Comparing Post-operative Pain and Other Outcomes in Carotid Endarterectomy Versus Transcarotid Artery Revascularization.

Background: Transcarotid artery revascularization (TCAR) is growing in popularity. Although major clinical end-points such as stroke rate and mortality are well-known, patient reported outcomes such as pain, and length of stay are among the purported benefits that are as yet untested. We sought to determine if there are differences in pain and other clinical outcomes when comparing carotid endarterectomy (CEA) and TCAR.

Plasma Fibrinogen Change as a Predictor of Major Bleeding During Catheter-Directed Thrombolysis.

Background: Our primary objective was to determine the relationship between plasma fibrinogen levels (PFLs) and major bleeding complications during catheter-directed thrombolysis, including final, nadir, and change over time. Furthermore, we sought to evaluate additional predictors of bleeding outcomes, including duration of lysis and total dose of tissue plasminogen activator received.

Methods: In this multicenter retrospective cohort study, we reviewed all patients undergoing catheter-directed thrombolysis between January 2016 and August 2021.

Hybrid Approach for Treatment of a Symptomatic Giant Splenic Artery Aneurysm.

A 56-year-old female presented with a symptomatic giant fusiform mid-splenic artery aneurysm (7.3 x 6.4 cm).

Impact of inferior vena cava thrombus extension on thrombolysis for acute iliofemoral thrombosis.

Background: Inferior vena cava (IVC) thrombosis may occur in patients with iliofemoral deep venous thrombosis (DVT), and its impact on thrombolysis outcomes is poorly defined. This study compared outcomes of patients undergoing thrombolysis for acute iliofemoral DVT with and without IVC involvement.

Methods: Patients who underwent thrombolysis for iliofemoral DVT between May 2007 and March 2014 were identified from a prospectively maintained database and divided into two groups: those with IVC involvement and those without.

Contemporary outcomes of civilian lower extremity arterial trauma.

Objective: Lower extremity arterial injury may result in limb loss after blunt or penetrating trauma. This study examined outcomes of civilian lower extremity arterial trauma and predictors of delayed amputation.

Methods: The records of patients presenting to a major level I trauma center from 2004 to 2014 with infrainguinal arterial injury were identified from a prospective institutional trauma registry, and outcomes were reviewed.

Endovascular management of symptomatic gastrointestinal complications associated with retrievable inferior vena cava filters.

Objective: With the increase in retrievable inferior vena cava (IVC) filter use, a higher than expected reported rate of pericaval tine penetration is observed. Symptomatic gastrointestinal (GI) complications associated with retrievable IVC filters have been documented; however, their management remains controversial. We describe a series of GI complications of retrievable IVC filters, detailing the spectrum of presenting symptoms and multiple treatment options, including the safety of endovascular retrieval.

Inferior vena cava filter placement during thrombolysis for acute iliofemoral deep venous thrombosis.

Objective: The objectives of this study were to evaluate the need for inferior vena cava (IVC) filters and to identify anatomic and patient-specific risk factors associated with embolization in patients undergoing thrombolysis for acute iliofemoral deep venous thrombosis (DVT).

Methods: Consecutive patients who underwent catheter-directed thrombolysis or pharmacomechanical thrombolysis (PMT) for iliofemoral DVT from May 2007 to March 2012 were identified from a prospectively maintained database. Patients were categorized in two groups, depending on the status of IVC filtration during the lysis procedures: patients with an IVC filter protection (group A) and patients without an IVC filter protection (group B).

Anatomic and functional outcomes of pharmacomechanical and catheter-directed thrombolysis of iliofemoral deep venous thrombosis.

Objective: Pharmacomechanical thrombolysis (PMT) and catheter-directed thrombolysis (CDT) are commonly used for the treatment of iliofemoral deep venous thrombosis (DVT). The purpose of this study was to examine the short- and long-term venous patency and venous valvular function as well as clinical outcomes of patients treated for iliofemoral DVT by PMT and CDT.

Methods: A retrospective review of all patients with symptomatic DVT treated between 2006 and 2011 with PMT or CDT was performed.

