Outcomes for symptomatic abdominal aortic aneurysms in the American College of Surgeons National Surgical Quality Improvement Program.

Background: Historically, symptomatic abdominal aortic aneurysms (AAAs) were found to have intermediate mortality compared with asymptomatic and ruptured AAAs; but with wider use of endovascular aneurysm repair (EVAR), a more recent study suggested that mortality of symptomatic aneurysms was similar to that of asymptomatic AAAs. These prior studies were limited by small numbers. The purpose of this study was to evaluate the mortality and morbidity associated with symptomatic AAA repair in a large contemporary population.

Open surgical revision provides a more durable repair than endovascular treatment for unfavorable vein graft lesions.

Objective: Lower extremity bypass grafts that develop stenoses are commonly treated with either open surgical or endovascular revision. Vein graft stenoses with unfavorable lesions (multiple lesions, lesions >2 cm in length, lesions in grafts <3 months old, lesions in grafts <3 mm in diameter) fare worse than those with favorable lesions when treated with endovascular therapy. However, it is not known if unfavorable lesions fare better with surgical revision than with endovascular treatment or than favorable lesions treated with surgery.

Bovine pericardial patch repair in infected fields.

Objective: Bovine pericardial patches (BPP) are frequently used for arterial reconstruction, but little data exist regarding their ability to resist infection. We hypothesize that BPP would provide a reasonable alternative to autologous vein patches in infected fields.

Methods: We used BPP to repair 51 arteriotomies (25 brachial, 23 femoral, three popliteal) in 48 consecutive patients (mean age, 68 years; 65% men, 75% diabetic, 67% dialysis dependent) undergoing removal of infected (33 gram-positive, three gram-negative, eight mixed flora, and four culture-negative) polytetrafluoroethylene grafts (35 arteriovenous grafts, nine femoral-distal bypasses, and four femoral patch angioplasties) between January 2007 and January 2011.

Medical management of spontaneous celiac artery dissection: case report and literature review.

Spontaneous visceral artery dissections are a rare occurrence. Here we report a case of spontaneous celiac artery dissection that was treated without surgery.

Choledochojejunostomy revision performed by using the laparoscopic linear cutter.

Choledochojejunostomy is commonly performed for biliary bypass for benign and malignant disease. Anastomotic stricture is a known complication of enteric surgery. We report the use of the laparoscopic linear cutter at laparotomy to revise a choledochojejunostomy created 12 years previously for benign disease.

Lower extremity arterial revascularization in obese patients.

Background: Obesity and associated comorbidities are associated with a high rate of complications and technical difficulties after a number of surgical procedures. We studied the role of obesity in outcomes in lower extremity arterial revascularization.

Methods: We reviewed all lower extremity arterial revascularizations performed at our institution in 2000.

Popliteal artery aneurysms: a comparison of outcomes in elective versus emergent repair.

Objective: The purpose of this study was to assess and compare outcomes of elective versus emergent operative repair of popliteal artery aneurysms.

Design: A retrospective analysis of a prospectively recorded vascular surgery database from June 1992 to December 2002 was performed with chart review. Main outcome measures Patient survival, limb salvage, and graft patency were evaluated.

Major lower extremity amputation: outcome of a modern series.

Hypothesis: Major lower extremity amputation results in significant morbidity and mortality.

Design: Retrospective database query and medical record review for January 1, 1990, to December 31, 2001. Mean follow-up was 33.

Diabetic neuropathy and microcirculation.

The microcirculation in diabetic and neuropathic feet is subject to the same changes found in other end organs of diabetic patients, such as the retina or the kidney. Complications such as foot ulceration lead to further morbidity and hospitalizations. Research into the causes of microcirculatory dysfunction has revealed an interplay of numerous factors.