RESUMEN
BACKGROUND: Recent research shows that placement of an intraluminal shunt during a carotid endarterectomy (CEA) can be associated with postoperative complications. Therefore, we compared CEA operations with or without shunting to further analyze their clinical outcomes. METHODS: From the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, 13,736 cases between 2016 and 2019 were analyzed to compare adult symptomatic and asymptomatic carotid stenosis patients who underwent a CEA operation, with or without shunt placement. RESULTS: Rates of stroke with a neurological deficit (p = 0.012), myocardial infarction (p = 0.021), and urinary tract infection (p = 0.030) were higher among symptomatic patients with shunting. Multivariate logistic regression revealed that risk of CNI was higher among both symptomatic (93.63%, p < 0.001) and asymptomatic (69.58%, p = 0.001) patients with shunting, irrespective of confounding variables. CONCLUSION: Shunting was found to be associated with higher rates of postoperative complications in both symptomatic and asymptomatic patient populations.
Asunto(s)
Estenosis Carotídea , Endarterectomía Carotidea , Accidente Cerebrovascular , Adulto , Humanos , Endarterectomía Carotidea/efectos adversos , Resultado del Tratamiento , Estenosis Carotídea/cirugía , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/complicaciones , Complicaciones Posoperatorias/epidemiología , Factores de Riesgo , Estudios Retrospectivos , Medición de RiesgoRESUMEN
Autogenous arteriovenous fistulas (AVFs) are the preferred access for hemodialysis. AVF occasionally develop venous aneurysms, and we report a modified staple aneurysmorrhaphy technique for treatment. Briefly, the lateral wall of the venous aneurysm is dissected and a longitudinal staple resection performed. Adjunct procedures include inflow banding and outflow venous angioplasty with possible stenting. In this initial experience, 20 aneurysms were resected in 17 patients. The average AVF age at time of repair was 5.8 years. Sixteen of 17 AVF remained patent, and there were no recurrences or mortalities. One patient had a loss of thrill intraoperatively after stapling and was successfully treated with cephalic vein embolectomy. All AVF were cannulated for dialysis immediately following the procedure. The average follow-up period was 12.5 months. Given the benefits of uninterrupted fistula use and avoidance of temporary catheter placement, this technique is a promising therapy for arteriovenous fistula related venous aneurysms.
Asunto(s)
Aneurisma/cirugía , Derivación Arteriovenosa Quirúrgica/efectos adversos , Diálisis Renal , Procedimientos Quirúrgicos Vasculares , Venas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma/etiología , Aneurisma/fisiopatología , Angioplastia/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Flujo Sanguíneo Regional , Estudios Retrospectivos , Stents , Grapado Quirúrgico , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Procedimientos Quirúrgicos Vasculares/efectos adversos , Venas/fisiopatologíaRESUMEN
The purpose of this study was to report the success rate of treating pseudoaneurysm using ultrasound-guided thrombin injection at a community hospital. Over 16-month period, 42 patients with femoral artery pseudoaneurysms were treated using ultrasound-guided thrombin injection. Our results showed that ultrasound-guided thrombin injection has a high success rate, and can be safely performed at a community hospital.