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Lower extremity bypass

Douglas W Jones, Kirsten Dansey, Allen D Hamdan
Patients with end-stage renal disease (ESRD) who present with critical limb ischemia (CLI) have become an increasingly common and complex treatment problem for vascular surgeons. Dialysis patients have high short-term mortality rates regardless of whether revascularization is pursued. ESRD patients with CLI can be managed with: local wound care, endovascular or surgical revascularization, or amputation. Some patients may heal small foot wounds with local wound care alone, even if distal perfusion is marginal, as long as any infectious process has been controlled...
October 20, 2016: Vascular and Endovascular Surgery
Raghu L Motaganahalli, Matthew R Smeds, Michael P Harlander-Locke, Peter F Lawrence, Naoki Fujimura, Randall R DeMartino, Giovanni De Caridi, Alberto Munoz, Sherene Shalhub, Susanna H Shin, Kwame S Amankwah, Hugh A Gelabert, David A Rigberg, Jeffrey J Siracuse, Alik Farber, E Sebastian Debus, Christian Behrendt, Jin H Joh, Naveed U Saqib, Kristofer M Charlton-Ouw, Catherine M Wittgen
BACKGROUND: Adventitial cystic disease (ACD) is an unusual arteriopathy; case reports and small series constitute the available literature regarding treatment. We sought to examine the presentation, contemporary management, and long-term outcomes using a multi-institutional database. METHODS: Using a standardized database, 14 institutions retrospectively collected demographics, comorbidities, presentation/symptoms, imaging, treatment, and follow-up data on consecutive patients treated for ACD during a 10-year period, using Society for Vascular Surgery reporting standards for limb ischemia...
October 14, 2016: Journal of Vascular Surgery
Yaseen Oweis, Zachary Viets, Anup S Shetty
In the acute care setting, radiologists are frequently asked to assist in the evaluation of patients presenting with signs and symptoms of lower extremity peripheral vascular disease. Non-traumatic peripheral vascular emergencies are most commonly the result of thrombosis, either in a native vessel or within a bypass graft or stent. Arterial emboli, peripheral aneurysm with embolus or thrombosis, and direct arterial trauma are additional, less common causes. Traumatic peripheral vascular emergencies include vessel occlusion, transection, pseudoaneurysms, active extravasation, and arteriovenous fistulas...
October 11, 2016: Abdominal Radiology
B S Sukovatykh, L N Belikov, M B Sukovatykh, D V Sidorov, M A Inarkhov, E B Inokhodova
AIM: to improve treatment of patients with severe atherosclerotic lesion of lower extremities arteries followed by critical ischemia by optimization of femoropopliteal bypass surgery. MATERIAL AND METHODS: Treament and survey of 60 patients with severe atherosclerotic lesion of femoropopliteotibial segment and critical lower limb ischemia were analyzed. Patients were divided into 2 groups depending on technique of femoropopliteal bypass. Conventional in situ autovenous technique was used in group 1...
2016: Khirurgiia
Richard F Neville, Samit K Gupta, David J Kuraguntla
OBJECTIVE: Prosthetic grafts used for lower extremity revascularization and dialysis access fail because of hyperplastic stenosis and thrombosis. Graft surveillance is advocated to monitor function; however, graft failure can occur between episodic examinations. An innovative sensor with wireless, microchip technology allows automated surveillance with assessment of graft function using a "cloud"-based algorithm. We performed proof-of-concept experiments with in vitro and in vivo models to assess the feasibility such a real-time graft surveillance system...
September 29, 2016: Journal of Vascular Surgery
Peter A Soden, Sara L Zettervall, Thomas Curran, Ageliki G Vouyouka, Philip P Goodney, Joseph L Mills, John W Hallett, Marc L Schermerhorn
OBJECTIVE: Prior studies on the cause and effect of surgical variation have been limited by utilization of administrative data. The Vascular Quality Initiative (VQI), a robust national clinical registry, provides anatomic and perioperative details allowing a more robust analysis of variation in surgical practice. METHODS: The VQI was used to identify all patients undergoing infrainguinal open bypass or endovascular intervention from 2009 to 2014. Asymptomatic patients were excluded...
September 27, 2016: Journal of Vascular Surgery
Joshua D Mixson, Thomas E Brothers
OBJECTIVE: Tobacco smoking after lower extremity revascularization for claudication has repeatedly been shown to increase the risk of adverse events, such that many vascular specialists consider that refusal to abstain from smoking constitutes a major contraindication to open surgical bypass or endovascular intervention. METHODS: A Markov decision analysis (DA) model was used to compare the options of direct revascularization vs medical therapy only in smokers with claudication...
