Committee on Surgical Combat Casualty Care position statement on the use of single surgeon teams and invited commentaries.

Background: Over the last 20 years of war, there has been an operational need for far forward surgical teams near the point of injury. Over time, the medical footprint of these teams has decreased and the utilization of mobile single surgeon teams (SSTs) by the Services has increased. The increased use of SSTs is because of a tactical mobility requirement and not because of proven noninferiority of clinical outcomes.

Leaning forward: Early arterial access promotes resuscitative endovascular balloon occlusion of the aorta utilization in battlefield casualties.

Uncontrolled noncompressible torso hemorrhage remains a leading cause of potentially preventable death on the battlefield. The utilization of resuscitative endovascular balloon occlusion of the aorta (REBOA) has gained considerable traction in civilian and military trauma care. Establishment of arterial access remains the rate-limiting step in endovascular aortic occlusion.

Endovascular repair of ruptured aortic aneurysms using carbon dioxide contrast angiography.

Background: Endovascular aneurysm repair (EVAR) has become a common approach to the management of ruptured abdominal aortic aneurysms (rAAA). The use of iodinated contrast during EVAR for rAAA has several disadvantages, including contrast nephropathy, potential allergic response, and the need for high-pressure injection. We evaluated the use of carbon dioxide (CO(2)) as the primary contrast agent for endovascular repair of ruptured aortic aneurysms.

Paraneoplastic pemphigus in a burn intensive care unit: case report and review of the literature.

Paraneoplastic pemphigus is a rare cause of acute diffuse blistering in the adult patient. It commonly presents with subepidermal blistering, epidermal necrosis, and symptoms of mucosal irritation, such as conjunctivitis and vaginal ulceration. Because of its rarity, it is frequently misdiagnosed as Stevens-Johnson syndrome or toxic epidermal necrolysis.

Endovenous laser ablation: venous outcomes and thrombotic complications are independent of the presence of deep venous insufficiency.

Objective: We hypothesize that endovenous laser ablation (EVA) therapy is equally successful in improving venous insufficiency symptoms in patients with or without deep venous insufficiency (DVI).

Methods: From January 2005 through August 2007, EVA of the great saphenous vein (GSV) was attempted in 364 patients (460 limbs) with symptomatic GSV reflux. The GSV was successfully cannulated and obliterated in all but 17 limbs.

A contemporary analysis of outcomes for operative repair of type A aortic dissection in the United States.

Background: Despite recent advances, reported mortality rates after repair for acute type A aortic dissection vary from 5% to 30%. This study was conducted to assess cross-sectional mortality after operative repair of type A dissection in the United States, and to determine whether a volume-outcome relationship exists for this operative procedure.

Methods: Data were obtained from the Nationwide Inpatient Sample, which is a cross-sectional administrative database incorporating 20% of all annual US hospital discharges.

Factors associated with outcome after interventional treatment of symptomatic iliac vein compression syndrome.

Background: Iliac vein compression syndrome (IVCS) results from compression of the left iliac vein by the overlying right iliac artery against the pelvic brim. In many cases, patients are symptomatic. In symptomatic cases, management consists of angioplasty and stenting.

Diffusion of new technology for the treatment of renovascular hypertension in the United States: surgical revascularization versus catheter-based therapy, 1988-2001.

Background: Trends in the management of renovascular hypertension were evaluated by using a representative national database to determine whether a shift in treatment technology and outcomes has occurred.

Methods: Clinical information regarding the treatment of renovascular hypertension in 5433 patients from 1988 to 2001 was derived from the Nationwide Inpatient Sample (NIS) database. Patients were classified into 3 groups: combined aortic and renal revascularization, isolated renal revascularization, and catheter-based procedures (angioplasty with or without stenting).

Increased MMP-9 expression and activity by aortic smooth muscle cells after nitric oxide synthase inhibition is associated with increased nuclear factor-kappaB and activator protein-1 activity.

Objective: To determine the mechanism underlying increased expression and activity of matrix metalloproteinase 9 (MMP-9) by rat aortic smooth muscle cells (RA-SMC) after inhibition of inducible nitric oxide synthase (iNOS).

