Fewer Cardiopulmonary Complications and Shorter Length of Stay in Anterolateral Thoracolumbar Spine Exposures Using a Small-Incision Specialized Retractor System.

One of the challenges of spine surgery is the need for adequate exposure of the anterolateral spinal column. Improved retractor systems with integrated lighting minimize the need for large thoracotomy, flank, or abdominal incisions. In 2013, we began using the NuVasive MaXcess system via a minimal-access lateral incision for thoracic and thoracolumbar spine exposures.

Asymptomatic patients with unsuccessful percutaneous inferior vena cava filter retrieval rarely develop complications despite strut penetrations through the caval wall.

Objective: We established a program for retrieval of inferior vena cava (IVC) filters within our hospital system. When percutaneous retrieval fails, we only recommend open surgical removal for symptoms and other complications. We examined our outcomes with conservative management of unsuccessful percutaneous retrieval and open surgical removal for symptomatic/complicated IVC filters.

Risk of Mortality After Resolution of Spinal Malperfusion in Acute Dissection.

Background: Spinal cord ischemia (SCI) may develop in patients presenting with acute aortic dissection. We sought to determine how SCI and its recovery affect outcomes.

Methods: We reviewed patients with SCI in acute type A aortic dissection (ATAAD) and acute type B aortic dissection (ATBAD) from September 1999 to May 2014.

New type A dissection after acute type B aortic dissection.

Objective: Aortic dissection is a dynamic process that can progress both proximal and distal to the initial entry tear. We sought to determine associations for development of proximal progression or new type A aortic dissection (NTAD) after acute type B dissection (ATBD) and its effect on survival of the patient.

Methods: We reviewed all cases of acute aortic dissection that we managed from 1999 to 2014.

Management strategies in acute type B aortic intramural hematoma.

Purpose Of Review: Intramural hematoma (IMH) is one of the acute aortic syndromes. IMH was originally noted as an 'aortic dissection without intimal tear.' It had been speculated that IMHs were caused by ruptured vasa vasorum in the aortic media and distinguished from classical aortic dissections.

Indications and Outcomes of Open Inferior Vena Cava Filter Removal.

Background: Despite recommendations for retrieval of inferior vena cava (IVC) filters, most are not removed in a timely manner. Longer IVC filter dwell times are associated with caval wall perforation and tilting that make percutaneous retrieval more difficult. Open IVC filter removal is generally reserved for patients with symptoms referable to the filter, such as chronic back and abdominal pain.

Patterns in the Management of Acute Limb Ischemia: A VESS Survey.

Background: Treatment strategies for acute limb ischemia (ALI) are abundant with few established guidelines. We sought to determine nationwide ALI treatment patterns in the modern era.

Methods: Anonymous electronic surveys examining the management of ALI involving native vessel and bypass occlusion were sent to all members of the Vascular and Endovascular Surgery Society (n = 738).

Need for Limb Revascularization in Patients with Acute Aortic Dissection is Associated with Mesenteric Ischemia.

Background: Acute aortic dissection (AAD) can cause limb ischemia due to branch vessel occlusion. A minority of patients have persistent ischemia after central aortic repair and require peripheral arterial revascularization. We investigated whether the need for limb revascularization is associated with adverse outcomes.

Injury grade is a predictor of aortic-related death among patients with blunt thoracic aortic injury.

Objective: The current Society for Vascular Surgery Clinical Practice Guidelines suggest urgent (<24 hours) thoracic endovascular aortic repair for grade (G) II to G IV blunt thoracic aortic injuries (BTAIs). The purpose of this study was to determine whether some patients may require more emergency treatment.

Methods: We reviewed imaging variables of prospectively collected BTAI patients between 1999 and 2014.

Outcome comparison between open and endovascular management of axillosubclavian arterial injuries.

Background: Endovascular repair (ER) of axillosubclavian arterial injuries is a minimally invasive alternative to open repair (OR). The purpose of this study was to compare the outcomes of ER vs OR.

Methods: A retrospective study was performed of patients who sustained axillosubclavian arterial injuries admitted to two high-volume academic trauma centers between 2003 and 2013.

Determinants of Operative Mortality in Patients With Ruptured Acute Type A Aortic Dissection.

Background: Acute type A aortic dissection (ATAAD) is a surgical emergency associated with high mortality and morbidity. We analyzed our 15-year experience in the management of ruptured ATAAD (rATAAD) and non-rATAAD to determine the predictors of early and late mortality.

Methods: We reviewed all cases with ATAAD between 1999 and 2014.

Outcomes of Patients With Acute Type B (DeBakey III) Aortic Dissection: A 13-Year, Single-Center Experience.

Background: Aortic dissection remains the most common aortic catastrophe. In the endovascular era, the management of acute type B aortic dissection (ATBAD) is undergoing dramatic changes. The aim of this study is to evaluate the long-term outcomes of patients with ATBAD who were treated at our center over a 13-year period.

Is Total Arch Replacement Associated With Worse Outcomes During Repair of Acute Type A Aortic Dissection?

Background: As acute type A aortic dissection (ATAAD) remains a challenge, the extent of resection of the transverse arch remains debated during operative repair. The purpose of this study was to compare the outcomes of total arch repair versus ascending/proximal arch repair for ATAAD.