September 26, 2016: Journal of Vascular Surgery
Emily R Lagergren, Kelly Kempe, Timothy E Craven, S Tucker Kornegay, Nitin Garg, Gabriela Velazquez-Ramirez, Justin B Hurie, Matthew S Edwards, Matthew A Corriere
INTRODUCTION: Inferior lower extremity bypass (LEB) outcomes have been reported among women with peripheral artery disease, but the mechanisms responsible for this disparity are unknown. Great saphenous vein (GSV) is considered the conduit of choice for LEB; GSV diameter is associated with graft patency and therefore is often used as a criterion for suitability for use as bypass conduit. We hypothesized that gender-based differences in GSV may contribute to LEB outcomes disparities. To explore this hypothesis, we performed a gender-based analysis of GSV anatomic characteristics among patients with peripheral arterial disease (PAD) who were studied with duplex ultrasound vein mapping during evaluation for LEB...
September 22, 2016: Annals of Vascular Surgery
Peter A Soden, Sara L Zettervall, Katie E Shean, Sarah E Deery, Jeffrey A Kalish, Christopher T Healey, Nikhil Kansal, Marc L Schermerhorn
BACKGROUND: Isolated common femoral endarterectomy was recently reported to have a 30-day mortality of 3.4%. The effect of adjunctive femoral endarterectomy at the time of lower extremity bypass is not well described, and therefore, the purpose of this study was to determine its associated perioperative and long-term risk. METHODS: Vascular Study Group of New England registry data were used to identify patients undergoing initial lower extremity bypass from 2003 to 2015...
September 12, 2016: Journal of Vascular Surgery
Guo-Tao Ma, Qi Miao, Xing-Rong Liu, Chao-Ji Zhang, Yue-Hong Zheng, Jiang Shao, Ning-Hai Cheng, Shun-da DU, Jian-Zhou Liu, Chao Jiang
Objective To investigate the diagnosis and surgical treatment strategies of intravenous leiomyomatosis(IVL)extending through inferior vena cava into the right cardiac cavities. Methods Thirty patients of IVL extending through inferior vena cava into the right cardiac cavities were treated in Peking Union Medical College Hospital from November 2002 to January 2015.The following variables were studied: age,cardiopulmonary bypass time,deep hypothermic circulatory arrest time,origins of IVL,blood loss,duration of post-operative hospital stay,hospitalization expenses,edema of lower extremity,blood transfusion,postoperative complication,residual IVL,and re-grow or recurrence...
August 2016: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
Kunitaro Watanabe, Shingo Mitsuda, Joho Tokumine, Alan Kawarai Lefor, Kumi Moriyama, Tomoko Yorozu
INTRODUCTION: Atherosclerosis has a complex etiology that leads to arterial obstruction and often results in inadequate perfusion of the distal limbs. Patients with atherosclerosis can have severe complications of this condition, with widespread systemic manifestations, and the operations undertaken are often challenging for anesthesiologists. CASE REPORT: A 79-year-old woman with chronic heart failure and respiratory dysfunction presented with bilateral gangrene of the distal lower extremities with obstruction of the left common iliac artery due to atherosclerosis...
August 2016: Medicine (Baltimore)
Peter A Soden, Sara L Zettervall, Klaas H J Ultee, Bruce E Landon, A James O'Malley, Philip P Goodney, Randall R DeMartino, Shipra Arya, Marc L Schermerhorn
BACKGROUND: Dual antiplatelet therapy (DAPT) after coronary stenting prolongs survival by preventing both in-stent thrombosis and other cardiovascular atherothrombotic events. Patients with peripheral artery disease (PAD) typically have a heavy burden of unrevascularized coronary artery disease and also stand to benefit from increased atherothrombotic protection with DAPT. The potential benefit of DAPT compared with aspirin alone in patients with PAD is not well described. METHODS: We identified all patients undergoing an initial elective lower extremity revascularization (bypass or endovascular) from 2003 to 2016 in the Vascular Quality Initiative registry discharged on aspirin or aspirin plus a thienopyridine antiplatelet agent (DAPT)...
August 26, 2016: Journal of Vascular Surgery
Frank J Veith, Enrico Ascher, Neal S Cayne
Standard approaches to lower extremity arteries may be rendered difficult or unusable because of scarring or infection, or both. This article describes unusual alternative approaches to facilitate lower extremity bypasses that would normally require approaches to the common femoral, deep femoral, or popliteal arteries. Techniques are described for using the distal external iliac artery, the distal two-thirds of the deep femoral artery, and the above-knee and below-knee popliteal artery approached laterally.