Endovascular strategies for treatment of embolizing thoracoabdominal aortic lesions.

Objective: Aortic sources of peripheral and visceral embolization remain challenging to treat. The safety of stent graft coverage continues to be debated. This study reports the outcomes of stent coverage of these complex lesions.

CT-guided injection of N-butyl cyanoacrylate glue for treatment of chylous leak after aorto-mesenteric bypass.

Lymphangiography and thoracic duct embolization are well-described techniques for the diagnosis and treatment of thoracic lymphatic leaks refractory to conservative treatment. However, thoracic duct embolization is not an option in patients with abdominal chylous leaks. The present report describes a 68-year-old man who underwent an aortomesenteric bypass complicated by a high-output postoperative chylothorax (>2,000 ml/day) and chylous ascites (>7,000 ml/paracentesis).

Comparison of modern open infrarenal and pararenal abdominal aortic aneurysm repair on early outcomes and renal dysfunction at one year.

Objective: This study was conducted to review contemporary results of elective open infrarenal abdominal aortic aneurysm (IAAA) and pararenal abdominal aortic aneurysm (PAAA) repairs and determine predictors of death and acute and 1-year renal dysfunction (RD).

Methods: A retrospective review identified 432 consecutive patients undergoing open IAAA (233 patients) or PAAA (184 patients) repair between January 2000 and December 2007. Demographic, preoperative, intraoperative, and postoperative variables were collected.

Inflow thrombosis does not adversely affect thrombolysis outcomes of symptomatic iliofemoral deep vein thrombosis.

Objective: The presence of popliteal or tibial vein clot is thought to adversely affect thrombolysis for iliofemoral deep vein thrombosis (DVT). We examined the effect of inflow thrombosis on functional and anatomic outcomes.

Methods: Data for 44 patients treated for symptomatic iliofemoral DVT between 2006 and 2009 were retrospectively reviewed.

Cirrhosis is not a contraindication to laparoscopic cholecystectomy: results and practical recommendations.

Background: Gallstones appear more frequently in patients with cirrhosis and open cholecystectomy in this patient population is associated with higher morbidity and mortality. The aim of the present study was to evaluate experience with laparoscopic cholecystectomy in patients with cirrhosis and to provide recommendations for management.

Methods: Retrospective review of laparoscopic cholecystectomy in patients with cirrhosis from March 1999 to May 2008 was performed.

Late collapse of a thoracic endoprosthesis.

Thoracic stent graft collapse is a rare complication of thoracic endovascular aortic repair that is mostly asymptomatic and occurs ≤ 3 months of the procedure. We describe the case of a 36-year-old man who presented with symptomatic endograft collapse 38 months after an initial thoracic endovascular aortic repair that was performed for traumatic aortic transection. He had sudden and complete loss of bilateral lower extremity motor and sensory functions (spinal cord ischemia) and anal sphincter tone.

Bradyarrhythmias during rheolytic pharmacomechanical thrombectomy for deep vein thrombosis.

Purpose: To explore possible mechanisms of bradycardia occurring during rheolytic pharmacomechanical thrombectomy (PMT) for deep venous thrombosis (DVT) and to propose a treatment algorithm for this phenomenon.

Methods: Intraoperative anesthesia records, operative notes, and hospital records of 57 patients treated with the AngioJet rheolytic thrombectomy device for DVT over a 3-year period were retrospectively reviewed. Of the 57 patients, 7 (12.

Recurrent laryngeal nerve injury following uncomplicated carotid angioplasty and stenting.

Purpose: To describe a unique instance of cranial nerve injury related to uncomplicated carotid artery stenting (CAS).

Case Report: A 74-year-old woman with a history of expressive aphasia and right upper/lower extremity weakness underwent staged CAS procedures under local anesthesia and conscious sedation. After routine predilation with a 4-mm balloon, a tapered 7 x 10 x 30-mm Acculink stent was placed and dilated with a 5-mm balloon.

Preactivation of NKT cells with alpha-GalCer protects against hepatic ischemia-reperfusion injury in mouse by a mechanism involving IL-13 and adenosine A2A receptor.

