A meta-analysis on the effect of proximal landing zone location on stroke and mortality in thoracic endovascular aortic repair.

Background: Thoracic endovascular aortic repair (TEVAR) involving the aortic arch may increase the opportunity for stroke owing to disruption of cerebral circulation and embolization. In this study, a systematic meta-analysis was performed to examine the impact of proximal landing zone location on stroke and 30-day mortality after TEVAR.

Methods: MEDLINE and Cochrane Library were searched for all original studies of TEVAR reporting outcomes of stroke or 30-day mortality for at least two adjacent proximal landing zones, based on the Ishimaru classification scheme.

Analysis of a Novel Inpatient Acute Limb Ischemia Alert System.

Objectives: Acute limb ischemia (ALI) is a surgical emergency that generally develops in the outpatient setting. Hospitalized patients are also at risk for acute limb ischemia, but their presentation may be atypical or altered by medical therapy. Our institution developed an alert system to facilitate the prompt recognition and treatment of ALI that occurs in the inpatient population.

The Application of Virtual Reality in Patient Education.

Background: Virtual reality (VR) provides an immersive image-viewing experience that has recently been expanding in use in clinical medicine. We developed a three-dimensional (3D) model of an abdominal aortic aneurysm (AAA) for patients with a diagnosis of an AAA to view in VR to assess the use of VR in patient education.

Methods: This was a cross-sectional study using an educational intervention.

Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry.

Objective: We sought to determine the risk factors for subsequent bleeding and recurrent venous thromboembolism (VTE) events following isolated noncatheter-associated upper extremity deep venous thrombosis (non-CA-UEDVT) to better inform future treatment decisions for this group of patients.

Methods: The RIETE registry (Registro Informatizado de Enfermedad TromboEmbólica [Computerized Registry of Patients with Venous Thromboembolism]) is a prospective international registry of patients with objectively confirmed symptomatic VTE. Patients with a symptomatic, isolated, proximal UEDVT from March 2001 through March 2015 were analyzed.

Previous hemodialysis access improves functional outcomes of the proximal radial artery fistula in males.

Background: The proximal radial artery fistula (PRA) has been established as an early viable surgical option for arteriovenous fistula creation. The overall assisted primary patency reported in the literature approaches 100% at 1 year. We hypothesize that this excellent patency does not represent a functional result when seen in light of successful cannulation and fistula utilization.

DVT surveillance program in the ICU: analysis of cost-effectiveness.

Background: Venous Thrombo-embolism (VTE--Deep venous thrombosis (DVT) and/or pulmonary embolism (PE)--in traumatized patients causes significant morbidity and mortality. The current study evaluates the effectiveness of DVT surveillance in reducing PE, and performs a cost-effectiveness analysis.

Methods: All traumatized patients admitted to the adult ICU underwent twice weekly DVT surveillance by bilateral lower extremity venous Duplex examination (48-month surveillance period--SP).

Low incidence of pulmonary embolism associated with upper-extremity deep venous thrombosis.

Background: Most recent Chest 2008 guidelines counsel at least 3 months of anticoagulation for acute upper-extremity deep venous thrombosis (UEDVT). These guidelines are inconsistently followed, perhaps owing to relatively limited information regarding clinical outcomes among patients with UEDVT. Our institution maintains an UEDVT registry of consecutively encountered patients with sonographically confirmed UEDVT.

Upper extremity deep venous thrombosis: reassessing the risk for subsequent pulmonary embolism.

Background: Although the incidence of upper extremity deep venous thrombosis (UEDVT) diagnoses has increased, anticoagulation therapy for UEDVT remains inconsistent and of variable duration. This study sought to analyze our institution's current treatment practices for UEDVT and assess the risk for subsequent pulmonary embolism (PE).

Methods: Between April 2005 and July 2007, 200 consecutively encountered patients with UEDVTs were identified in the Peripheral Vascular Laboratory.

Saphenous vein graft aneurysm with graft-enteric fistula after renal artery bypass.

A 65-year-old female presented with upper gastrointestinal hemorrhage thirty years following an aorta-to-right renal artery bypass constructed with saphenous vein. Upper endoscopy demonstrated a duodenal ulcer, and a CAT scan demonstrated aneurysmal degeneration of her renal artery bypass with duodenal impingement. Laparotomy demonstrated erosion of the aneurysm through the posterior wall of the duodenum; extra-anatomic renovascular reconstruction and primary duodenal repair was performed.

Feasibility of endovascular repair in penetrating axillosubclavian injuries: a retrospective review.

Background: Penetrating injuries to the axillary and subclavian vessels are a source of significant morbidity and mortality. Although the endovascular repair of such injuries has been increasingly described, an algorithm for endovascular versus conventional surgical repair has yet to be clearly defined. On the basis of institutional endovascular experience treating vascular injuries in other anatomic locations, we defined an algorithm for the management of axillosubclavian vascular injuries.

Intrathymic islet transplantation in the canine: I. Histological and functional evidence of autologous intrathymic islet engraftment and survival in pancreatectomized recipients.

Background: Although an attractive alternative to daily insulin therapy, allogeneic pancreatic islet transplantation has yielded suboptimal results in clinical trials, in contrast to islet allotransplantation in animal models, which have demonstrated consistent success. The successful transplantation of isolated islets to the thymus, with a single concomitant dose of antilymphocyte serum, has been demonstrated in rodents, and more significantly, such intrathymic islet allografts have been shown to induce recipient tolerance toward subsequent extrathymic donor strain islet allografts. Intrathymic islet autotransplantation has been pursued, as a prelude to studies of allogeneic IT islet transplantation and tolerance induction, in canine, porcine, and non-human primate models, to assess the large animal thymus as a site capable of supporting a viable islet graft.