October 2016: Journal of Vascular Surgery
Maher Fattoum, Stefan Kennel, Peter Knez, Thomas Schmitz-Rixen, Hazem Khout, Matthias H Tenholt
OBJECTIVE: This study was conducted to determine whether it was feasible to increase the diameter of smaller great saphenous veins (GSVs) in preparation for possible bypass and whether such a conditioned conduit could be used with reasonable patency. METHODS: Twenty-five patients (26 cases: 24 peripheral arterial occlusive disease, 2 popliteal aneurysms) with GSV diameters between 2 and 3 mm underwent in situ GSV valvulotomy and were observed for 3 months. After GSV dilation to >3 mm for below-knee revascularization and >3...
September 2016: Journal of Vascular Surgery
Clara K Zhu, Pegeen W Eslami, Mohammad H Eslami
INTRODUCTION: We set out to compare the rates of Medicare reimbursement to physicians versus hospitals for several major vascular procedures over a period of five years. METHODS: We queried the Wolters Luwer MediRegs database to collect Medicare reimbursement data from fiscal years 2011 to 2015. We surveyed reimbursements for carotid endarterectomy (CEA), carotid angioplasty and stenting (CAS), femoropopliteal bypass, and lower extremity fem-pop revascularization with stenting...
August 20, 2016: Annals of Vascular Surgery
Mikolaj Walensi, Christian Berg, Michael Piotrowski, Franz-Eduard Brock, Johannes N Hoffmann
The adductor canal compression syndrome is one of the several rare nontraumatic causes of arterial occlusions, which may lead to critical ischemia of the lower limb. We report the case of a 46-year-old athletic woman, who suffered from activity-related paresthesia and sharp pain in the left upper and lower leg for 2 years. Imaging and neurological investigations of the spine remained without pathological findings that would explain the patient's complaints. Actually, the patient presented with symptoms of critical lower limb ischemia...
August 20, 2016: Annals of Vascular Surgery
T Bisdas, G Torsello, A Stachmann, R T Grundmann
AIM: On the basis of the CRITISCH registry outcomes in patients with critical limb ischemia (CLI) undergoing lower extremity bypass surgery were analyzed according to the site of distal anastomosis and type of bypass material. PATIENTS AND METHODS: A total of 284 patients with lower extremity bypasses consisting of 75 patients with bypasses above the knee (group 1), 80 with bypasses below the knee (group 2) and 129 crural or pedal bypasses (group 3) were included in the study...
2016: Gefässchirurgie: Zeitschrift Für Vaskuläre und Endovaskuläre Chirurgie
Shaunak S Adkar, Ryan S Turley, Ehsan Benrashid, Sandhya Lagoo, Cynthia K Shortell, Leila Mureebe
OBJECTIVE: The initiation of bundled payment for care improvement (BPCI) by Centers for Medicare & Medicaid Services (CMS) has led to increased financial and performance accountability. As the majority of vascular surgery patients are elderly and reimbursed via CMS, improving their outcomes will be critical for durable financial stability. As a first step in forming a multi-disciplinary pathway for the elderly vascular patient, we sought to identify modifiable perioperative variables in geriatric patients undergoing lower extremity arterial bypass (LEB)...
August 12, 2016: Annals of Vascular Surgery
Marja-Tellervo Mäkinen, Anne Pesonen, Irma Jousela, Janne Päivärinta, Satu Poikajärvi, Anders Albäck, Ulla-Stina Salminen, Eero Pesonen
OBJECTIVE: The aim of this study was to compare deep body temperature obtained using a novel noninvasive continuous zero-heat-flux temperature measurement system with core temperatures obtained using conventional methods. DESIGN: A prospective, observational study. SETTING: Operating room of a university hospital. PARTICIPANTS: The study comprised 15 patients undergoing vascular surgery of the lower extremities and 15 patients undergoing cardiac surgery with cardiopulmonary bypass...
August 2016: Journal of Cardiothoracic and Vascular Anesthesia
Kenneth R Nakazawa, Natalia N Egorova, John R Power, Peter L Faries, Ageliki G Vouyouka
OBJECTIVE: As part of the Surgical Care Improvement Project (SCIP), a national quality partnership of organizations including the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention implemented several perioperative guidelines regarding antibiotic, venous thromboembolism (VTE), and beta-blocker prophylaxis for surgical patients. We evaluated the effect of SCIP on in-hospital surgical site infections (SSI), graft infections, VTE, myocardial infarctions (MI), cardiac complications, mortality, and length of stay following elective major vascular surgery...
August 10, 2016: Annals of Vascular Surgery
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