Preemptive treatment of type II endoleak for abdominal aortic aneurysm with renal fusion (horseshoe kidney).

Objective: To assess viability and safety of preemptive treatment of type II endoleak for abdominal aortic aneurysm (AAA) repairs.

Methods: A 69-year-old man with renal fusion (horseshoe kidney) was referred for treatment of a 5.5 cm AAA.

Longitudinal assessment of health-related quality of life and clinical outcomes with at home advanced pneumatic compression treatment of lower extremity lymphedema.

Objective: This prospective, longitudinal, pragmatic study describes at home treatment with a proprietary advanced pneumatic compression device (APCD) for patients with lower extremity lymphedema (LED).

Methods: Following institutiona review board approval, four participating Veterans Affairs centers enrolled LED patients from 2016 to 2022. The primary outcome measures were health-related quality of life (HR-QoL) questionnaires (lymphedema quality of life-leg and the generic SF-36v2) obtained at baseline and 12, 24, and 52 weeks.

Anterior Abdominal Varicosities Due to Unilateral Common and External Iliac Vein Occlusion Five Decades Post-Injury.

Abdominopelvic varicosities are a rare occurrence after traumatic venous injuries. Several disorders exist that present with abdominopelvic varicosities such as May-Thurner syndrome, pelvic congestion syndrome, and nutcracker syndrome; however, it has rarely been described after trauma. We present a case in 70-year-old male, who in 1974 sustained a penetrating injury from fragments secondary to mortar explosion, requiring exploratory laparotomy.

A Pilot Study of Surgical Trainee Participation in Humanitarian Surgeries.

Background: The impact of general surgery resident participation on operative case time and postoperative complications has been broadly studied in the United States. Although surgical trainee involvement in international humanitarian surgical care is escalating, there is limited information as to how this participation affects care rendered. This study examines the impact of trainee involvement on case length and immediate postoperative complications with regard to operations in low- and middle-income settings.

Septic embolization from stented arteriovenous fistula.

Anastomotic stenosis of an arteriovenous fistula is often amenable to percutaneous intervention (angioplasty and stenting) and unlikely to be complicated by infection. A 69-year-old man underwent pre-emptive arteriovenous fistula construction that required interval placement of a covered stent for juxta-anastomotic stenosis. The patient presented 1 year after the intervention with systemic sepsis that required stent graft explantation and revision.

Open versus Endovascular Repair of Abdominal Aortic Aneurysm.

Background: Elective endovascular repair of an abdominal aortic aneurysm results in lower perioperative mortality than traditional open repair, but after 4 years this survival advantage is not seen; in addition, results of two European trials have shown worse long-term outcomes with endovascular repair than with open repair. Long-term results of a study we conducted more than a decade ago to compare endovascular repair with open repair are unknown.

Methods: We randomly assigned patients with asymptomatic abdominal aortic aneurysms to either endovascular repair or open repair of the aneurysm.

Reliability and accuracy of duplex ultrasound vein mapping for dialysis access.

Background: Duplex ultrasound vein mapping (DUVM) may increase autogenous dialysis access procedures but has not been universally adopted by surgeons.

Methods: We determined reliability and accuracy of arm vein measurements on physical examination (PE) and DUVM, compared to direct measurements in the operating room (OR, gold standard). Operative plans were developed from each set of measurements and we evaluated which approach identified more options for autogenous procedures.

Isolated blunt abdominal aortic injury without concomitant abdominal injuries treated with endovascular stent grafting.

Blunt injury of the abdominal aorta is a rare event, seen in only 0.07% to 0.17% of all blunt traumas.

Previously unappreciated carotid artery stenosis diagnosed by cone beam computerized tomography.

Stroke is the third leading cause of death in the western world. Calcification noted on cone beam computerized tomography, frequently used to evaluate the maxillofacial structures for extent of tumor, trauma, and implant placement, may indicate atherosclerotic disease in the carotid artery. Internal carotid artery stenosis is a recognized risk factor for stroke; multiple, large randomized controlled trials have demonstrated a decreased risk of stroke after repair of the stenotic artery.

Long-term comparison of endovascular and open repair of abdominal aortic aneurysm.

Background: Whether elective endovascular repair of abdominal aortic aneurysm reduces long-term morbidity and mortality, as compared with traditional open repair, remains uncertain.

Methods: We randomly assigned 881 patients with asymptomatic abdominal aortic aneurysms who were candidates for both procedures to either endovascular repair (444) or open repair (437) and followed them for up to 9 years (mean, 5.2).

The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum.

The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema, skin changes, or venous ulcers. Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs.

Screening for abdominal aortic aneurysm with electronic clinical reminders.

Background: Based on randomized, population-based screening protocols, a single ultrasound examination reduces mortality from an abdominal aortic aneurysm (AAA) by facilitating elective surgical intervention before rupture. Ultrasound screening is accurate, noninvasive, inexpensive, and cost effective. By using a comprehensive electronic medical record, we inquired whether an age-prompted clinical reminder would facilitate the detection of AAA.

Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial.

Context: Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm (AAA) improves short-term outcomes compared with traditional open repair.

Objective: To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim report of a 9-year trial.

Design, Setting, And Patients: A randomized, multicenter clinical trial of 881 veterans (aged > or = 49 years) from 42 Veterans Affairs Medical Centers with eligible AAA who were candidates for both elective endovascular repair and open repair of AAA.

Complications of arteriovenous hemodialysis access: recognition and management.

English language citations reporting complications of arteriovenous access for hemodialysis are critically reviewed and discussed. Venous hypertension, arterial steal syndrome, and high-output cardiac failure occur as a result of hemodynamic alterations potentiated by access flow. Uremic and diabetic neuropathies are common but may obfuscate recognition of potentially correctable problems such as compression or ischemic neuropathy.

The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access.

Recognizing the impact of the decision making by the dialysis access surgeon on the successful placement of autogenous arteriovenous hemodialysis access, the Society for Vascular Surgery assembled a multispecialty panel to develop practice guidelines in arteriovenous access placement and maintenance with the aim of maximizing the percentage and functionality of autogenous arteriovenous accesses that are placed. The Society commissioned the Knowledge and Encounter Research Unit of the Mayo Clinic College of Medicine, Rochester, Minnesota, to systematically review the available evidence in three main areas provided by the panel: timing of referral to access surgeons, type of access placed, and effectiveness of surveillance. The panel then formulated practice guidelines in seven areas: timing of referral to the access surgeon, operative strategies to maximize the placement of autogenous arteriovenous accesses, first choice for the autogenous access, choice of arteriovenous access when a patient is not a suitable candidate for a forearm autogenous access, the role of monitoring and surveillance in arteriovenous access management, conversion of a prosthetic arteriovenous access to a secondary autogenous arteriovenous access, and management of the nonfunctional or failed arteriovenous access.

Vicarious excretion of parenteral contrast material after endovascular abdominal aortic aneurysm repair.

The aim of this study is to describe the finding of vicarious excretion of intravascular contrast media in association with endovascular management of an aortic aneurysm and to discuss the clinical significance. Vicarious excretion of intravascular contrast material through the hepatobiliary system will be encountered occasionally following endovascular procedures. Plain abdominal images obtained for the purpose of graft position and structural integrity will increase recognition of this finding.