Contemporary Review to Reduce Groin Surgical Site Infections in Vascular Surgery.

Surgical site infection (SSIs) in lower extremity vascular procedures is a major contributor to patient morbidity and mortality. Despite previous advancements in preoperative and postoperative care, the surgical infection rate in vascular surgery remains high, particularly when groin incisions are involved. However, successfully targeting modifiable risk factors reduces the surgical site infection incidence in vascular surgery patients.

Open bilateral common femoral and popliteal vein aneurysm repair.

Although venous aneurysms are rare, typically asymptomatic, and most commonly found incidentally on imaging studies, patients with this pathology can develop pulmonary emboli owing to these aneurysms acting as a nidus for thrombus formation. There is no clear consensus regarding conservative management with anticoagulation vs operative intervention as the best treatment of deep venous aneurysms. We report the clinical course and surgical treatment of a patient presenting with both bilateral common femoral vein and bilateral popliteal venous aneurysms who had a known history of prior symptomatic pulmonary emboli.

Evaluating a Novel Telescoping Catheter Set for Treatment of Central Venous Occlusions.

Background: Central venous occlusive disease (CVOD) is a prevalent problem in patients with end-stage renal disease (ESRD) and can lead to access malfunction or ligation for symptomatic relief. The purpose of this study is to evaluate the efficacy of the TriForce® Peripheral Crossing Set (Cook Medical), a novel reinforced telescoping catheter set designed to provide additional support for crossing difficult central venous occlusions.

Methods: This is a single-center retrospective study from a quaternary referral center.

Balloon-Assisted Ultrasound-Guided Percutaneous Thrombin Injection of Iatrogenic Femoral Artery Pseudoaneurysms: A Case Report and Description of the Technique.

Ultrasound-guided thrombin injection (UGTI) has emerged as the first-line treatment for moderately sized or persistent pseudoaneurysms (PSAs). Although rare, the most feared complication of UGTI is arterial thrombosis or embolism during the off-label injection of thrombin causing acute limb ischemia requiring emergent surgical intervention. Higher thrombin volume, rapidity of injection, and wide or short-neck PSAs are all thought to increase the risk of arterial thrombosis or embolism during this procedure.

Early cannulation of the Hemodialysis Reliable Outflow graft.

Objective: In complex dialysis patients, central venous stenosis may preclude additional upper extremity access options. The Hemodialysis Reliable Outflow graft (Merit Medical Systems, Inc.) can bypass this stenosis providing patients with an additional upper extremity long-term access option.

Predictors of poor outcome in infrainguinal bypass for trauma.

Background: Trauma remains a leading cause of morbidity and mortality worldwide. Vascular injuries are present in approximately 1% to 2% of trauma patients, with the majority of injuries occurring to the extremities. Trauma patients with vascular injuries have been shown to have increased morbidity and mortality as well as the need for increased resources compared with those without vascular injuries.

Gross and histological features of excised portions of posterior mitral leaflet in patients having operative repair of mitral valve prolapse and comments on the concept of missing (= ruptured) chordae tendineae.

Objectives: The aim of the study is to describe gross and histological features of operatively excised portions of mitral valves in patients with mitral valve prolapse (MVP).

Background: Although numerous articles on MVP (myxomatous or myxoid degeneration, billowing or floppy mitral valve) have appeared, 2 virtually constant histological features have been underemphasized or overlooked: 1) the presence of superimposed fibrous tissue on both surfaces of the leaflets and surrounding many chordae tendineae; and 2) the absence of many chordae tendineae on the ventricular surfaces of the leaflets as the result of their being hidden (i.e.

Anomalous cord from the raphe of a congenitally bicuspid aortic valve to the aortic wall producing either acute or chronic aortic regurgitation.

Objectives: This report calls attention to an unappreciated cause of both acute and chronic aortic regurgitation (AR).

Background: Although stenosis develops in most patients with a congenitally bicuspid aortic valve (BAV), in others with this anomaly, pure AR (no element of stenosis) develops, some in the absence of infection or other clear etiology.

Methods: We describe 5 men who underwent aortic valve replacement for pure AR associated with a BAV containing an anomalous cord attaching the raphe of the conjoined cusp near its free margin to the wall of the ascending aorta cephalad to the sinotubular junction.

Natural history of unoperated aortic stenosis during a 50-year period of cardiac valve replacement.

Although a number of publications have described the natural history of patients with aortic stenosis (AS), the definition of "natural history" varies widely. Those describing a large number of patients with AS without operative therapy with necropsy findings are rare. Two hundred sixty patients >15 years of age with AS were studied at necropsy over a 50-year period by the same investigator.

Natural history of adults with congenitally malformed aortic valves (unicuspid or bicuspid).

Appreciation of the frequency of the congenitally malformed aortic valve has come about during the last 50 years, a period during which aortic valve replacement became a predictably successful operation. Study of patients at necropsy with either a congenitally unicuspid (1 true commissure) or bicuspid (2 true commissures) valve in whom no aortic valve operation has been performed has not been conducted during these 50 years, to our knowledge. We studied 218 patients at necropsy with congenitally malformed aortic valves: 28 (13%) had a unicuspid valve and 190 (87%), a bicuspid valve.

Acute aortic dissection with tear in ascending aorta not diagnosed until necropsy or operation (for another condition) and comparison to similar cases receiving proper operative therapy.

