Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 16 de 16
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Vasc Surg ; 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31611104

RESUMO

OBJECTIVE: Patients are increasingly referring to the Internet after a diagnosis of vascular disease. This study was performed to quantitatively define the accuracy and reliability of information on YouTube regarding abdominal aortic aneurysms (AAA). METHODS: A systematic search of YouTube was conducted using multiple AAA-specific keywords. The default YouTube search setting of "relevance" was used to replicate an average search attempt, and the first 50 results from each keyword search were reviewed and analyzed by two independent reviewers. Descriptive characteristics, Journal of the American Medical Association Score, modified DISCERN score, Video Power Index, and a novel scoring system for the management of AAAs, the AAA-Specific Score (AAASS), were used to record data. Inter-rater agreement was analyzed using intraclass correlation coefficient estimates and the Kruskal-Wallis test was used for intergroup comparisons. RESULTS: Fifty-one videos were included for analysis. The mean Journal of the American Medical Association Score, DISCERN, and AAASS values among videos were 1.74/4.00 (standard deviation [SD], 0.84), 2.37/5.00 (SD, 0.97), and 6.63/20.00 (SD, 3.23), respectively. Of all the included videos, 78% were educational in nature, 14% were patient testimonials, and 8% were news programs. Based on the AAASS, the majority of analyzed videos fell into the poor category (41%), followed next by the very poor (31%), moderately useful (25%), very useful (2%), and exceptional (0%) categories. Videos by nonphysicians were significantly more popular (P < .05) than vascular surgeon sources. CONCLUSIONS: Although variable in source and content, the completeness and reliability of information offered on YouTube for AAA diagnosis and treatment is poor. Patients watching YouTube for information on their AAA diagnosis are receiving an incomplete and perhaps misleading picture of available diagnostic and treatment options. Given that vascular surgeons are likely to be affected by unrealistic treatment expectations from patients accessing online materials regarding AAA, it is important to acknowledge the nature of content on these platforms.

2.
J Vasc Surg ; : 1909-1917, 2019 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-30792058

RESUMO

OBJECTIVE: The Society for Vascular Surgery's Annual Meeting acts as a means of disseminating research findings among vascular surgeons through the presentation of research abstracts. Following presentation at the meeting, research is often compiled into a full-text manuscript and submitted to a peer-reviewed journal. However, not all abstracts accepted to the Vascular Annual Meeting (VAM) eventually have a corresponding full-text publication. The objectives of this study were to establish the publication rate of abstracts presented between 2012 and 2015 to the VAM and to identify factors correlating with publication status. METHODS: Abstracts presented at the VAM were available through the Journal of Vascular Surgery. Data extracted from eligible abstracts included level of evidence according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence scheme, type of study (prognostic, therapeutic/harm, diagnostic), sample size, and status of outcome (positive, negative, or descriptive findings). Publication status of the abstracts was determined through a comprehensive literature review of PubMed (MEDLINE), Ovid (MEDLINE), and Embase. A multivariable logistic regression was conducted to determine factors correlating with publication status. RESULTS: The publication rate during the study period was 43.0% with a median time to publication of 9 months, with 412 of the 958 abstracts having a corresponding full-text publication in 48 journals with weighted mean impact factor of 3.40. Eleven journals collectively published 372 (90.3%) of the articles, with the Journal of Vascular Surgery publishing 280 (68.0%) of the manuscripts. Our logistic regression model demonstrated that factors positively affecting publication status were a positive status of outcome (odds ratio, 2.59; 95% confidence interval, 1.56-4.28) and a logarithmic increase in the sample size of the study (odds ratio, 1.35; 95% confidence interval, 1.13-1.60). In addition, studies with a corresponding full-text publication had a greater median sample size (250) compared with those without one (143; P < .001). CONCLUSIONS: From 2012 to 2015, 43.0% of VAM abstracts had a corresponding full-text publication, with greater sample size and a positive status of outcome positively correlating with likelihood of publication. Studies with negative findings made up a small proportion of conference abstracts (9.6%) and were the least likely to be published. Given the relatively small size of the specialty of vascular surgery, it may be particularly important to be mindful of publication bias. It may be worthwhile to give additional consideration to acceptance of abstracts or publication of studies with negative results that meaningfully contribute to the literature.