Hepatic preconditioning has emerged as a promising strategy of activating natural pathways to augment tolerance to liver ischemia-reperfusion (IR) injury. Liver-resident natural killer T (NKT) cells play an important role in modulating the local immune and inflammatory responses. This work was aimed to investigate whether preactivation of NKT cells could provide a beneficial "preconditioning" effect to ameliorate the subsequent hepatic IR injury.

Technical challenges and utility of anterior exposure for thoracic spine pathology.

Background: Thoracic surgeons are frequently called upon to provide exposure to the anterior cervicothoracic, thoracic, and proximal lumbar spine. We reviewed our surgical experience and the perioperative outcomes of these spinal approaches. Relevant technical and anatomic considerations of each procedure are highlighted.

Noninvasive radiofrequency ablation of cancer targeted by gold nanoparticles.

Introduction: Current radiofrequency ablation (RFA) techniques require invasive needle placement and are limited by accuracy of targeting. The purpose of this study was to test a novel non invasive radiowave machine that uses RF energy to thermally destroy tissue. Gold nanoparticles were designed and produced to facilitate tissue heating by the radiowaves.

Arginase blockade protects against hepatic damage in warm ischemia-reperfusion.

Background: Liver ischemia reperfusion (I/R) injury is associated with profound arginine depletion due to arginase release from injured hepatocytes. Nitric oxide (NO), shown to have protective effects in I/R, is produced by nitric oxide synthase (NOS) from the substrate arginine. The purpose of this study was to determine if nor-NOHA, a novel arginase inhibitor, would be able to increase circulating arginine levels and decrease hepatic damage following warm I/R.

HMGB1 release induced by liver ischemia involves Toll-like receptor 4 dependent reactive oxygen species production and calcium-mediated signaling.

Ischemic tissues require mechanisms to alert the immune system of impending cell damage. The nuclear protein high-mobility group box 1 (HMGB1) can activate inflammatory pathways when released from ischemic cells. We elucidate the mechanism by which HMGB1, one of the key alarm molecules released during liver ischemia/reperfusion (I/R), is mobilized in response to hypoxia.

Glycochenodeoxycholate (GCDC) inhibits cytokine induced iNOS expression in rat hepatocytes.

Background: Although the accumulation of hydrophobic bile acid (e.g., glycine conjugated chenodeoxycholic acid, GCDC) is considered to be an important factor contributing to cholestatic liver dysfunction, its pathogenesis is poorly understood.

Increasing numbers of hepatic dendritic cells promote HMGB1-mediated ischemia-reperfusion injury.

Endogenous ligands released from damaged cells, so-called damage-associated molecular pattern molecules (DAMPs), activate innate signaling pathways including the TLRs. We have shown that hepatic, warm ischemia and reperfusion (I/R) injury, generating local, noninfectious DAMPs, promotes inflammation, which is largely TLR4-dependent. Here, we demonstrate that increasing dendritic cell (DC) numbers enhance inflammation and organ injury after hepatic I/R.

Liver I/R injury is improved by the arginase inhibitor, N(omega)-hydroxy-nor-L-arginine (nor-NOHA).

Liver ischemia-reperfusion (I/R) injury is associated with profound arginine depletion due to arginase release from injured hepatocytes. The purpose of this study was to determine whether arginase inhibition with N(omega)-hydroxy-nor-l-arginine (nor-NOHA) would increase circulating arginine levels and decrease hepatic damage during liver I/R injury. The effects of nor-NOHA were initially tested in normal animals to determine in vivo toxicity.

Cutting edge: high-mobility group box 1 preconditioning protects against liver ischemia-reperfusion injury.

High mobility group box 1 (HMGB1) is a NF released extracellularly as a late mediator of lethality in sepsis and as an early mediator of inflammation following injury. Here we demonstrate that in contrast to the proinflammatory role of HMGB1, preconditioning with HMGB1 results in protection following hepatic ischemia/reperfusion (I/R). Pretreatment of mice with HMGB1 significantly decreased liver damage after I/R.