Acute aortic dissection (AD) with a tear in ascending aorta (AA) is recognized to masquerade occasionally as another condition, and therefore the proper diagnosis is never made or made too late. During a recent 3-year period (2009 to 2011) at Baylor University Medical Center at Dallas, 30 patients with acute AD with tear in AA were diagnosed: 23 (77%) were diagnosed clinically and underwent proper urgent operative therapy; the remaining 7 (23%) with AD with tear in AA were not diagnosed until operation (for another condition) or necropsy or retrospectively by review of antemortem computed tomographic scan after death. The number of patients with AD from tear in AA whose cardiac condition was not diagnosed clinically and who died in the hospital but did not have an autopsy is unclear.

Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis.

Reports differ regarding the effect of concomitant coronary artery bypass grafting (CABG) in patients who undergo aortic valve replacement (AVR) for aortic stenosis (AS), and no reports have described the effect of aortic valve structure in patients who undergo AVR for AS. A total of 871 patients aged 24 to 94 years (mean 70) whose AVR for AS was their first cardiac operation, with or without first concomitant CABG, were included. Patients who underwent mitral valve procedures were excluded.

Aortic medial elastic fiber loss in acute ascending aortic dissection.

The cause of acute aortic dissection continues to be debated. One school of thought suggests that underlying aortic medial cystic necrosis is the common denominator. The purpose of the present study was to determine if there was loss and, if so, how much loss of medial elastic fibers in the ascending aorta in patients with acute aortic dissection with the entrance tear in the ascending aorta.

Presence of a congenitally bicuspid aortic valve among patients having combined mitral and aortic valve replacement.

Although bicuspid aortic valve occurs in an estimated 1% of adults and mitral valve prolapse in an estimated 5% of adults, occurrence of the 2 in the same patient is infrequent. During examination of operatively excised aortic and mitral valves because of dysfunction (stenosis and/or regurgitation), we encountered 16 patients who had congenitally bicuspid aortic valves associated with various types of dysfunctioning mitral valves. Eleven of the 16 patients had aortic stenosis (AS): 5 of them also had mitral stenosis, of rheumatic origin in 4 and secondary to mitral annular calcium in 1; the other 6 with aortic stenosis had pure mitral regurgitation (MR) secondary to mitral valve prolapse in 3, to ischemia in 2, and to unclear origin in 1.

Effect of body mass index on survival in patients having aortic valve replacement for aortic stenosis with or without concomitant coronary artery bypass grafting.

The purpose of this report is to describe the effect of body mass index (BMI) on 30-day and late outcome in patients having aortic valve replacement (AVR) for aortic stenosis (AS) with or without concomitant coronary artery bypass grafting. From January 2002 through June 2010 (8.5 years), 1,040 operatively excised stenotic aortic valves were submitted to the cardiovascular laboratory at Baylor University Medical Center at Dallas.

Comparison of the structure of the aortic valve and ascending aorta in adults having aortic valve replacement for aortic stenosis versus for pure aortic regurgitation and resection of the ascending aorta for aneurysm.

Background: There is debate concerning whether an aneurysmal ascending aorta should be replaced when associated with a dysfunctioning aortic valve that is to be replaced. To examine this issue, we divided the patients by type of aortic valve dysfunction-either aortic stenosis (AS) or pure aortic regurgitation (AR)-something not previously undertaken.

Methods And Results: Of 122 patients with ascending aortic aneurysm (unassociated with aortitis or acute dissection), the aortic valve was congenitally malformed (unicuspid or bicuspid) in 58 (98%) of the 59 AS patients, and in 38 (60%) of the 63 pure AR patients.

Natural history of syphilitic aortitis.

No large studies of cardiovascular syphilis at necropsy have been reported since 1964. We examined at necropsy 90 patients who had characteristic morphologic findings of syphilitic aortitis. None had ever undergone cardiovascular surgery.

Comparison of interpretations of valve structure between cardiac surgeon and cardiac pathologist among adults having isolated aortic valve replacement for aortic valve stenosis (+/- aortic regurgitation).

Most studies concerning aortic valve structure in patients having aortic valve replacement have utilized the valve structure (unicuspid, bicuspid, tricuspid) as that called by the cardiac surgeon performing the operation. We determined valve structure of 744 operatively excised stenotic aortic valves submitted to the surgical pathology laboratory of a single hospital over a 6-year period and then compared valve structure determined by a single cardiac pathologist (WCR) with that recorded in the operative report dictated by the operating surgeon. Compared with that determined from examination of the operatively excised valve by the cardiac pathologist, valve structure determined at operation was congruous in 59% (440 of 744 patients), incongruous in 20% (152 of 744), of uncertain structure in 1% (9 of 744), and not mentioned in 19% (143 of 744).

Cardiac transplantation for cardiac sarcoidosis with initial diagnosis by examination of the left ventricular apical "core" excised for insertion of a left ventricular assist device for severe chronic heart failure.

Three quinquagenarians who underwent insertion of a left ventricular assist device (LVAD) because of severe heart failure and for whom histologic examination of the left ventricular apical "core" (removed to insert the device) showed noncaseating giant cell granulomas typical of sarcoidosis are described. Later, cardiac transplantation showed widespread sarcoid granulomas in the walls of the right and left ventricles and ventricular septum in 2 patients and extensive scarring in the third patient in the absence of coronary narrowing. Previously, 11 patients who underwent cardiac transplantation because of cardiac sarcoidosis had been reported, and in 1 of these patients, diagnosis was also initially made by examination of the left ventricular core excised at the time of insertion of an LVAD.