3.
Can J Anaesth ; 66(2): 182-192, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30535668

RESUMO

PURPOSE: Postoperative infection, particularly in cardiac surgery, results in significant morbidity, mortality, and healthcare cost. Identification of novel predictors of postoperative infection can target high-risk populations for prophylactic intervention. METHODS: Steroids in cardiac surgery (SIRS) was a multi-centre randomized-controlled trial assessing intraoperative administration of methylprednisone during cardiac surgery, which enrolled 7,507 patients across 80 centres in 18 countries. It demonstrated that administration of steroids had no effect on mortality or major morbidity after cardiac surgery. Our primary objective was to identify risk factors for postoperative surgical site infections using SIRS participants as a cohort. We excluded patients who did not undergo surgery, died intraoperatively, or died within 48 hr of the operation. Patients were assessed for development of "surgical site infection" over the first 30 days postoperatively. Using theoretical and previously identified risk factors, we used forward stepwise entry to create a binary logistic regression model. RESULTS: Follow-up at 30 days was complete for all patients; 7,406 were included in the cohort. Surgical site infection occurred in 180 (4.8%) and 184 (5.0%) of patients in the placebo and steroid arms respectively. Significant risk factors (P < 0.05 level) included: diabetes managed with insulin (adjusted odds ratio [aOR]: 1.55; 95% confidence interval [CI] 1.13 to 2.12), oral hypoglycemics (aOR 1.60; 95% CI 1.18 to 2.16), or diet (aOR 1.81; 95% CI 1.16 to 2.83), female sex (aOR 1.34; 95% CI 1.05 to 1.71), renal failure with (aOR 2.03; 95% CI 1.06 to 3.91), and without (aOR 1.50; 95% CI 1.04 to 2.14) dialysis, > 96 min cardiopulmonary bypass (CPB) time (aOR 1.84; 95% CI 1.44 to 2.35), body mass index (BMI) < 22.3 (aOR 0.44; 95% CI 0.28 to 0.71) or > 30 (aOR 1.49; 95% CI 1.17 to 1.89), peak intensive care unit blood glucose (aOR 1.02 per mmol·L-1; 95% CI 1.00 to 1.04), and coronary artery bypass grafting (CABG) operation type (aOR 2.59; 95% CI 1.87 to 3.59). CONCLUSIONS: Patients undergoing CABG, requiring longer CPB, with higher BMI, or with diabetes, are at elevated risk of surgical site infection. Strategies to mitigate this risk warrant further investigation.

