Vascular access surgery can be safely performed in an ambulatory setting.

INTRODUCTION:: Ambulatory surgery is associated with lower costs, but there is lack of evidence of the safety for ambulatory vascular access surgery. The objective of this study is to substantiate the safety and effectiveness of performing vascular access surgery in an ambulatory setting. METHODS:: A review of our prospectively maintained database including all vascular access open surgeries (creations and repairs) performed by our Vascular Access Unit between 2013 and 2017 was compiled. Patient comorbidities, surgery details, hospital admission conditions, and 1-week and 1-month follow-up patency and complications (death, infection, bleeding, and readmission/reintervention) were scrutinized. RESULTS:: In the last 5 years, 1414 vascular access procedures were performed (67.8% access creations, 32.2% previous access repairs) in 1012 patients. Most surgeries were performed under local anesthesia (59.2%) or axillary plexus block (38.4%) and mainly in an ambulatory setting, without overnight hospital stays (90.9%). During the first postoperative week follow-up, 9 cases (0.6%) needed readmission or reintervention; significant infection materialized in 11 (0.8%) and 10 cases (0.7%) showed noteworthy hematoma or bleeding, only three (0.2%) requiring reintervention. The primary composite endpoint of 24-h death and 1 week readmission, reintervention, infection, or bleeding was 1.9% (27 cases); 1-month access failure was 6.2%. After univariate analysis, ambulatory settings were not related to higher rates of complications or readmissions. CONCLUSION:: Arteriovenous access surgery can be safely performed in an ambulatory setting, in spite of complex cases, comorbidities, or the increasing implementation of axillary plexus blocks. Surgical results and patency are good, and complications necessitating readmission remain very low.

Total endovascular repair of aberrant right subclavian artery aneurysm using the periscope technique: a case report.

INTRODUCTION: Aneurysmal degeneration of aberrant right subclavian artery (ARSA) carries a relevant risk of rupture. Timely elective treatment is mandatory. Therapeutic options include open surgery repair or hybrid surgical and endovascular repair. Few reports of total endovascular approach repair have been reported. PRESENTATION OF THE CASE: We report the first case of total endovascular repair of an aneurysmal ARSA using a thoracic aortic endograft with a "periscope" covered stent into the ARSA itself. DISCUSSION: The total endovascular approach was considered for patient's age and her poor compliance to the idea of a surgical revascularization of the ARSA, which has to be preserved since the LSA was diseased. The urgent situation did not allow for the use of a custom-made graft, so the idea of a "periscope" covered graft both to preserve the flow of the ARSA and to exclude the aneurysmal lesion seemed to be the best choice. CONCLUSION: The "periscope" technique allowed the urgent treatment of aneurysmal ARSA with good clinical results.