1,721,023 research outputs found
Late rejection of an entire polytetrafluoroethylene carotid patch with complete restitution of vascular continuity.
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Carotid endarterectomy and contralateral internal carotid artery occlusion:perioperative risks and long-term stroke and survival rates.
No full textBackground. The aim of this article was to analyze the perioperative mortality and stroke risk rates and late benefits of carotid endarterectomy (CE) contralateral to an occluded internal carotid artery (ICA), on the basis of our surgical experience from July 1990 to June 1996.
Methods. In 57 (14.7%) of 336 patients undergoing 388 CEs, the contralateral ICA was occluded (group I). All operations were performed under general anesthesia with selective shunting based on electroencephalographic criteria. Shunting was used in 36 (63.1%) of 57 revascularizations in group I and 47 (14.2%) of 331 operations performed on the remaining 279 patients with patent contralateral ICAs (group II) (p < 0.001).
Results. Perioperative strokes occurred in two patients (3.5%) in group I and three patients (1%) in group II (difference not significant). The only perioperative death, which occurred in one patient (1.7%) in group I, was the result of a perioperative stroke; two patients (0.7%) in group II died within 30 days of operation (difference not significant). Life-table cumulative stroke-free rates at 1, 3, and 5 years were 95%, 95%, and 95% in group I and 98.8%, 98.2%, and 98.2% in group II, respectively
(p = 0.272). Life-table cumulative survival rates at 1, 3, and 5 years were 97.5%, 94.2%, and 78.1% in group I and 99.2%, 94.8%, and 71.7% in group II, respectively (p = 0.306).
Conclusions. The results of this analysis indicate that CE contralateral to an occluded ICA can be performed with acceptable perioperative mortality and stroke risk rates and late stroke-free and survival rates comparable to those seen in patients without contralateral ICA occlusion who have undergone operation. Nevertheless, we think it is misleading to imply that the risks of operating on the two groups are the same. Moreover, because no late stroke-related death occurred in patients with contralateral ICA
occlusion, it would appear that superior late stroke-free rates did not translate into a prolonged survival advantage
Il razionale del trattamento chirurgico d'elezione negli aneurismi dell'aorta addominale di piccolo calibro.
No full textElongation of the internal carotid artery and abdominal aortic aneurysm: Is there a relationship?
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Carotid angioplasty and stenting in high-risk patients with severe symptomatic carotid stenosis.
No full textCarotid plaque gross morphology and clinical presentation: A prospective study of 457 carotid artery specimens.
No full textBackground and purpose. In carotid artery disease,the relationship between carotid plaque morphologyand the patient’s neurologic symptoms is reportedly conflicting. The aim of this study was to correlate gross carotid plaque characteristics with the presenting symptoms in a relatively large series of patients who underwent carotid endarterectomy (CEA).
Methods. Four hundred and five patients who underwent 461 CEAs were divided into three groups: (1) transiently symptomatic [transient ischemic attack (TIA) or amaurosis fugax]; (2) prior stroke; and (3) asymptomatic. The degree of stenosis based on the preoperative angiograms was used in association with the presenting symptoms as the primary criterion in the decision to operate. Carotid plaque characteristics, including ulcerated plaque (UP), intraplaque hemorrhage (IH), uncomplicated plaque, and degree of stenosis, were recorded prospectively for 457 CEAs, since 4 CEAs were excluded from the study. All CEA specimens were grossly evaluated at surgery.
Results. There was a statistically higher incidence of UP in transiently symptomatic (P 5 0.008) or prior stroke (P 5 0.006) patients than in the asymptomatic group. When IH was onsidered independently, its incidence did not differ significantly between the three groups. Previously symptomatic patients tended to have higher-grade stenosis than asymptomatic patients, although the difference failed to reach statistical significance (P 5 0.06). Although the incidences of UP and IH were higher in the higher-grade stenosis group, the difference was again not significant.
Conclusions. Carotid UP correlates closely with an initial presentation of TIA, amaurosis fugax, or prior stroke, while the association between IH and presenting symptoms is less clear. Although there is an insignificant trend toward a correlation between the higher degrees of stenosis and the onset of transient symptoms, the degree of stenosis appears unaffected by the morphology of the plaque. These findings suggest that plaque morphology may play an important role in the presentation of carotid artery disease
Infrapopliteal arterial revascularization for limb-threatening ischemia in patients with chronic kidney disease.
No full textIs diabetes mellitus a risk factor for carotid endarterectomy? A prospective study.
No full textBackground. Although many randomized trials and other multicenter studies have demonstrated the benefits of carotid endarterectomy (CEA) in selected symptomatic and asymptomatic patients, several
investigators have noted an increased rate of perioperative neurologic and cardiac morbidity in diabetic patients. To compare the perioperative outcome of CEA in diabetic patients (group I) versus nondiabetic patients (group II), we analyzed a consecutive series of CEAs performed by the same vascular surgeon at the same institution.
Methods. Data collection was prospective for all CEA procedures performed between August 1, 1992 and March 31, 1999. Group I and group II were matched for clinical presentation, percentage of internal
carotid artery stenosis and indication for surgery.
Results.Of 547 CEAs performed in 474 patients, 199 (36.4%) were in group I. Group I was younger at presentation than group II (P < .005) and women were in a higher proportion in group I than in
group II (43.7% vs 27.1%, P = .0001). Although the incidence of peripheral atherosclerotic disease was comparable in the 2 groups, there was a significantly higher incidence of previous vascular surgery
in group I (P = .01). Perioperative neurologic and cardiac morbidity rates were comparable in the 2 groups. The overall perioperative mortality rate was 0.5%. Long-term information was obtained in all
patients (mean, 44 months; range, 1 to 75 months). No differences were found in the recurrent stenosis and occlusion rates between the 2 groups. Although there was no difference in the late mortality between the 2 groups, diabetic patients had a significantly higher cardiac-related death incidence (P = .01) than nondiabetic patients.
Conclusions. The findings of this analysis indicate that CEA can be performed in diabetic patients with excellent perioperative morbidity and mortality rates and late stroke-free and survival rates that are comparable with those recorded in nondiabetic patients
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