4.
J Vasc Surg ; 69(1): 242-248.e1, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29503005

RESUMO

OBJECTIVE: In the treatment of an infected aorta, open repair and replacement with a rifampin-impregnated Dacron vascular graft decrease the risk of prosthetic graft infections, with several protocols available in the literature. We hypothesize that the same holds true for endovascular aneurysm repair, and after studying and optimizing rifampin solution concentration and incubation period to maximize the coating process of rifampin on Dacron endovascular stent grafts (ESGs), we propose a rapid real-time perioperative protocol. METHODS: Several prepared rifampin solutions, including a negative control solution, were used to coat multiple triplicate sets of Dacron endovascular aortic stent grafts at different but set incubation periods. Rifampin elution from the grafts was studied by spectroscopic analysis. Once an optimized solution concentration and incubation time were determined, the elution of rifampin over time from the graft and the graft's surface characteristics were studied by ultraviolet-visible spectroscopy and atomic force microscopy. RESULTS: All coated ESGs with any concentration of prepared rifampin solution, regardless of incubation time, immediately demonstrated a visible bright orange discoloration and subsequently after elution procedures returned to the original noncolored state. At the 25-minute incubation time (standard flush), there was no statistical difference in the amount of rifampin coated to the ESGs with 10-mg/mL, 30-mg/mL, and 60-mg/mL solutions (0.06 ± 0.01, 0.07 ± 0.05, and 0.044 ± 0.01, respectively; P > .05). This was also true for a 10-minute incubation time (express flush) of 10-mg/mL and 60-mg/mL rifampin solution concentrations (0.04 ± 0.007 and 0.066 ± 0.014, respectively; P = .22). The elution-over-time of coated rifampin ESG, although not statistically significant, did seem to plateau and to reach a steady state by 50 hours and was confirmed by surface characteristics using atomic force microscopy. CONCLUSIONS: Having studied two variables of rifampin coating techniques to Dacron ESGs, the authors propose a rapid real-time perioperative coating protocol by using a 10-mg/mL rifampin solution for a 10-minute incubation period. As rifampin loosely binds to Dacron ESGs by weak intermolecular forces, a rifampin-coated ESG would need to be inserted in a timely fashion to treat the diseased aorta and to deliver its antibiotic affect. A rapid perioperative coating protocol followed by immediate deployment makes our proposed technique especially useful in an urgent and unstable clinical scenario.


Assuntos
Aneurisma Infectado/cirurgia , Antibacterianos/química , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Materiais Revestidos Biocompatíveis , Procedimentos Endovasculares/instrumentação , Rifampina/química , Stents , Aneurisma Infectado/microbiologia , Antibacterianos/administração & dosagem , Aneurisma Aórtico/microbiologia , Liberação Controlada de Fármacos , Cinética , Teste de Materiais , Microscopia de Força Atômica , Polietilenotereftalatos , Desenho de Prótese , Rifampina/administração & dosagem , Espectrofotometria Ultravioleta , Propriedades de Superfície
5.
J Vasc Surg Venous Lymphat Disord ; 6(6): 779-787.e6, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30336907

RESUMO

OBJECTIVE: The objective of this study was to compare the nontumescent-based endovenous therapies with the standard tumescent-based endovenous therapies in regard to clinical effectiveness and procedural outcomes in patients with saphenofemoral incompetence and varicose veins. METHODS: The following databases were searched for studies that were randomized or quasi-randomized trials comparing nontumescent-based endovenous procedures with those requiring tumescence: Cochrane Central Register of Controlled Trials (1950-January 2017), MEDLINE (1946-January 2017), and Embase (1950-January 2017). There were no restrictions based on language or publication status. In the case of ongoing studies, the World Health Organization's International Clinical Trials Registry Platform and the online ClinicalTrials.gov registry were also searched. We also reviewed reference lists of articles relevant to our study to ensure a more complete review. Two authors independently screened and selected studies to be included. These two authors also independently assessed the risk of bias using the Cochrane risk of bias tool. Data were extracted and pooled using a random-effects model. RESULTS: A total of nine studies were found in the literature search, of which five were included in analysis. Four outcomes were reviewed. A significant difference was found between the comparator groups for mean intraprocedural pain score (effect estimate, -0.66), favoring nontumescent-based therapies. There was no difference for Venous Clinical Severity Score (effect estimate, -0.21) for clinical assessment and the Aberdeen Varicose Vein Questionnaire score (effect estimate, 0.27) for the disease-specific quality of life between the groups. The outcome of failure of truncal ablation at 30 days had no significant difference between the groups (risk ratio, 1.27), although a subgroup analysis demonstrated a trend toward improved results with the novel nontumescent-based treatments (risk ratio, 0.21) compared with the old nontumescent-based treatments (risk ratio, 8.6). CONCLUSIONS: Currently available evidence from reasonable-quality clinical trials comparing tumescent-based with non-tumescent-based endovenous therapies shows no overall difference between the groups on a number of outcomes. Mean intraprocedural pain score appears to favor nontumescent-based interventions. Newer randomized trials comparing the treatment modalities are needed to further clarify the benefits of nontumescent-based therapies, particularly with regard to long-term outcomes.


