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1.
J Vasc Surg Venous Lymphat Disord ; 7(6): 824-831, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31495764

RESUMO

BACKGROUND: Whereas numerous studies have demonstrated noninferiority of cyanoacrylate embolization (CAE) relative to endovenous laser ablation (EVLA), little is known about the natural history of the vein or the glue that is implanted. This study provides the first description of duplex ultrasound changes of the great saphenous vein (GSV) after CAE relative to EVLA as well as a pragmatic view of outcomes in clinical practice. METHODS: Patients treated with CAE and EVLA at our institution were matched by time of procedure and vein size. GSV diameter was measured at the saphenofemoral junction, midthigh, and knee. Duplex ultrasound imaging was repeated after treatment in the same noninvasive laboratory with an identical protocol. Clinical data were collected by retrospective chart review. RESULTS: Of 481 eligible patients, 119 underwent postoperative duplex ultrasound imaging. Although there was a trend toward decreased vein diameter over time in CAE patients relative to their preoperative vein diameter, this failed to reach statistical significance at the midthigh (P = .32) or at the knee (P = .511). In EVLA patients, as follow-up interval increased, the vein was less frequently visualized on ultrasound at the midthigh (P = .046) and knee (P = .038). At >2 years of follow-up, >80% of EVLA patients had no visible vein segment. Anatomic recurrence was observed in 10.5% of CAE patients and 8.2% of EVLA patients, which was not statistically significantly different (P = .60). The majority of recurrence was observed in the presence of incompetent tributaries. CONCLUSIONS: After CAE of the GSV, our results indicate that the glue cast remains for at least 3 years. Although our results suggest that the glue is broken down over time, this process is much slower than expected. In contrast, after EVLA, the vein tissue is remodeled and is no longer visible with time. In our study, which represents a pragmatic clinical population with a large (median, 9.2 mm) vein diameter, we again demonstrate no statistically significant difference in recurrence rates. Whereas CAE offers an attractive treatment option for GSV incompetence, the glue cast remains for a prolonged time, and longer follow-up studies than those currently available are indicated.

2.
Ann Vasc Surg ; 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31344462

RESUMO

BACKGROUND: The National Surgical Quality Improvement Program (NSQIP) is a prospectively collected database that collects 30-day patient outcome data, and analyzes these data for risk adjusted comparisons. The purpose of this review is to determine how this database is used in vascular surgery literature. METHODS: With the assistance of a librarian, a comprehensive search string was developed to survey the NSQIP vascular surgery literature in PubMed, EMBASE, MEDLINE, and CINAHL. Two reviewers independently reviewed the articles. To be included in the study articles had to relate to one of the domains of vascular surgery and utilize the NSQIP database. RESULTS: One hundred fifty-six articles were included in this review. All studies were retrospective and the most common study type was retrospective cohort studies (65.4%). Although 2016 was the year with the most published articles (22.4%), 2014 and 2015 stand out as going against the upward trend of number of published articles in respect to year. The most prominent aims of the studies were to find preoperative predictors of adverse outcomes (50.6%). There were a minority of studies investigating quality improvement following implementation of the NSQIP (5.1%) or validation and examination of risk predicting tools (3.8%). Of the surgical domains investigated by studies, the use of aneurysm repair data was most common (33.3%) followed by lower extremity revascularization or amputation (28.2%). Within these surgical domains, majority of studies were interested specifically in open cases (51.9%). Although there was some range in outcomes investigated, mortality and morbidity were one of the primary outcomes in majority of the studies (mortality 65.0%, morbidity 57.3%). CONCLUSIONS: Since its inception, the NSQIP has grown in both hospital implementation and vascular surgery literature. Although a variety of literature exists that uses said NSQIP data to predict and compare adverse events, not much literature exists surrounding the translation of implementing these findings into the hospital setting. Additionally, despite the size of the database, many existing studies investigate similar aims and outcomes to each other.

3.
J Vasc Surg ; 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.

4.
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
5.
Ann Surg ; 268(2): 357-363, 2018 Aug.
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.

6.
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
7.
Trauma Case Rep ; 12: 24-27, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29644279

RESUMO

Traumatic dissection of the innominate artery is a rare clinical entity. Management of a patient with motorsensory compromise and dissection extending to the subclavian and right common carotid arteries is quite rare and can be quite involved. Here we present such a case and discuss the unique peri-operative decision-making in the context of what is reported in the literature. Restoration of motorsensory function is critical and in this case, requiring a multi-disciplinary team.

8.
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
9.
Vascular ; 17(1): 23-8, 2009 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19344579

RESUMO

The purpose of this article is to report the feasibility and preliminary results of the treatment of isolated iliac artery aneurysms (IAAs) with Anaconda limbs (Vascutek Ltd., Inchinnan, Renfrewshire, Scotland). A prospective cohort is reported of consecutive IAAs treated by two senior surgeons from May to December 2006. One or more Anaconda limbs were used, and internal iliac arteries were embolized if necessary. Twelve IAAs in 11 patients were treated. The average IAA diameter was 4.3 +/- 1.1 cm, and the average diameter of stent used was 14 +/- 2.5 mm, with an average total length of 97 +/- 25 mm. At a mean follow-up of 12 +/- 4 months, there were no graft-related complications, graft occlusions, or requirements for reintervention. Endovascular treatment for isolated IAAs under local anesthesia using Anaconda limbs is feasible, safe, and effective. However, as with all new technology, longer follow-up data are necessary.


Assuntos
Implante de Prótese Vascular/métodos , Prótese Vascular , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ligas , Estudos de Viabilidade , Seguimentos , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Artéria Ilíaca/diagnóstico por imagem , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Poliésteres , Estudos Prospectivos , Desenho de Prótese , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Grau de Desobstrução Vascular
10.
J Surg Oncol ; 84(3): 120-6, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14598354

RESUMO

BACKGROUND AND OBJECTIVES: A minimum number of lymph nodes must be assessed for accurate diagnosis of stage II colon cancer. We assessed number of lymph nodes retrieved, pathological ultra-staging, and outcome in stage II colon cancer. MATERIALS AND METHODS: Consecutively treated patients with stage II colon cancer were identified. Baseline and outcome data were collected. Retrospective ultra-staging using lymphovascular invasion (LVI) and nodal micrometastases was performed. Patients were divided into two groups: group I had 6 nodes retrieved. Survival was analyzed. RESULTS: One hundred and fifteen patients were included in the study. The 5 year overall survival was worse in group I versus II (P = 0.03). LVI and micrometastases were identified but neither predicted survival. Disease failure in group I was due to distant metastases rather than local recurrence. CONCLUSIONS: Inadequate retrieval and assessment of lymph nodes is associated with worse outcome in stage II colon cancer patients. Recurrence patterns support the hypothesis that disease recurrence occurred due to inaccurate staging. In this small study, LVI or nodal micrometastases did not predict survival. Maximal attention should be paid to the total number of lymph nodes retrieved before embarking on potentially more resource intensive staging methods.


Assuntos
Neoplasias do Colo/patologia , Linfonodos/patologia , Estadiamento de Neoplasias/métodos , Idoso , Neoplasias do Colo/mortalidade , Neoplasias do Colo/cirurgia , Feminino , Humanos , Linfonodos/irrigação sanguínea , Metástase Linfática , Masculino , Invasividade Neoplásica , Metástase Neoplásica/patologia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
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