Understanding who benefits from endovascular aortic repair in those deemed unfit for open repair.

Introduction: Patients with abdominal aortic aneurysms (AAAs) who are deemed unacceptable candidates for open repair (UNFIT) pose a clinical challenge. The EVAR2 Trial randomized UNFIT patients to endovascular aortic repair (EVAR) vs no intervention from 1999 to 2003, concluding that survival was not improved by EVAR. However, outcomes after EVAR over the last 2 decades have dramatically changed.

Long-term survival after descending thoracic and thoracoabdominal aortic aneurysm repair.

Objective: Patients with descending thoracic aortic aneurysms (dTAA) or thoracoabdominal aortic aneurysms (TAAA) often have a variety of medical comorbidities. Those that are deemed acceptable for intervention undergo complicated repairs with good early outcomes. The purpose of this study was to identify variables that were associated with mortality over time.

Association Between Body Mass Index and Perioperative Mortality After Repair of Ruptured Abdominal Aortic Aneurysms.

Objective: The attempt to repair a ruptured abdominal aortic aneurysm carries a significant risk of perioperative mortality. The relationship between body mass index (BMI) and outcomes after repair of ruptured abdominal aortic aneurysms (AAAs) has not been well defined. We report the association of BMI with outcomes after ruptured AAA repair.

Spinal Cord Ischemia Rescue after Hybrid Total Arch Repair with Frozen Elephant Trunk: A Case Report.

Frozen elephant trunk repair is a technique described to simplify total arch repair for Stanford type A aortic dissection. Spinal cord ischemia is a devastating complication after frozen elephant trunk repair. In this report, we describe a case of spinal cord ischemia resulting in paralysis after frozen elephant trunk repair.

Operative Mortality and Morbidity in Ruptured Abdominal Aortic Aneurysms in the Endovascular Age.

Background: Controversy exists about technique of repair for ruptured abdominal aortic aneurysms (rAAA). We studied rAAA treated at a single tertiary center from 2005 to 2015 to determine operative morbidity and mortality in open and endovascular aortic aneurysm repair (EVAR) of rAAA.

Methods: All rAAA (n = 144) treated from 2005 to 2015 were reviewed using an IRB-approved database.

Advances in Treatment and Long-term Survival in Patients with Descending Thoracic Aortic Aneurysms Treated at a Single Tertiary Center from 1984 to 2014.

Background: We report long-term survival in open surgical and endovascular patients treated for descending thoracic aortic aneurysms (TAAs) at a single tertiary center from 1984 to 2014 to study the impact of transition to thoracic endovascular aortic repair (TEVAR) for TAA repair.

Methods: Using a prospectively maintained registry, all patients (n = 202) having open or endovascular repair (TEVAR) of descending TAAs were studied. Date of last contact or death was obtained on all patients from hospital records, Social Security Death Database, and verified online records.

Natural history of the proximal aorta in patients with descending thoracic aortic disease.

Objective: This study investigated the growth and behavior of the ascending aorta in patients with descending thoracic aortic disease.

Methods: We examined 200 patients with descending thoracic aortic disease including acute type B dissection (n = 95), chronic type B dissection (n = 38), intramural hematoma (n = 23), and thoracoabdominal aortic aneurysms (n = 44). Images from computed tomography and magnetic resonance imaging were evaluated after three-dimensional reconstruction to examine the growth rate in those with >1 year of imaging follow-up (n = 108).

The effect of intercostal artery reimplantation on spinal cord injury in thoracoabdominal aortic aneurysm surgery.

Objective: Intercostal artery (ICA) reimplantation (ICAR) is thought to decrease spinal cord injury (SCI) in thoracic aortic aneurysm and thoracoabdominal aortic aneurysm (TAAA) surgery. Patients treated from 1989 to 2005 without ICAR were compared with those treated from 2005 to 2013 with ICAR to determine whether ICAR reduced SCI. We hypothesized that ICAR would reduce SCI, especially in the highest-risk patients.

Parental and Volunteer Perception of Pyloromyotomy Scars: Comparing Laparoscopic, Open, and Nonsurgical Volunteers.

Introduction: Despite evidence from prospective trials and meta-analyses supporting laparoscopic pyloromyotomy (LP) over open pyloromyotomy (OP), the open technique is still utilized by some surgeons on the premise that there is minimal clinical benefit to LP over OP. Although the potential cosmetic benefit of LP over OP is often cited in reports, it has never been objectively evaluated.

Methods: After internal review board approval, the parents of patients from a previous prospective trial who had undergone LP (n = 9) and OP (n = 10) were contacted.

Intraoperative neuroprotective interventions prevent spinal cord ischemia and injury in thoracic endovascular aortic repair.

Objective: Transient and permanent paraparesis and paraplegia (spinal cord injury [SCI]) are reported in up to 13% of patients undergoing thoracic endovascular aortic repair (TEVAR) for descending thoracic aortic aneurysm, thoracoabdominal aortic aneurysm, and thoracic aortic dissection. We hypothesize that aggressive intraoperative and postoperative neuroprotective interventions prevent or significantly reduce all SCI in TEVAR.

Methods: Using a prospectively maintained, Institutional Review Board-approved database, we retrospectively reviewed all TEVARs performed in a university tertiary referral center from 2005 to 2014 to study the incidence of all transient and permanent lower extremity SCI.

Long-Term Outcomes of Patients with Tracheoesophageal Fistula/Esophageal Atresia: Survey Results from Tracheoesophageal Fistula/Esophageal Atresia Online Communities.