Assuntos
Anestesia Local , Embolização Terapêutica , Procedimentos Endovasculares/métodos , Veia Safena , Escleroterapia , Varizes/terapia , Insuficiência Venosa/terapia , Anestesia Local/efeitos adversos , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Escleroterapia/efeitos adversos , Resultado do Tratamento , Varizes/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem
6.
EJVES Short Rep ; 39: 44-46, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29922725

RESUMO

Introduction: Type A aortic dissection can present with malperfusion syndrome. Lower limb ischaemia may resolve with repair of the dissection; however, the long duration of repair and/or persistent ischaemia may leave tissue at risk of necrosis with potential for substantial morbidity. Report: Here, the case of a 67 year old man who presented with a Type A aortic dissection with malperfusion of the lower extremities is described. The Vascular Surgery and Cardiac Surgery divisions were consulted simultaneously. A decision was made to perform bilateral superficial femoral artery cannulation with perfusion initially via the right axillary artery prior to sternotomy, then via the cardiopulmonary bypass circuit. At completion of the arch replacement, lower extremity inflow was reassessed with formal repair of the femoral arteries. Post-operatively, the patient had complete return of motor-sensory function, despite densely ischaemic symptoms at presentation several hours previously. Discussion: Cannulation of the superficial femoral arteries serves as a means to limit limb ischaemia intra-operatively and potentially improve outcomes in the setting of Type A aortic dissection with lower extremity malperfusion.

7.
J Vasc Surg ; 67(3): 951-959, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29477206

RESUMO

OBJECTIVE: During the past decades, there has been an increasing emphasis on the use of high-quality evidence to inform clinical decision-making. The purpose of our study was to assess trends in the level of evidence (LOE) of abstracts presented at the Vascular Annual Meeting from 2012 to 2016. METHODS: All Vascular Annual Meeting abstracts for 2012 to 2016 were obtained through the Journal of Vascular Surgery. Two reviewers independently screened abstracts for eligibility. Research with a nonclinical focus was excluded from the study. Data extracted from eligible abstracts included study type (therapeutic, prognostic, diagnostic), study size, country of academic institution of primary author, presentation type, and whether the sample was recruited or from a database. Abstracts were assigned an LOE using the 2011 Oxford Centre for Evidence-Based Medicine classification scheme based on study design (eg, case series, randomized controlled trial). A χ2 test and analysis of variance test were conducted to assess nonrandom changes in LOE during the study period. RESULTS: Of the 1403 abstracts screened, 1147 were included. Inter-rater agreement was high (κ value for abstract screening was 0.93; κ value for data extraction was 0.89). Therapeutic studies were the most common study type (58%), followed by prognostic studies (37%), then diagnostic studies (5%). The majority of abstracts (75.0%) were submitted from North American institutions. Overall, 0.35% of the presentations were level I evidence, 3.1% level II, 52.8% level III, 38.0% level IV, and 5.7% level V. The average LOE per year fluctuated between 3.54 and 3.32, with a mean LOE of 3.45. The proportion of high-quality evidence (level I and level II) increased in the years 2015 and 2016, representing 78% of all level I and level II abstracts presented in the 5-year period. A χ2 test between LOE and year yielded a P value of .0084, indicating significant nonrandom change in LOE between 2012 and 2016. The majority of high LOE research was presented in poster sessions (37.5%), plenary sessions (27.5%), and international forum sessions/talks (25%) at the meeting. CONCLUSIONS: Overall, average LOE remained relatively consistent between 2012 and 2016, with most abstracts classified as level III or level IV. There was a gradual, albeit minor, increase in the proportion of level I and level II evidence in 2015 and 2016, potentially indicating the increasing commitment to producing and disseminating high-level research in vascular surgery. Furthermore, a lack of a classification tool specific to vascular surgery research occasionally presented a challenge in assigning LOE, perhaps indicating a need for such a tool in this specialty.


