Increased risk of renal dysfunction with percutaneous mechanical thrombectomy compared with catheter-directed thrombolysis.

Objective: Percutaneous mechanical thrombectomy (PMT) is regularly used in the treatment of both venous and arterial thrombosis. Although there has been no formal report, PMT has been linked to cases of reversible postoperative acute kidney injury (AKI). The purpose of this study is to evaluate the risk of renal dysfunction in patients undergoing PMT vs catheter-directed thrombolysis (CDT) for treatment of an acute thrombus.

Principal considerations for the contemporary high-fidelity endovascular simulator design used in training and evaluation.

Background: The simulation and rehearsal of virtual endovascular procedures are anticipated to improve the outcomes of actual procedures. Contemporary, high-fidelity simulation is based on feedback systems that combine concepts of mechanical, electrical, computer, and control systems engineering to reproduce an interactive endovascular case. These sophisticated devices also include psychometric instruments for objective surgical skill assessment.

New training paradigms and program requirements.

Specialized training in vascular surgery evolved over the second half of the 20th century and continues to do so in 2006. Apprenticeship-style training in the 1960s and 1970s gave way to formal curriculum- and case-based programs created in the 1980s to improve the quality and consistency of vascular care. Recent developments have resulted in the Accreditation Council for Graduate Medical Education's approval of additional training pathways leading to certification by the American Board of Surgery.

Successful management of life-threatening hemorrhage in a patient with synchronous lupus anticoagulant and factor VIII inhibitor.

Acquired factor VIII inhibitor is increasingly recognized as a cause of major soft tissue hemorrhage. The laboratory diagnosis can be obscured by the synchronous presence of the lupus anticoagulant, an extremely rare occurrence that has been reported outside the vascular surgery literature. Vascular surgeons should be knowledgeable of factor VIII inhibitor and aware that it can present with other blood disorders, making the diagnosis more difficult and management more complex.

Presentation, diagnosis, and management of arterial mycotic pseudoaneurysms in injection drug users.

Injection drug users frequently present with abscess, cellulitis, and endocarditis. The development of arterial mycotic pseudoaneurysm (AMP) as a sequela of injection drug use, however, is much less frequently reported. We undertook a study to determine the prevalence and presenting clinical characteristics of AMP, utilizing a retrospective review of all emergency department cases seen at one city public hospital for the 5-year period 1994-1999.

Abdominal aortic reconstruction in infected fields: early results of the United States cryopreserved aortic allograft registry.

Objective: Aortic reconstructions for primary graft infection (PGI), mycotic aneurysm (MA), and aortic graft-enteric erosion (AEE) bear high morbidity and mortality rates, and current treatment options are not ideal. Cryopreserved grafts have been implanted successfully in infected fields and may be suitable for abdominal aortic reconstructions. Registry data from several institutions were compiled to examine results of cryopreserved aortic allograft (CAA) placement.