 Outcome studies of tracheoesophageal fistula (TEF) and/or esophageal atresia (EA) are limited to retrospective chart reviews. This study surveyed TEF/EA patients/parents engaged in social media communities to determine long-term outcomes.  A 50-point survey was designed to study presentation, interventions, and ongoing symptoms after repair in patients with TEF/EA.

Postoperative renal failure in thoracoabdominal aortic aneurysm repair with simple cross-clamp technique and 4°C renal perfusion.

Objective: Acute renal failure (ARF) is reported in up to 12% of patients after thoracoabdominal aortic aneurysm (TAAA) repair with assisted circulation. ARF increases mortality, reduces quality of life, and increases length of hospital stay. This study analyzes ARF after TAAA repair done without assisted circulation.

Complications of spinal fluid drainage in thoracic and thoracoabdominal aortic aneurysm surgery in 724 patients treated from 1987 to 2013.

Objective: To study complications from spinal fluid drainage in open thoracic/thoracoabdominal and thoracic endovascular aortic aneurysm repairs to define risks of spinal fluid drainage.

Design: Retrospective, prospectively maintained, institutionally approved database.

Setting: Single institution university center.

Evolution in management of adolescent blunt aortic injuries--a single institution 22-y experience.

Background: In children, severe, life-threatening traumatic injuries of the thoracic aorta can be seen after motor vehicle collisions (MVCs) resulting in a sudden deceleration. Concurrent injuries in the thorax and abdomen can make treatment prioritization difficult and require early recognition and prompt intervention. With the increased utilization of minimally invasive endovascular approaches to traumatic aortic (TA) injuries, patients are often spared the increased surgical morbidity (spinal cord ischemia and renal insults) that can be seen with an open technique.

Postdischarge outcomes after endovascular abdominal aortic aneurysm repair.

Objective: Perioperative outcomes after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) have been rigorously studied; however, inpatient and postdischarge outcomes have not been separately analyzed. The objective of this study was to examine postdischarge 30-day outcomes after elective EVAR.

Methods: Patients who underwent an elective EVAR for AAA (n = 11,229) were identified from the American College of Surgeons 2005-2010 National Surgical Quality Improvement Project database.

Pulse wave velocity and cognitive function in older adults.

Arterial stiffness may be associated with cognitive function. In this study, pulse wave velocity (PWV) was measured from the carotid to femoral (CF-PWV) and from the carotid to radial (CR-PWV) with the Complior SP System. Cognitive function was measured by 6 tests of executive function, psychomotor speed, memory, and language fluency.

Infection control knowledge, attitudes, and practices among healthcare workers at Mulago Hospital, Kampala, Uganda.

Objective: Effective implementation of infection control programs and adherence to standard precautions are challenging in resource-limited settings. The objective of this study was to describe infection control knowledge, attitudes, and practices among healthcare workers (HCWs) in Uganda.

Design: We conducted a survey of hospital employees who had direct contact with patients or their immediate environment.

Carotid atherosclerosis and 10-year changes in cognitive function.

Background: Carotid atherosclerosis has been suggested to be involved in cognitive decline.

Methods: The Epidemiology of Hearing Loss Study is a longitudinal study of aging among Beaver Dam residents, WI. In 1998-2000, carotid intima-media thickness (IMT) and plaque were measured by ultrasound; cognitive function was measured by the Mini-Mental State Examination (MMSE).

Socioeconomic status and subclinical atherosclerosis in older adults.

Objective: This study investigated the long-term effects of socioeconomic status (SES) on atherosclerosis.

Methods: Data from the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study (Beaver Dam, WI, 1998-2000), were used to examine adult SES (education, household income, and longest-held job) and childhood SES (household density and parental home ownership at age 13) associations with carotid intima-media thickness (IMT) and carotid plaque in a cohort of 2042 men and women aged 53 to 94 years.

Results: For education, income, and occupation (women), those in the lowest SES group had statistically larger age-sex-adjusted IMT than those in the highest SES group (<12 vs.

It is not just assisted circulation, hypothermic arrest, or clamp and sew.

We have surgically treated 771 patients for thoracic and thoracoabdominal aortic aneurysms since 1983. Our primary effort has been to develop experimentally validated strategies to reduce paraplegia, renal failure, and mortality in these high-risk patients. This approach has led to a spinal cord protection protocol that has reduced paraplegia risk by 80% (observed/expected ratio = 0.

Presurgical localization of the artery of Adamkiewicz with time-resolved 3.0-T MR angiography.

Purpose: To evaluate the use of time-resolved magnetic resonance (MR) angiography in the presurgical localization of the artery of Adamkiewicz prior to reimplantation of the feeding intercostal artery, lumbar artery, or both during aortic aneurysm repair.

Materials And Methods: This institutional review board-approved retrospective study included 68 patients (36 men, 32 women) who underwent time-resolved spinal MR angiography (0.2 mmol per kilogram of body weight gadobenate dimeglumine administered at a rate of 2.

Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm.

Background: The ratio of red blood cell (PRBC) transfusion to plasma (FFP) transfusion (PRBC:FFP ratio) has been shown to impact survival in trauma patients with massive hemorrhage. The purpose of this study was to determine the effect of the PRBC:FFP ratio on mortality for patients with massive hemorrhage after ruptured abdominal aortic aneurysm (RAAA).

Methods: A retrospective review was performed of patients undergoing emergent open RAAA repair from January 1987 to December 2007.

Impact of intraoperative arteriography on limb salvage for traumatic popliteal artery injury.

Background: Time to revascularization is speculated to be a major determinant of limb salvage for traumatic popliteal injuries. The purpose of this study was to determine whether location of diagnostic arteriography affected outcome.

Methods: From 1996 to 2006, patients with popliteal injuries were identified from our trauma database.