Assuntos
Congressos como Assunto/tendências , Medicina Baseada em Evidências/tendências , Disseminação de Informação , Projetos de Pesquisa/tendências , Sociedades Médicas/tendências , Procedimentos Cirúrgicos Vasculares/tendências , Distribuição de Qui-Quadrado , Humanos , Fatores de Tempo
8.
J Endovasc Ther ; 25(2): 257-260, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29409382

RESUMO

PURPOSE: To report unconventional use of the resuscitative endovascular balloon occlusion of the aorta (REBOA) technique to restore hemodynamic stability in a patient who was hemorrhaging from aortic injury proximal to the target zone of occlusion. CASE REPORT: A 72-year-old woman underwent urgent thoracic stent-graft repair of a ruptured 8×8-cm mycotic pseudoaneurysm. Two months later, follow-up imaging revealed that the proximal aortic stent seal zone had degenerated, so a percutaneous procedure was performed 2 months later to preemptively reinforce the segment of stented aorta. Shortly after obtaining femoral access, the patient's condition abruptly deteriorated with profound hypotension, presumably a result of an access complication. REBOA was established in the supraceliac aorta, which sustained the mean arterial pressure while the anesthesiologist resuscitated the patient. Unexpectedly, angiography showed a rupture of the descending thoracic aorta immediately proximal to the upper stent-graft. Balloon inflation distal to the rupture site was maintained while the patient's hypotension was treated. Another stent-graft was quickly placed over the area of concern, overlapping proximal to the prior grafts. Once the aortic perforation was sealed, the patient stabilized hemodynamically. Inotropic support was weaned, and the REBOA occlusion catheter was deflated. Final angiograms of the arch and thoracic aorta confirmed no extravasation; angiograms of the infrarenal aorta and iliac arteries showed no evidence of injury. CONCLUSION: This case illustrates that applying REBOA distal to the injury site in certain clinical scenarios may sufficiently increase peripheral resistance to compensate temporarily for cardiovascular collapse secondary to aortic injury.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Oclusão com Balão , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Hemodinâmica , Hemorragia Pós-Operatória/terapia , Idoso , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Hemorragia Pós-Operatória/diagnóstico por imagem , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/fisiopatologia , Reoperação , Resultado do Tratamento
9.
Ann Surg ; 268(2): 357-363, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-28486392

RESUMO

OBJECTIVE: To determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in vascular surgical patients. BACKGROUND: MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in vascular surgery patients are poorly described. METHODS: This was an international prospective cohort study of 15,102 noncardiac surgery patients 45 years or older, of whom 502 patients underwent vascular surgery. All patients had fourth-generation plasma troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a TnT of 0.03 ng/mL of higher secondary to ischemia. The objectives of the present study were to determine (i) if MINS is prognostically important in vascular surgical patients, (ii) the clinical characteristics of vascular surgery patients with and without MINS, (iii) the 30-day outcomes for vascular surgery patients with and without MINS, and (iv) the proportion of MINS that probably would have gone undetected without routine troponin monitoring. RESULTS: The incidence of MINS in the vascular surgery patients was 19.1% (95% confidence interval (CI), 15.7%-22.6%). 30-day all-cause mortality in the vascular cohort was 12.5% (95% CI 7.3%-20.6%) in patients with MINS compared with 1.5% (95% CI 0.7%-3.2%) in patients without MINS (P < 0.001). MINS was independently associated with 30-day mortality in vascular patients (odds ratio, 9.48; 95% CI, 3.46-25.96). The 30-day mortality was similar in MINS patients with (15.0%; 95% CI, 7.1-29.1) and without an ischemic feature (12.2%; 95% CI, 5.3-25.5, P = 0.76). The proportion of vascular surgery patients who suffered MINS without overt evidence of myocardial ischemia was 74.1% (95% CI, 63.6-82.4). CONCLUSIONS: Approximately 1 in 5 patients experienced MINS after vascular surgery. MINS was independently associated with 30-day mortality. The majority of patients with MINS were asymptomatic and would have gone undetected without routine postoperative troponin measurement.


