External Iliac Occlusion Does Not Preclude Endovascular Management of Aortoiliac Disease-Technique and Evolution of Therapy.

Background: Controversy remains over how to best manage chronic total occlusions of the aortoiliac (AI) system. Uncovered stents are the traditional choice but offer less durability in theory with the risk of stent ingrowth. External iliac artery (EIA) occlusions are challenging due to access difficulty.

Endovascular Management of a Large Persistent Sciatic Artery Aneurysm.

The persistent sciatic artery (PSA) is a remnant of the fetal circulatory system that is preserved in less than 0.1% of the population. Up to 60% of patients with this vascular anomaly will go on to development of a PSA aneurysm (PSAA), which can produce a variety of symptoms including neuropathy, claudication, and acute limb-threatening ischemia.

Dialysis Access Hemorrhage: Access Rescue from a Surgical Emergency.

Background: Hemorrhage from a dialysis access can be a life-threatening condition. This study details our experience using access rescue strategies, including in situ graft replacement, primary repair, or conversion to an autogenous fistula, coupled with treatment of central vein occlusion to maintain access usage in patients presenting with conduit hemorrhage.

Methods: During a 3-year period (2012-2014), 26 patients (14 women, 12 men) on chronic hemodialysis were treated for access conduit bleeding (n = 18) or life-threatening hemorrhage (n = 8), located in the upper extremity (n = 23) or thigh (n = 3).

Renal Arteriovenous Malformations: A Rare Vascular Cause of Back Pain.

Background: Renal arteriovenous malformation (AVM) is a very rare phenomenon (fewer than 200 cases in the literature), most commonly (75%) presenting with hematuria in young women. Renal AVMs may be cirsoid (multibranched) or cavernous, with cirsoid morphology predominating 3:1. The historical treatment is partial nephrectomy.

Intervention after endovascular aneurysm repair: Endosalvage techniques including perigraft arterial sac embolization and endograft relining.

Endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysm (AAA). However, persistent AAA sac endoleak following EVAR can result in sac diameter increase requiring re-intervention in up to one-third of cases and even result in aneurysm rupture. In this case review, we summarize and detail endovascular re-interventions for each type of endoleak.

Vascular surgical site infection: risk factors and preventive measures.

Surgical site infection (SSI) after arterial intervention is a common nosocomial vascular complication and an important cause of postoperative morbidity. Its prevention requires the vascular surgeon and the health care team to be cognizant of its epidemiology and patient-specific risk factors to apply effective measures to reduce the incidence. The majority of vascular SSIs are caused by Gram-positive bacteria with methicillin-resistant Staphylococcus aureus (MRSA) now a prevalent pathogen that is involved in more than one-third of cases.

A multiregional registry experience using an electronic medical record to optimize data capture for longitudinal outcomes in endovascular abdominal aortic aneurysm repair.

Objective: Registries have been proven useful to assess clinical outcomes, but data entry and personnel expenses are challenging. We developed a registry to track patients undergoing endovascular aortic aneurysm repair (EVAR) in an integrated health care system, leveraging an electronic medical record (EMR) to evaluate clinical practices, device performance, surgical complications, and medium-term outcomes. This study describes the registry design, data collection, outcomes validation, and ongoing surveillance, highlighting the unique integration with the EMR.

Concomitant cholecystectomy should be routinely performed with laparoscopic Roux-en-Y gastric bypass.

Introduction: As the popularity of a laparoscopic Roux-en-Y Gastric Bypass (RYGB) surpassed that of an open approach, practice of concomitant cholecystectomy declined. Low rates of gallbladder disease following RYGB and high complication rates of concomitant cholecystectomy have been published, but these population-based studies have lacked long-term outcomes and survival data.

Study Design: The California Office of Statewide Health Planning and Development longitudinal database was queried for patients who underwent RYGB with or without cholecystectomy between 1995 and 2009.

Cholecystostomy offers no survival benefit in patients with acute acalculous cholecystitis and severe sepsis and shock.

Background: Acute acalculous cholecystitis is often managed with cholecystectomy or cholecystostomy, but data guiding surgical practice are lacking.

Materials And Methods: Longitudinal analysis of the California Office of Statewide Health Planning and Development Patient Discharge Data was performed from 1995-2009. Patients with acute acalculous cholecystitis were identified by International Classification of Diseases 9 code.

Long-term outcomes of patients with nonsurgically managed uncomplicated appendicitis.

Background: Emerging literature has supported the safety of nonoperative management of uncomplicated appendicitis.

Study Design: Patients with emergent, uncomplicated appendicitis were identified by appropriate ICD-9 diagnosis codes in the California Office of Statewide Health Planning and Development database from 1997 to 2008. Rates of treatment failure, recurrence, and perforation after nonsurgical management were calculated.

Mortality after ground-level fall in the elderly patient taking oral anticoagulation for atrial fibrillation/flutter: a long-term analysis of risk versus benefit.

Background: Elderly patients with atrial fibrillation or flutter who experience ground-level falls are at risk for lethal head injuries. Patients on oral anticoagulation (OAC) for thromboprophylaxis may be at higher risk for these head injuries. Trauma surgeons treating these patients face a difficult choice: (1) continue OAC to minimize stroke risk while increasing the risk of a lethal head injury or (2) discontinue OAC to avoid intracranial hemorrhage while increasing the risk of stroke.

TAMIS-assisted laparoscopic low anterior resection with total mesorectal excision in a cadaveric series.

Background: To demonstrate the feasibility of an innovative technique for the surgical management of rectal cancer, we performed transanal minimally invasive surgery assisted low anterior resection with total mesorectal excision (TAMIS-assisted LAR with TME) in a cadaver model. Transanal LAR via natural orifice transluminal endoscopic surgery has been reported in cadaveric series using rigid transanal platforms. This procedure has not been described using a combination of a single incision laparoscopy and TAMIS transanal endoscopic platform.

Mortality for intra-abdominal infection is associated with intrinsic risk factors rather than the source of infection.

Background: Intra-abdominal infections (IAIs) are an important cause of mortality and morbidity. Nosocomial IAIs (NIAIs) have been associated with higher mortality than community-acquired IAIs (CIAIs). We hypothesized that intrinsic risk factors were a better predictor of mortality than the type of infection.

Peritonitis - the Western experience.

Peritonitis is a common surgical emergency. This manuscript will provide an overview of recent developments in the management of peritonitis in the Western world. Emphasis is placed on the emergence of new treatments and their impact of outcomes.