A Randomized Prospective Blinded Study Evaluating the Effect of Music on Novice Surgical Trainees' Ability to Perform a Simulated Surgical Task.

Objective: To determine if playing music would affect novice surgical trainees' ability to perform a complex surgical task.

Background: The effect of music in the operating room (OR) is controversial. Some studies from the anesthesiology literature suggest that OR music is distracting and should be banned.

A Novel Approach to Limb Salvage: Healing Transmetatarsal Amputations without a Viable Plantar Flap.

Background: The lack of a viable plantar flap in patients undergoing transmetatarsal amputation has been considered an indication for below-knee amputation (BKA). In an effort to reduce limb loss in this patient population, we sought to review our experience with transmetatarsal amputation salvage in patients with an open, guillotine transmetatarsal amputation. We hypothesized that performing a transmetatarsal amputation without a viable flap would extend time of independent ambulation and improve limb salvage.

Outcomes of Local and Regional Anesthesia for Superficialization of Brachiobasilic Arteriovenous Fistulas.

Background: Superficialization, the second stage of a two-stage brachiobasilic arteriovenous fistula (BB-AVF), can be performed under local (LA), regional (RA), or general anesthesia (GA). Given the numerous comorbidities in patients with end-stage renal disease (ESRD), our preference is to use RA or LA when feasible. Our goal was to review the success rate of RA and LA, need for conversion to GA, and cardiac morbidity and mortality for BB-AVF superficialization.

Percutaneous Access of an Expanding Internal Iliac Artery Aneurysm via a Direct Posterior Transgluteal Approach.

Background: Internal iliac artery aneurysms (IIAAs) are rare, comprising 0.3% of all aortoiliac aneurysms. Endovascular management is associated with lower morbidity and mortality than open repair.

Giant Bilobed Hepatic Artery Aneurysm with Occlusion of the Celiac Axis: Repair Using a Bifurcated Graft.

Hepatic artery aneurysms are uncommon, with fewer than 500 cases noted in the literature. Bilobed hepatic artery aneurysms are extremely rare, with no documented cases in the literature. Although often asymptomatic, these visceral aneurysms are at high risk of rupture.

Effect of adjunct femoral endarterectomy in lower extremity bypass on perioperative and 1-year outcomes.

Background: Isolated common femoral endarterectomy was recently reported to have a 30-day mortality of 3.4%. The effect of adjunctive femoral endarterectomy at the time of lower extremity bypass is not well described, and therefore, the purpose of this study was to determine its associated perioperative and long-term risk.

Carotid baroreceptor stimulation blood pressure response mapped in patients undergoing carotid endarterectomy (C-Map study).

Objective: Continuous stimulation of the carotid baroreceptors has been shown to evoke a sustained systolic blood pressure (SBP) reduction in hypertensive subjects. This study conducted a detailed mapping of the SBP and heart rate response to electrical stimulus at different locations in the carotid sinus region in patients undergoing a carotid endarterectomy (CEA).

Methods: The Carotid Sinus Autonomic Response Mapping (C-Map) Study is a multicenter, prospective, non-randomized, acute feasibility study conducted in 10 hypertensive subjects undergoing CEA.

Essentials of endovascular abdominal aortic aneurysm repair imaging: postprocedure surveillance and complications.

Objective: Lifelong postprocedural imaging surveillance is necessary after endovascular abdominal aortic aneurysm repair (EVAR) to assess for complications of endograft placement, as well as device failure and continued aneurysm growth. Refinement of the surveillance CT technique and development of ultrasound and MRI protocols are important to limit radiation exposure.

Conclusion: A comprehensive understanding of EVAR surveillance is necessary to identify life-threatening complications and to aid in secondary treatment planning.

Essentials of endovascular abdominal aortic aneurysm repair imaging: preprocedural assessment.

Objective: To understand the abdominal aortic aneurysm imaging characteristics that must be accurately described for endovascular aortic aneurysm repair treatment planning, including evaluation of the landing zones, aneurysm morphology, and vascular access..

Conclusion: A comprehensive understanding of preprocedural imaging is necessary to produce detailed and clinically useful imaging reports and assist the interventionalist in planning endovascular abdominal aortic aneurysm repair.

Hospital volume of thoracoabdominal aneurysm repair does not affect mortality in California.

Objectives: Open thoracoabdominal aneurysm repair (TAAR) is a rarely performed but a complicated and morbid procedure. This study compares the morbidity and mortality of open TAAR at high- versus low-volume hospitals.

Methods: Included patients from California Office of Statewide Health Policy and Development patient discharge database who underwent an open TAAR between 1995 and 2010.

A multicenter, randomized, controlled trial of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair (the PEVAR trial).

Objective: The first multicenter randomized controlled trial was designed and conducted to assess the safety and effectiveness of totally percutaneous endovascular aortic aneurysm repair (PEVAR) with use of a 21F endovascular stent graft system and either an 8 F or 10 F suture-mediated closure system (the PEVAR trial, NCT01070069). A noninferiority trial design was chosen to compare percutaneous access with standard open femoral exposure.