Assuntos
Isquemia Miocárdica/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Troponina T/sangue , Procedimentos Cirúrgicos Vasculares , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/etiologia , Razão de Chances , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos
10.
Ann Vasc Surg ; 45: 247-252, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28689946

RESUMO

BACKGROUND: The aim of this study is to describe our institutional experience using iliac branch grafts (IBGs) in aortoiliac aneurysm repair. METHODS: From October 2009 to April 2016, 41 consecutive patients (all men), mean age 71.7 years (range 55-87), underwent IBG implantation. Abdominal aortic aneurysm with common iliac artery involvement (n = 21) or bilateral common iliac artery aneurysms (n = 20) were indications. Computed tomography was used to evaluate patency and postoperative endoleaks within 1 month of implantation and after 1 year. RESULTS: A total of 42 IBGs were deployed in 41 patients successfully. One hundred percent of grafts implanted were patent at 1 month and at annual follow-up. There was 1 mortality at 30 days, due to acute renal failure. Sixteen type II and 1 type Ib endoleaks were found, for which 3 reinterventions were performed and the remainder treated conservatively. Five patients had complications which required reintervention. CONCLUSIONS: IBG placement has excellent short-term outcomes and potential to limit buttock claudication in the treatment of abdominal aortic aneurysms involving the iliac arteries.


Assuntos
Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Aneurisma Ilíaco/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma Aórtico/tratamento farmacológico , Aneurisma Aórtico/fisiopatologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Bases de Dados Factuais , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Endoleak/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/etiologia , Claudicação Intermitente/fisiopatologia , Masculino , Pessoa de Meia-Idade , Ontário , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
BMC Health Serv Res ; 15: 13, 2015 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-25608648

RESUMO

BACKGROUND: The primary objective was to estimate the national burden of illness in Canada for diabetic foot ulcer (DFU) for 2011. Secondary objectives included estimating the national incidence and prevalence of DFU, and the 3-year average cost for DFU incident cases. METHODS: Analyses were conducted using four national databases for the period April 1, 2006 to March 31, 2011, with cases being identified by ICD-10 CA codes. Resource utilization and costs, expressed in 2011 Canadian dollars, were estimated for DFU-related hospitalizations, emergency care (ER), same day surgeries, home care, long term care, physician visits and caregiver time losses. RESULTS: In Canada in the year 2011, DFU was associated with 16,883 hospital admissions (327,140 days), 31,095 ER or clinic visits, 41,367 rehabilitation clinic visits, and 26,493 interventions, including 6,036 amputations and 5,796 surgical debridements. This acute institution care represented $320.5 M, and with an additional $125.4 M for home care and $63.1 M for long term care, the annual cost associated with DFU-related care was $547.0 M, or $21,371 annual cost per prevalent case. In 2011, the national prevalence of DFU was 25,597 cases (75.1 per 100,000 population), consisting of 16,161 men (63.1%) and 9,436 women (36.9%), and an estimated 14,449 incident cases. For an incident case of DFU, the average 3-year cumulative cost was $52,360. CONCLUSION: The annual burden for DFU cases that have at least one admission or ER/clinic visit over a 5 year period is higher than previously reported.


Assuntos
Efeitos Psicossociais da Doença , Pé Diabético/economia , Idoso , Amputação/economia , Amputação/estatística & dados numéricos , Canadá/epidemiologia , Pé Diabético/epidemiologia , Métodos Epidemiológicos , Feminino , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Classificação Internacional de Doenças , Assistência de Longa Duração/economia , Assistência de Longa Duração/estatística & dados numéricos , Masculino
12.
Ann Vasc Surg ; 28(2): 411-20, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24200134

