Incidental Findings in Trauma Patients: How Big is the Challenge?

Introduction: The purpose of this study was to examine the prevalence of incidental findings (IFs) identified during workup of trauma patients and the effectiveness with which they were documented and communicated.

Materials And Methods: We performed a retrospective analysis of all trauma patients ≥15 y of age in 2018, who underwent at least one computed tomography scan. Patients' Electronic Medical Record was reviewed for the presence of IFs.

Hemoglobin A1c as a measure of disease severity and outcome in limb threatening ischemia.

Background: Diabetes mellitus is a known risk factor in the development of peripheral vascular disease. Hemoglobin A1c (HbA1c) has been used by clinicians as a means to measure short to intermediate term glucose control in diabetics. Trials evaluating tight glucose control using HbA1c measurements have recently been conducted for several medical conditions.

Is the length of follow-up evaluation in published reports on the treatment of infrainguinal occlusive disease decreasing?

Background: There is increasing pressure for the rapid development and implementation of new techniques and procedures. This study examined whether or not there has been a trend toward increasingly short follow-up times for studies evaluating the treatment of lower-extremity occlusive disease.

Methods: A search was performed of PubMed using the term "femoropopliteal occlusive disease" from 1976 to 2006.

Proportion of patients with critical limb ischemia who require an open surgical procedure in a center favoring endovascular treatment.

Endovascular interventions have gained widespread acceptance as primary and secondary treatments for critical lower extremity ischemia (CLI), and many believe there is little need for open bypasses for CLI. Despite this, some patients presenting with CLI require traditional lower extremity bypass procedures at some point for successful limb salvage. To determine the proportion of patients requiring an open procedure, we reviewed our 1-year experience with CLI patients at a center committed to endovascular approaches whenever possible.

Long-term outcome of inferior vena cava filter placement in patients undergoing gastric bypass.

Background: It has been well established that inferior vena cava (IVC) filter placement at the time of open gastric bypass (OGB) surgery in patients with a body mass index of more than 55 kg/m(2) reduces both the pulmonary embolism rate and the perioperative mortality. However, little is known about the long-term effects of IVC filter placement in this particular group of patients.

Methods: Over an 8-year period, a total of 571 morbid obese patients underwent OGB procedures, and 58 (10%) of them required placement of an IVC filter before their procedure.

Incidence and characteristics of venous thromboembolic disease during pregnancy and the postnatal period: a contemporary series.

Background: To evaluate the incidence and characteristics of venous thromboembolic events (VTE) associated with pregnancy in a contemporary patient series.

Methods: We performed a retrospective review of 33,311 deliveries between June 2003 and June 2008. Patients with objective documentation of a VTE during pregnancy or the 3-month postnatal period were identified from hospital discharge International Classification of Disease Codes edition 9 codes.

Experience with a modified composite sequential bypass technique for limb-threatening ischemia.

Background: Composite sequential femoro-popliteal-distal bypass is a valuable option for treatment of critical limb ischemia when autogenous vein is limited and an isolated popliteal or distal arterial segment exists. We report a modified technique for composite sequential bypass and the results with its use over a 14-year period.

Methods: Twenty-five modified composite sequential bypass procedures were performed on 24 patients to treat gangrene, ischemic ulceration, and severe rest pain.

Endovascular management of multiple arteriovenous fistulae following failed laser-assisted pacemaker lead extraction.

A woman presented for evaluation of new-onset left arm edema after failed laser-assisted pacemaker lead extraction. Initial workup demonstrated a left subclavian artery to vein arteriovenous fistula (AVF). She underwent repair of the AVF with placement of a covered stent in the subclavian artery, however, her symptoms did not completely resolve.

Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms.

Background: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial.

Objective: To clarify these we examined a collected experience with use of EVAR for RAAA treatment from 49 centers.

Methods: Data were obtained by questionnaires from these centers, updated from 13 centers committed to EVAR treatment whenever possible and included treatment details from a single center and information on 1037 patients treated by EVAR and 763 patients treated by open repair (OR).

Experience with covered stents for the management of hemodialysis polytetrafluoroethylene graft seromas.

Prosthetic graft seromas is a rare complication that has been traditionally managed with open methods using partial graft replacement and open drainage. We report the first two cases of hemodialysis graft seromas successfully treated with a covered stent. Both patients underwent arteriovenous graft placement from the brachial artery to the axillary vein using a standard wall, tapered 4 to 7 mm polytetrafluoroethylene graft, but developed a seroma at the arterial end of the graft.

Perimalleolar and pedal thromboembolectomy and bypasses to treat distal embolization during aortoiliac aneurysm repairs.

Objectives: Lower extremity embolization occurs during aortoiliac aneurysm repair and may require major amputation when distal arteries are occluded. Because nonoperative treatments are often ineffective, we evaluated an aggressive operative approach.

Methods: In the past 11 years, we performed 328 endovascular and 350 open aortoiliac aneurysm repairs.