Methods And Results: Treatment of interleukin-1beta-stimulated RA-SMC with aminoguanidine led to an increase of 96% in MMP-9 activity (P = 0.003) by gelatin zymography, a 40% increase in pro-MMP-9 protein (P = 0.

Neutropenia impairs venous thrombosis resolution in the rat.

Objectives: Neutrophil influx is one of the first events in a formed deep venous thrombosis (DVT), but whether these cells are active participants in the resolution process is not clear. This study tests the hypothesis that neutrophils (PMN) are active participants in DVT resolution.

Methods: Thrombosis was induced by inferior vena caval (IVC) ligation in male Sprague-Dawley rats, and rats were sacrificed at 2, 4, or 7 days for evaluation of the thrombus.

Ultrasound measurement of aortic diameters in rodent models of aneurysm disease.

Background: This investigation was undertaken to evaluate transabdominal ultrasound (US) measurements of aortic diameters in rats and mice as a complementary method to video microscopy (VM), the current standard for assessing the diameter of rodent aortas.

Methods: Aortic diameters were measured in 64 rats (n = 132 sets) and 12 mice (n = 36 sets) following experimental induction of aortic aneurysms. Diameters were measured at the renal vein, midinfrarenal aorta, and aortic bifurcation.

A nonintrinsic regional basis for increased infrarenal aortic MMP-9 expression and activity.

Objective: This investigation was undertaken to determine whether intrinsic or regional factors at different anatomic sites of the aorta affect expression and activity of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs).

Methods: Aortas from Sprague-Dawley rats (n = 22) were divided into arch, descending thoracic, and infrarenal abdominal segments. Specimens were stimulated with interleukin-1beta (IL-1beta) (2 ng/mL) for 72 hours.

The effect of body wall on video signal analysis measurements.

Rectangular body wall specimens were extracted from 16 juvenile swine and 9 adult beagle hounds after euthanasia. The body wall specimen included the epidermis to parietal membrane, with falciform fat removed. Ten images of a reference phantom with known attenuation and 10 additional images of the phantom with the specimen placed between the transducer and phantom surface were collected with a 5-MHz ultrasound system and computer with frame grabber board.

P-selectin inhibition enhances thrombus resolution and decreases vein wall fibrosis in a rat model.

Purpose: The purpose of this study was to compare the efficacy of P-selectin inhibition with standard anticoagulant and thrombolytic therapy in a rodent model of established deep vein thrombosis (DVT).

Methods: Rats underwent temporary inferior vena cava (IVC) ligation for 2 days to create a stasis-induced thrombosis. On day 2, the animals had the IVC ligature removed and received either recombinant P-selectin glycoprotein ligand-Ig (rPSGL-Ig; 4 mg/kg) intravenously, low-molecular weight heparin (LMWH; 450 IU/kg) subcutaneously, tissue plasminogen activator (tPA; 0.

Southern Association for Vascular Surgery William J. von Leibig Award. Inflammation and intimal hyperplasia associated with experimental pulmonary embolism.

Objective: We tested the hypothesis that a venous thromboembolism to the pulmonary arterial system (pulmonary embolism [PE]) would cause an inflammatory response within the pulmonary arterial (PA) wall marked by elevated cytokines and chemokines and an influx of inflammatory cells.

Methods: Experimental PE was induced in 70 rats and confirmed with angiography and O(2) saturation depression, and an additional 70 rats underwent sham operations. PA and lung tissue were removed at 3 hours and at 1, 2, 4, 6, 8, and 14 days (n = 10 per time point), were analyzed for proinflammatory cytokines and chemokines, and underwent histologic analysis.

Impaired vasoreactivity despite an increase in plasma nitrite in patients with abdominal aortic aneurysms.

Objective: This investigation was designed to determine whether differences in vasoreactivity occur in patients with abdominal aortic aneurysms (AAAs) as compared with patients with peripheral arterial occlusive disease (PAOD) or individuals (controls) without known vascular disease.

Methods: Brachial artery vasoreactivity was assessed in a blinded fashion, after endothelium-dependent (ED) and endothelium-independent (EI) flow-mediated vasodilation, in age-matched, male patients with AAAs (n = 11) or PAOD (n = 9) or in controls (n = 10). There were no significant differences in prestudy systolic or diastolic blood pressure, body mass index, or antilipidemic medications among the groups studied.