RESUMO

INTRODUCTION: An aberrant right subclavian artery (ARSA) with or without an associated Kommerell's diverticulum (KOD) is a rare vascular anomaly. Patients with an ARSA may present with a variety of symptoms, including rupture. Options for repair include open, endovascular, and a hybrid approach, with no clear consensus on which is best because of the rarity of the anomaly. We present 2 cases that underwent hybrid repair and a systematic review of the literature. METHODS: A systematic review of the literature was performed from 2000-2012 searching for patients with ARSA with or without KOD who underwent endovascular repair. Twenty-four articles were identified, including a few case reports and small case series, for a total of 31 patients. A chart review was also performed on 2 patients at our institution who underwent a hybrid repair for symptomatic ARSA. RESULTS: We report the presenting history, management, and follow-up of 2 symptomatic patients with ARSA with associated KOD. Both patients underwent a hybrid approach for repair, with no reported complications. After postoperative imaging and clinical follow-up, both patients remained in good general condition without signs of vascular complications. Our systematic literature review identified 31 reported cases of patients with ARSA who underwent endovascular repair (10 patients without an associated KOD and 21 patients with a KOD). The patients ranged in age from 21-82 years of age (average: 56 years). Of these patients, 17 (55%) were women. The presenting symptoms varied, and some patients had multiple symptoms noted on presentation, including dysphagia, dyspnea, or asymptomatic patients. In those patients with an associated KOD, the average size of the diverticulum was 3.3 cm (range: 2.3-7 cm). A number of operative strategies were used in the reported cases, depending on the presence of absence of an associated KOD. The average reported duration of hospital stay was 5.4 days (range: 1-60 days). Seven patients had postoperative complications (22%). There were 3 mortalities reported (10%). Only 1 of these could be directly related to the surgical procedure. Reported decrease in aneurysm size was between 25-50%, although this was not reported for most patients. Four of 31 patients (13%) had an endoleak (1 type I endoleak, 2 type II endoleaks, and 1 type IV endoleak). The range of reported follow-up varied between 6 weeks and 92 months, with 9 patients having no follow-up reported. CONCLUSION: Hybrid approach to repair of an ARSA with associated KOD appears to be feasible, safe, and effective. Despite the poor quality and heterogeneity of the evidence available in the literature for this rare condition, we believe that this could be the preferred treatment option for an ARSA either with or without KOD.


Assuntos
Aneurisma/cirurgia , Aorta Torácica/cirurgia , Implante de Prótese Vascular , Anormalidades Cardiovasculares/cirurgia , Transtornos de Deglutição/cirurgia , Divertículo/cirurgia , Procedimentos Endovasculares , Artéria Subclávia/anormalidades , Malformações Vasculares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma/diagnóstico , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Anormalidades Cardiovasculares/diagnóstico , Transtornos de Deglutição/diagnóstico , Divertículo/complicações , Divertículo/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Subclávia/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico , Adulto Jovem
13.
Vasc Endovascular Surg ; 47(5): 394-6, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23632775

RESUMO

An infected aortic endograft is an uncommon event, and when it happens it can be of significant morbidity and mortality to the patient. We present here a case of a patient with an infected aortic endograft following percutaneous translumbar sac embolization for a type II endoleak leading to sac expansion. The cultured pathogen was Propionibacterium acnes, a commonly occurring skin bacterium that leads to the clinical condition "acne vulgaris." The patient underwent graft explantation and reconstruction with autogenous femoral vein. To our knowledge, there are no previously published reports of aortic graft infections with P acnes.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Infecções por Bactérias Gram-Positivas/microbiologia , Propionibacterium acnes/isolamento & purificação , Infecções Relacionadas à Prótese/microbiologia , Stents/efeitos adversos , Idoso , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/diagnóstico , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Procedimentos Endovasculares/instrumentação , Veia Femoral/transplante , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/cirurgia , Humanos , Masculino , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Reoperação , Resultado do Tratamento
14.
J Vasc Surg ; 57(6): 1676-83, 1683.e1, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23719040

