, M S Gohel, I J Franklin, A H Davies
BACKGROUND: Varicose veins and chronic venous disease are common, and some funding bodies ration treatment based on a minimum diameter of the incompetent truncal vein. This study assessed the effect of maximum vein diameter on clinical status and patient symptoms. METHODS: A prospective observational cohort study of patients presenting with symptomatic varicose veins to a tertiary referral public hospital vascular clinic between January 2011 and July 2012. Patients underwent standardized assessment with venous duplex ultrasonography, and completed questionnaires assessing quality of life (QoL) and symptoms (Aberdeen Varicose Vein Questionnaire, EuroQol Five Domain QoL assessment and EuroQol visual analogue scale)...
August 2, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28756046/a-preoperative-risk-score-for-transfusion-in-infrarenal-endovascular-aneurysm-repair-to-avoid-type-and-cross
#14
Thomas F X O'Donnell, Katie E Shean, Sarah E Deery, Thomas C F Bodewes, Mark C Wyers, Kerry L O'Brien, Robina Matyal, Marc L Schermerhorn
OBJECTIVE: Preoperative type and cross are often routinely ordered before elective endovascular aneurysm repair (EVAR), but the cost of this practice is high, and transfusion is rare. We therefore aimed to stratify patients by their risk of transfusion to identify a cohort in whom a type and screen would be sufficient. METHODS: We queried the targeted vascular module of the National Surgical Quality Improvement Program (NSQIP) for all elective EVARs from 2011 to 2015...
July 26, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28750481/aqueous-shunts-for-glaucoma
#15
REVIEW
Victoria L Tseng, Anne L Coleman, Melinda Y Chang, Joseph Caprioli
BACKGROUND: Aqueous shunts are employed to control intraocular pressure (IOP) for people with primary or secondary glaucomas who fail or are not candidates for standard surgery. OBJECTIVES: To assess the effectiveness and safety of aqueous shunts for reducing IOP in glaucoma compared with standard surgery, another type of aqueous shunt, or modification to the aqueous shunt procedure. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 8), MEDLINE Ovid (1946 to August 2016), Embase...
July 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28739464/prophylactic-groin-wound-vacuum-assisted-therapy-in-vascular-surgery-patients-at-enhanced-risk-for-postoperative-wound-infection
#16
Luke O Pesonen, Brian G Halloran, Abdulhameed Aziz
OBJECTIVE: Vascular groin wounds have higher than expected surgical site infection (SSI) rates and some patients are at enhanced risk. The Wiseman et al. paper suggests an objective scoring system that identifies patients at enhanced risk of postdischarge SSI. We hypothesize that prophylactic groin wound vacuum-assisted closure (VAC) therapy in enhanced risk patients will decrease SSI and readmission and the Wiseman model provides potential evidence that enhanced risk patients can be objectively identified...
July 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28728556/influence-of-staphylococcus-aureus-on-outcomes-after-valvular-surgery-for-infective-endocarditis
#17
Sang Myung Han, Robert A Sorabella, Sowmya Vasan, Mark Grbic, Daniel Lambert, Rahul Prasad, Catherine Wang, Paul Kurlansky, Michael A Borger, Rachel Gordon, Isaac George
BACKGROUND: As Staphylococcus aureus (SA) remains one of the leading cause of infective endocarditis (IE), this study evaluates whether S. aureus is associated with more severe infections or worsened outcomes compared to non-S. aureus (NSA) organisms. METHODS: All patients undergoing valve surgery for bacterial IE between 1995 and 2013 at our institution were included in this study (n = 323). Clinical data were retrospectively collected from the chart review. Patients were stratified according to the causative organism; SA (n = 85) and NSA (n = 238)...
July 20, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28692690/risk-of-surgical-site-infection-acute-kidney-injury-and-clostridium-difficile-infection-following-antibiotic-prophylaxis-with-vancomycin-plus-a-beta-lactam-versus-either-drug-alone-a-national-propensity-score-adjusted-retrospective-cohort-study
#18
MULTICENTER STUDY
Westyn Branch-Elliman, John E Ripollone, William J O'Brien, Kamal M F Itani, Marin L Schweizer, Eli Perencevich, Judith Strymish, Kalpana Gupta
BACKGROUND: The optimal regimen for perioperative antimicrobial prophylaxis is controversial. Use of combination prophylaxis with a beta-lactam plus vancomycin is increasing; however, the relative risks and benefits associated with this strategy are unknown. Thus, we sought to compare postoperative outcomes following administration of 2 antimicrobials versus a single agent for the prevention of surgical site infections (SSIs). Potential harms associated with combination regimens, including acute kidney injury (AKI) and Clostridium difficile infection (CDI), were also considered...
July 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28689947/a-novel-iliac-morphology-score-predicts-procedural-mortality-and-major-vascular-complications-in-transfemoral-aortic-valve-replacement
#19
Juliet Blakeslee-Carter, David Dexter, Paul Mahoney, Sadie Ahanchi, Samuel Steerman, Sebastian Larion, Brandon Cain, Jean Panneton
OBJECTIVES: Vascular complications remain a significant technical challenge for transfemoral TAVR (Transcatheter Aortic Valve Replacement). The goal of this study was to develop a pre-operative tool for prediction of major vascular complications of TAVR. METHODS: A retrospective review was performed of all patients who underwent transfemoral TAVR at a tertiary medical center from 2011-2015. Iliofemoral arterial measurements were obtained with CTA 3D reconstructions images and an Iliac Morphology Score (IMS) was created from these measurements...
July 6, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28657940/the-fifth-vital-sign-postoperative-pain-predicts-30-day-readmissions-and-subsequent-emergency-department-visits
#20
Tina Hernandez-Boussard, Laura A Graham, Karishma Desai, Tyler S Wahl, Elise Aucoin, Joshua S Richman, Melanie S Morris, Kamal M Itani, Gordon L Telford, Mary T Hawn
OBJECTIVE: We hypothesized that inpatient postoperative pain trajectories are associated with 30-day inpatient readmission and emergency department (ED) visits. BACKGROUND: Surgical readmissions have few known modifiable predictors. Pain experienced by patients may reflect surgical complications and/or inadequate or difficult symptom management. METHODS: National Veterans Affairs Surgical Quality Improvement data on inpatient general, vascular, and orthopedic surgery from 2008 to 2014 were merged with laboratory, vital sign, health care utilization, and postoperative complications data...
September 2017: Annals of Surgery
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