Methods: Between 2010 and 2012, 20 U.

Mineralization in calcified plaque is like that of cortical bone--further evidence from ultrashort echo time (UTE) magnetic resonance imaging of carotid plaque calcification and cortical bone.

Purpose: This study aims to investigate carotid plaque calcification (CPC) using two-dimensional (2D) and 3D ultrashort echo time (UTE) magnetic resonance imaging (MRI) sequences and compare T1, T2*, water concentration, and bone mineral density (BMD) of CPC with those of cortical bone.

Methods: Twelve carotid plaque specimens and eight tibial cortical bone samples were imaged with UTE sequences. Adiabatic inversion recovery prepared UTE (IR-UTE) acquisitions were used for T2* measurement.

Case report and review of the literature total endovascular repair of acute ascending aortic rupture: a case report and review of the literature.

Thoracic aortic endografting has been successfully implemented to treat aneurysmal disease of the distal aortic arch and descending thoracic aorta. Although there are reports of ascending aortic endovascular interventions, the total endovascular repair of a ruptured ascending aorta secondary to a Type A dissection has not been described. We report the case of a 77-year-old patient who presented with a ruptured ascending aortic aneurysm secondary to degeneration of a Stanford type A aortic dissection.

Early ambulation after percutaneous femoral access with use of closure devices and hemostatic agents.

Background: Patient satisfaction after percutaneous endovascular procedures is significantly influenced by the amount of time to ambulation postprocedure. The purpose of this study was to assess the complication rates of early ambulation after use of closure devices or topical hemostatic agents for femoral access sites for endovascular procedures.

Methods: A retrospective review was performed of all patients who underwent an endovascular procedure from a femoral access site between January 2004 and March 2008.

Management of vascular graft infections with soft tissue flap coverage: improving limb salvage rates--a veterans affairs experience.

Graft infections are one of the most challenging issues in surgery with an incidence of 0.7 to 7 per cent, with femoral site infections being the most common (13% incidence). The gold standard treatment has been graft removal, wide débridement, and extra-anatomical bypass.

Hybrid repair of isolated internal iliac artery aneurysm.

Isolated aneurysms of the internal iliac artery (IIIAA) represent a rare pathology. The application of endovascular therapy has been shown to reduce both mortality and blood loss. We present a case of an isolated left internal iliac artery aneurysm treated with a hybrid approach.

Complete femoral artery and vein avulsion from a hyperextension injury: a case report and literature review.

Blunt peripheral extremity vascular injuries are much less frequent than those of penetrating injuries, especially in the absence of significant musculoskeletal trauma. We present an unusual case of complete femoral artery and vein avulsion that resulted from a forced hip hyperextension and thigh abduction after slipping when a patient's foot became entrapped in a ladder. The patient presented with an acutely ischemic right lower extremity 8 hr postinjury, which necessitated immediate surgical exploration, temporary intravascular shunting, interposition grafting, and prophylactic fasciotomy.

Right thyrocervical trunk bronchial artery collateral: source of type II Endoleak after endovascular repair of thoracic aortic aneurysm.

A patient with an enlarging thoracic aortic aneurysm (TAA) after endovascular repair showed a persistent endoleak on follow-up imaging at three and six months. He subsequently underwent angiography and transcatheter embolization of a right thyrocervical trunk bronchial collateral. Examination of potential anomalous or collateral thoracic pathways is mandatory when considering treatment of a Type II endoleak following endovascular TAA repair.

Endovascular repair of an aortopulmonary fistula via the axillary artery.

A 62-year-old man presented with several months of progressive hemoptysis. He has a history of aortobifemoral bypass and thoracofemoral bypass grafts, which were both removed due to infection. Evaluation with multiple imaging modalities revealed a descending thoracic aortic pseudoaneurysm around the retained Dacrontrade mark graft with bronchiectatic changes and consolidation of the adjacent left lower lobe.

Timing of pedal bypass failure and its impact on the need for amputation.

Although the utility of dorsalis pedis (DP) bypass for limb ischemia has been well established, the fate of limbs with a failed bypass to the DP artery remains unclear. Data of all patients undergoing DP bypass grafting within a 12-year period from two university hospitals' vascular registries were retrospectively reviewed. Outcomes of early (<30 days) and delayed graft failure (>30 days) were examined.

A decade of experience with dorsalis pedis artery bypass: analysis of outcome in more than 1000 cases.

Objective: The purpose of this study was to review our experience over the last decade with the dorsalis pedis bypass for ischemic limb salvage in patients with diabetes mellitus.

Methods: The study was a retrospective analysis of a computerized vascular registry and chart review. From January 10, 1990 to January 11, 2000, 1032 bypasses to the dorsalis pedis artery were performed in 865 patients (27.

A comparison of antegrade and retrograde mesenteric bypass.

Mesenteric artery bypass originating from the supraceliac aorta (antegrade bypass) has been the standard orientation of visceral artery bypass grafts. Retrograde bypass, in which the bypass originates from the iliac arteries, has not been as widely accepted. The purpose of our study was to compare the results of these two types of bypass in a similar population.