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Room-temperature development of covalent organic and natural frameworks as the immobile cycle regarding open-tubular capillary electrochromatography.
In addition in the literature many different treatment options for this condition are reported, either medical and/or surgical, but an ideal approach has not yet been fully identified. We report 5 cases of internal CAD due to the vascular variant of Eagle syndrome treated in two different Italian institutions (Department of Vascular and Endovascular Surgery, Galliera Hospital, Genoa and Department of Vascular Surgery, Santi Filippo e Nicola Hospital, Avezzano, L'Aquila) and a careful and analytical review of the available literature on this topic. A 62-year-old man was admitted with non-healing wounds on his right toes. Computed tomography and angiography showed heavily calcified arteries in both lower extremities and steno-occlusive lesions of the right femoropopliteal artery. During Supera stenting, the catheter tip detached after adhering to the heavily calcified vessel wall. VX-445 nmr Endovascular removal of the detached tip was performed using ipsilateral peroneal access with a 5 French angiographic catheter and a through-and-through wire. Contrast-enhanced computed tomography and angiography after 16 months showed patent Supera stents. Our report suggests that detachment of the Supera stent delivery catheter tip could occur, especially in patients with heavily calcified vessels associated with peripheral artery disease, and demonstrates the possibility for endovascular retrieval of the detached tip. BACKGROUND Registry studies have shown the Endurant stent graft is associated with low rates of all-cause- and aneurysm-related mortality when used for the endovascular treatment of abdominal aortic aneurysm (AAA). However, many were limited by length of follow-up and all had a proportion of patients lost to follow-up. The aim of this study was to report results from a large, real-world experience using Endurant utilising methods to ensure complete ascertainment of mortality. METHODS This study describes a large, single vascular unit experience using the Endurant stent graft in consecutive patients treated between August 2008 and March 2019. RESULTS One-hundred and eighty patients (mean age 76.0±8.6 years; 90% male) with mean AAA diameter 57.5 ± 10.5mm underwent endovascular aortic aneurysm repair (EVAR). Technical success was achieved in all cases. At median follow-up of 55.0 months (interquartile range 29.8 - 79.0), 51 (28.3%) patients had died. Kaplan-Meier estimate of 5-year overall-survival and freedom from aneurysm-related death was 71.6% and 99.4%, respectively. Lower survival rates were observed in patients who underwent EVAR at age ≥80 years (59.2% vs 78.3%; P less then 0.01) and with aneurysm diameter ≥70mm (55.6% vs 73.8%; P=0.03). Thirteen endoleaks (7.2%; 4 Type 1A, 2 Type 1B, 7 Type 2) were observed during follow-up (mean time from implantation 8.7±4.2 (range 1-52) months). Eleven patients (6.1%) required secondary intervention for limb occlusion (n=7), endoleak (n=3) and re-stenosis (n=1). CONCLUSION Results from this real-world study of consecutive patients treated for AAA using the Endurant stent graft demonstrate that it is safe and effective, with excellent long-term outcomes for anatomy that falls both inside and outside IFU recommendations. OBJECTIVE Healthcare quality metrics are crucial to medical institutions, payers, and patients. Obtaining current and reliable quality data is challenging, as publicly reported databases lag by several years. Vizient Clinical Data Base (previously University Health Consortium (UHC)) is utilized by over 5000 academic and community medical centers to benchmark healthcare metrics with results based on predetermined Vizient service lines. We sought to assess the accuracy and reliability of vascular surgery service line metrics, as determined by Vizient. METHODS Vizient utilizes encounter-data submitted by participating medical centers and generates a diverse array of health care metrics ranging from mortality to costs. All inpatient cases captured by Vizient under the vascular surgery service line were identified at the University of Massachusetts Medical Center (fiscal year 2016). Each case within the service line was reviewed and categorized as "vascular" or "non-vascular" based on care provided by UMass vasculascular surgery cases, only 69% of these cases were placed within the vascular surgery service line. CONCLUSION Health care quality metrics play an important role for all stakeholders but obtaining accurate and reliable data to implement improvements is challenging. In this single institution experience, inpatient cases that were not under the direction or care of a vascular surgeon resulted in significantly negative impacts on LOS, cost, complication rate, and mortality to the vascular surgery service line, as defined by a national clinical database. Therefore, clinicians must understand the data abstracting and reporting process prior to implementing effective strategic plans. Ruptured thoracoabdominal aneurysms (rTAAA) are rare and carry a significant rate of morbidity and mortality. Aortocaval fistula secondary to rTAAA are even more infrequent. We describe an urgent and staged endovascular treatment of a ruptured extent III thoracoabdominal aortic aneurysm with an aortocaval fistula by performing vena cava stenting to treat aortocaval fistula as a damage control maneuver prior to transfer and subsequent TAAA repair with a physician-modified endograft at a quaternary level hospital. INTRODUCTION Despite improved revascularization options, many patients with chronic limb-threatening ischaemia (CLI) require lower limb amputation. Duplex ultrasound (DUS) is recommended as first choice imaging technique in CLI. However, the prognostic utility of DUS for planning lower limb amputations has never been described before. This study aims to evaluate if DUS and findings from physical examination could be used to help predict the best level of lower limb amputation in patients with CLI. METHODS A retrospective cohort of 124 patients with CLI and a lower limb amputation was analyzed. Outcome measurements were reoperation, revision and conversion rates, which were related to findings from physical examination and DUS examinations. RESULTS 39 reoperations were performed, of which 17 stump revisions and 22 conversions from below to above knee amputation. There was a discrepancy in findings of physical examination and DUS of 25% and 64% of femoral and popliteal pulsations respectively. Conversion rates increased with a more proximal occlusion on DUS.
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