Methods: We retrospectively reviewed our aortic database of ATAAD between October 1999 and December 2014.

The predictive value of multidetector CTA on outcomes in patients with below-the-knee vascular injury.

Background: Multidetector computed tomographic angiography (MDCTA) has become the gold standard for the early assessment of lower extremity vascular injury. The objective of this study was to evaluate the predictive value of MDCTA documented vessel run-off to the foot on limb salvage rates after lower extremity vascular injury.

Methods: All trauma patients undergoing lower extremity MDCTA for suspected vascular injury assessed at 2 high-volume Level I trauma centers between January 2009 and December 2012.

Axillary artery thrombosis in a baseball pitcher.

Isolated nonatherosclerotic axillary artery disease is a rare condition. External axillary artery compression can result in occlusion or aneurysm formation and subsequent upper extremity ischemia or distal thromboembolism. Chronic compression from use of crutches and repetitive stretching/compression of the axillary artery secondary to overhead motion during high-performance athletic activities are often implicated as the cause.

Contemporary management and outcomes of blunt thoracic aortic injury: a multicenter retrospective study.

Background: Blunt thoracic aortic injuries (BTAIs) are composed of a spectrum of lesions ranging from intimal tear to rupture, yet optimal management and ultimate outcome have not been clearly established.

Methods: This is a retrospective multicenter study of BTAIs from January 2008 to December 2013. Demographics, diagnosis, treatment, and in-hospital outcomes were analyzed.

Reprint of: Early and late outcomes of acute type A aortic dissection with intramural hematoma.

Introduction: Controversy remains regarding management of acute type A dissection with intramural hematoma (IMH). Our purpose was to analyze our experience and report outcomes after repair of acute type A aortic dissection with IMH.

Methods: We analyzed all patients from a single center who underwent open repair for acute type A aortic dissection with IMH.

Early and late outcomes of acute type A aortic dissection with intramural hematoma.

Introduction: Controversy remains regarding management of acute type A dissection with intramural hematoma (IMH). Our purpose was to analyze our experience and report outcomes after repair of acute type A aortic dissection with IMH.

Methods: We analyzed all patients from a single center who underwent open repair for acute type A aortic dissection with IMH.

Patient height as a risk factor for poor outcome in acute type B aortic dissection.

Background: Height has been shown in epidemiological studies to have mixed associations with long-term mortality. Shorter stature is related to higher all-cause and coronary disease mortality, and taller stature is related to higher cancer and aortic aneurysm mortality. We evaluated height as a predictor of acute aortic dissection complexity and long-term mortality in a cohort of patients with acute type B aortic dissection.

Complicated type B aortic dissection causing ischemia in the celiac and inferior mesenteric artery distribution despite patent superior mesenteric artery bypass.

Mortality rates associated with acute type B aortic dissection (ABAD) complicated by malperfusion remains significant. Optimal management of patients with ABAD is still debatable. We present a case report of a 50-year-old man who was admitted due to ABAD.

Open repair of adult aortic coarctation mostly by a resection and graft replacement technique.

Background: We report on our experience with treatment of adults requiring de novo or redo open aortic coarctation repair mostly by a resection and interposition graft technique.

Methods: We retrospectively reviewed all patients older than 16 years requiring open repair of aortic coarctation. Indications for repair, operative details, and outcomes were analyzed.

Technical and financial feasibility of an inferior vena cava filter retrieval program at a level one trauma center.

Background: Considering new guidelines for retrievable inferior vena cava filters (IVCFs), we examine our initial experience after establishing a comprehensive filter removal program in our level 1 trauma center. We evaluated the technical and financial feasibility of this program and barriers to IVCF retrieval, including insurance status and costs, in trauma patients.

Methods: Trauma patients receiving IVCFs from May 2011 to 2013 were consented and prospectively enrolled in the study program.

In vitro efficacy of antibiotic beads in treating abdominal vascular graft infections.

Objective: Abdominal aortic vascular graft infection often involves several different organisms. Antibiotic polymethyl methacrylate (PMMA) beads may be effective in controlling infection after débridement, but bacterial species identification and antibiotic susceptibility are often not available at the time of operation, generating a need for a broad-spectrum drug combination for empirical use. We sought to determine an effective antibiotic in PMMA beads for use in abdominal vascular graft infection.

Pneumomediastinum: etiology and a guide to diagnosis and treatment.

Background: Pneumomediastinum may be associated with mediastinal organ injury. The aim of this study was to identify predictive factors of mediastinal organ injury in patients with pneumomediastinum to guide diagnosis and treatment.

Methods: A retrospective review was conducted including patients aged ≥18 years with Current Procedural Terminology code 518.

Reinfection after resection and revascularization of infected infrarenal abdominal aortic grafts.

Objective: Despite advances in perioperative care, long-term and amputation-free survival rates are poor after resection of infected abdominal aortic grafts. We reviewed our cases to determine the rate of reinfection and risk factors for mortality and limb loss.

Methods: We reviewed cases with infrarenal aortic graft infection from 1999 to 2013.