RESUMO

BACKGROUND: The objective of this study is to provide an up-to-date meta-analysis on the short- and long-term mortality rates of elective repair of abdominal aortic aneurysms (AAAs) via the open and endovascular approaches. METHODS: MEDLINE, EMBASE, and Cochrane Central Register of Controlled trials, conference proceeding from major vascular meetings were searched for randomized trials comparing open vs elective endovascular aneurysm repair (EVAR) of AAAs. A random-effects model was used for analysis. Risk ratio (RR) and 95% confidence intervals (CIs) of open vs EVAR were calculated for short- and long-term mortality and reintervention rates. RESULTS: The analysis encompassed four randomized controlled trials with a total of 2783 patients. The open repair group resulted in significantly increased 30-day postoperative all-cause mortality compared with EVAR repair group (3.2% vs 1.2%; RR, 2.81; 95% CI, 1.60-4.94); however, there is no statistical difference in the long-term all-cause mortality between both groups (RR, 0.97; 95% CI, 0.86-1.10). Interestingly, fewer patients underwent reintervention procedures in the open repair group compared with those who had EVAR repair (9.3% vs 18.9%; RR, 0.49; 95% CI, 0.40-0.60), but this finding is doubtful due to the large heterogeneity. Lastly, no statistical difference in long-term mortality rates attributable to cardiovascular disease (CVD), aneurysm related, or stroke were found between the two types of repair. CONCLUSIONS: Results of this meta-analysis demonstrate that the 30-day all-cause mortality rate is higher with open than with EVAR repair; however, there is no statistical difference in the long-term all-cause and cause-specific mortality between both groups. The reintervention rate attributable to procedural complication was higher in the EVAR group. Because of the equivalency of long-term outcomes and the short-term benefits of EVAR, an endovascular-first approach to AAAs can be supported by the meta-analysis.


Assuntos
Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Cirúrgicos Eletivos , Humanos , Reoperação/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares
15.
CMAJ ; 183(14): 1581-8, 2011 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-21876014

RESUMO

BACKGROUND: Severe traumatic brain injury often leads to death from withdrawal of life-sustaining therapy, although prognosis is difficult to determine. METHODS: To evaluate variation in mortality following the withdrawal of life-sustaining therapy and hospital mortality in patients with critical illness and severe traumatic brain injury, we conducted a two-year multicentre retrospective cohort study in six Canadian level-one trauma centres. The effect of centre on hospital mortality and withdrawal of life-sustaining therapy was evaluated using multivariable logistic regression adjusted for baseline patient-level covariates (sex, age, pupillary reactivity and score on the Glasgow coma scale). RESULTS: We randomly selected 720 patients with traumatic brain injury for our study. The overall hospital mortality among these patients was 228/720 (31.7%, 95% confidence interval [CI] 28.4%-35.2%) and ranged from 10.8% to 44.2% across centres (χ(2) test for overall difference, p < 0.001). Most deaths (70.2% [160/228], 95% CI 63.9%-75.7%) were associated with withdrawal of life-sustaining therapy, ranging from 45.0% (18/40) to 86.8% (46/53) (χ(2) test for overall difference, p < 0.001) across centres. Adjusted odd ratios (ORs) for the effect of centre on hospital mortality ranged from 0.61 to 1.55 (p < 0.001). The incidence of withdrawal of life-sustaining therapy varied by centre, with ORs ranging from 0.42 to 2.40 (p = 0.001). About one half of deaths that occurred following the withdrawal of life-sustaining therapies happened within the first three days of care. INTERPRETATION: We observed significant variation in mortality across centres. This may be explained in part by regional variations in physician, family or community approaches to the withdrawal of life-sustaining therapy. Considering the high proportion of early deaths associated with the withdrawal of life-sustaining therapy and the limited accuracy of current prognostic indicators, caution should be used regarding early withdrawal of life-sustaining therapy following severe traumatic brain injury.


Assuntos
Lesões Encefálicas/mortalidade , Lesões Encefálicas/terapia , Mortalidade Hospitalar , Cuidados para Prolongar a Vida , Adulto , Canadá/epidemiologia , Estado Terminal , Feminino , Escala de Coma de Glasgow , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Padrões de Prática Médica , Prognóstico , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA