Administration of platelets to ruptured abdominal aortic aneurysm patients before open surgery: a prospective, single-blinded, randomised study.

BACKGROUND: In patients undergoing open surgery for a ruptured abdominal aortic aneurysm (rAAA), survivors demonstrate a high platelet count, and proactive administration of platelets (and fresh frozen plasma) appears to influence mortality. OBJECTIVES: This trial investigated the effect of platelets administered before transport to surgery. METHODS: In a prospective study design, patients were randomised to receive platelets (intervention; n = 61) or no platelets (control; n = 61) before transport to vascular surgery from 11 local hospitals. The study was terminated when one of the vascular surgical centres implemented endovascular repair for rAAA patients. RESULTS: Thirty days after surgery, mortality was 36% for patients with intervention vs 31% for controls (P = 0·32). Post-operative thrombotic events (14 vs 15; P = 0·69), renal failure (11 vs 10; P = 0·15) and pulmonary insufficiency (34 vs 39; P = 0·15) were similar in the two groups of patients. No adverse reactions to platelet administration were observed. In addition, length of stay in the intensive care unit was unaffected by intervention. CONCLUSIONS: For patients planned for open repair of a rAAA, we observed no significant effect of early administration of platelets with regard to post-operative complications and stay in the ICU or in hospital and also no significant effect on mortality.

Percutaneous transluminal angioplasty in selected patients with severe carotid artery stenoses: the results of a consecutive series of 24 patients.

OBJECTIVES: To assess clinically and with duplex scanning the results of percutaneous transluminal angioplasty in a subgroup of patients with carotid artery stenosis. DESIGN: A retrospective study. MATERIALS: Twenty-four patients with focal hemispheric neurological symptoms from a concentric, smooth carotid stenosis more than 70% treated with balloon dilatation. Control investigations were performed with duplex scanning. RESULTS: Angiography after PTA revealed no residual stenosis in 15 patients (62%), a stenosis of less than 50 was seen in seven patients (30%) and PTA was ineffective in two patients (8%). Three patients (13%) had transient ischaemic attacks during the procedure but none had strokes. One patient experienced short lasting paraesthesia of the arm a few hours after the PTA procedure. After a follow-up of a mean of 11 months (1-38) no recurrent symptoms had occurred. Clinical success was thus achieved in 22 of 24 patients (92%). At duplex scanning, 16 (66%) patients had no stenosis, six patients (30%) had a stenosis of 70%, one patient (4%) a stenosis of 80%, and one patient had an occluded carotid artery. CONCLUSION: Our results indicate that PTA in a selected group of patients with carotid artery stenosis is safe and the interim, long-term results are promising. The procedure must be evaluated in a randomised prospective study against surgical treatment.