Incidence and significance of nonaneurysmal-related computed tomography scan findings in patients undergoing endovascular aortic aneurysm repair.

Objective: This study examined the frequency and nature of incidental findings seen on computed tomography (CT) scans during preoperative and postoperative follow-up in patients undergoing endovascular aortic aneurysm repair (EVAR).

Methods: Between January 1, 2000, and March 1, 2006, 176 consecutive patients who underwent EVAR at our institution were retrospectively reviewed. Patients were included in the study if all preoperative and postoperative surveillance CT scans were performed at our institution.

Endovascular aortic repair should be the gold standard for ruptured AAAs, and all vascular surgeons should be prepared to perform them.

When ruptured abdominal aortic aneurysms (AAAs) are not treated, they cause death. In addition, ruptured abdominal aortic aneurysms (RAAAs) have high mortality (35%-70%) and morbidity rates when treated by standard open surgical methods. These high perioperative mortality and morbidity rates have not been substantially reduced despite the introduction of many improvements in open operative technique or perioperative care.

The incidence of pulmonary embolism in open versus laparoscopic gastric bypass.

Obesity independently increases the risk of pulmonary embolism (PE). We compare a superobese population (body mass index [BMI] > 55 kg/m(2)) undergoing open gastric bypasses (OGBs) with a similarly matched group of laparoscopic gastric bypasses (LGB) to see if the incidence of PE differs. We included all patients undergoing OGB (n = 193, average BMI = 51 kg/m(2)) at our institution by a single surgeon between July 1999 and April 2001.

Histologic and duplex comparison of the perclose and angio-seal percutaneous closure devices.

The intravascular and extravascular effects of percutaneous closure devices have not been well studied. We assessed the performance and healing characteristics in dogs of two devices approved by the US Food and Drug Administration. Nine adult male dogs were anesthesized prior to percutaneous access of both femoral arteries with a 6F sheath.

Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures.

Objective: Patients undergoing open gastric bypass (OGB) for morbid obesity are at significant risk for pulmonary embolism (PE) despite the use of subcutaneous heparin injections and sequential compression devices. Prophylactic preoperative inferior vena cava (IVC) filter placement may reduce this risk. We report our experience with simultaneous IVC filter placement and OGB in an operating room setting.

Femoral artery to prosthetic graft anastomotic dehiscence owing to infection: successful treatment with arterial reconstruction and limb salvage.

A 66-year-old man had foot gangrene and a fixed contracture of the knee following two failed femoropopliteal bypasses, one with vein and one with polytetrafluoroethylene (PTFE). An external iliac to anterior tibial artery bypass and skeletal traction via the os calcis resulted in limb salvage and successful normal ambulation. After 3 months, he ruptured the infected femoral anastomosis of the failed PTFE femoropopliteal bypass with external bleeding.

Absence of proximal neck dilatation and graft migration after endovascular aneurysm repair with balloon-expandable stent-based endografts.

Objective: Proximal neck dilatation (PND) and/or endograft migration with the subsequent development of type I endoleak is a significant cause of late endograft failure after endovascular abdominal aortic aneurysm repair (EVAR). Although there are numerous reports examining PND in patients receiving endografts that use self-expanding stents (SES) for proximal fixation, there are no such reports for patients treated with endografts that use balloon-expanding stents (BES). The purpose of this study was to investigate PND and endograft migration after EVAR with BES endografts.

Influence of type II endoleak volume on aneurysm wall pressure and distribution in an experimental model.

Objective(s): We have previously shown that type II endoleak size is a predictor of aneurysm growth after aortic endografting. To better understand this observation, we investigated the influence of endoleak size on pressure transmitted to the aneurysm wall and its distribution within the aneurysm sac.

Methods: In an ex vivo model, an artificial aneurysm sac was incorporated within a mock circulation comprised of rubber tubing and a pulsatile pump.

Discontinuous, staccato growth of abdominal aortic aneurysms.

Background: To evaluate whether abdominal aortic aneurysm (AAA) growth in individual patients can be characterized as continuous or discontinuous (staccato).

Study Design: From 1996 to 2002, 609 patients presented with unruptured AAAs. Of these, 278 underwent prompt repair and 331 were observed.

Predicting aneurysm enlargement in patients with persistent type II endoleaks.

Objective: The clinical significance of type II endoleaks is not well understood. Some evidence, however, indicates that some type II endoleaks might result in aneurysm enlargement and rupture. To identify factors that might contribute to aneurysm expansion, we analyzed the influence of several variables on aneurysm growth in patients with persistent type II endoleaks after endovascular aortic aneurysm repair (EVAR).

Fate of collateral vessels following subintimal angioplasty.

Purpose: To evaluate the fate of collateral vessels adjacent to and within the target lesion following subintimal angioplasty (SIA).

Methods: Pre and postprocedural angiograms were reviewed for 29 patients undergoing SIA of the lower extremity arteries over a 3-year period. The number of patent collateral vessels View Article and Find Full Text PDF