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Penetrating injuries to the inferior vena cava and/or iliac veins are a source of hemorrhage but may also predispose patients to venous thromboembolism (VTE). AZD9291 price We sought to determine the relationship between iliocaval injury, VTE and mortality.

The National Trauma Data Bank was queried for penetrating abdominal trauma from 2015-2017. Univariate analyses compared baseline characteristics and outcomes based on presence of iliocaval injury. Multivariable analyses determined the effect of iliocaval injury on VTE and mortality.

Of 9,974 patients with penetrating abdominal trauma, 329 had iliocaval injury (3.3%). Iliocaval injury patients were more likely to have a firearm mechanism (83% vs. 43%, P < 0.001), concurrent head (P=0.036), spinal cord (P < 0.001), and pelvic injuries (P < 0.001), and higher total injury severity score (median 20 vs. 8.0, P < 0.001). They were more likely to undergo 24-hr hemorrhage control surgery (69% vs. 17%, P < 0.001), but less likely to receive VTE chemoprophylar developing VTE.
Iliocaval injuries occur in less then 5% of penetrating abdominal trauma but are associated with more severe injury patterns and high mortality rates. Regardless of repair type, survivors should be considered high risk for developing VTE.
Chronic venous insufficiency (CVI) encompasses a myriad of clinical manifestations including lower extremity swelling and pain, ulcerations and chronic skin changes such as stasis dermatitis, and lipodermatosclerosis. CVI effects greater than 25 million Americans and has a significant socioeconomic and psychosocial impact. Treatment of CVI varies depending on the etiology. For those patients with deep venous reflux, restoration of the deep venous valvular system is critical. Popliteal vein external banding is a novel technique to treat deep venous reflux. Our study aims to retrospectively review the early outcomes for the largest U.S. series of patients undergoing popliteal vein external banding.

Patients with C4, C5, and C6 disease with underlying deep venous reflux were treated with external banding of the popliteal vein. Basic demographic, ultrasound, and procedural data were collected. Patients were seen in clinic and underwent post procedure duplex. Procedure-specific complications were also assessedechnically easier than most deep venous reconstructive options and may have an important role in the multimodal treatment of patients with advanced CVI.
Popliteal vein external banding represents a viable treatment modality for patients with venous insufficiency secondary to deep venous reflux. It is technically easier than most deep venous reconstructive options and may have an important role in the multimodal treatment of patients with advanced CVI.
The creation and maintenance of durable hemodialysis access is critically important for reducing patient morbidity and controlling overall costs within health systems. Our objective was to quantify the costs associated with hemodialysis access creation and its maintenance over time within a rate-controlled health system where charges equate to payments.

The Maryland Health Services Cost Review Commission administrative claims database was used to identify patients who underwent first-time access creation from 2012-2020. Patients were identified using CPT codes for access creation, and costs were accrued for the initial encounter and all subsequent outpatient access-related encounters. T-tests and Wilcoxon tests were used to compare reinterventions and access-related costs ($USD) between arteriovenous fistulae (AVF) and arteriovenous grafts (AVG). Multivariable modeling was used to quantify the association of access type with charge variation.

Overall, 12,716 patients underwent first-time access creationive likelihood of AVF maturation.
AVF require fewer interventions and are associated with lower costs at placement and over the first three years of maintenance compared to AVG. The use of AVF for first-time hemodialysis access represents an opportunity for healthcare savings in appropriately selected patients with a high preoperative likelihood of AVF maturation.
Laser in situ fenestration (LISF) is an expanding technique for arch vessel revascularization in thoracic endovascular aortic repair (TEVAR). We present a single center's early and midterm outcomes using adjunctive LISF with TEVAR for treatment of various arch pathologies.

24 patients underwent TEVAR with LISF (2017-2020). Patients were evaluated by an Aortic Team consisting of cardiothoracic and vascular surgeons and were deemed unfit for open surgical repair. Informed consent emphasized the procedure's off-label nature. Thoracic stent-grafts were sized by preoperative Computed Tomography Angiogram and intraoperative Intravascular Ultrasound, with oversizing determined by pathology. Extra-anatomic debranching was performed in staged or concurrent fashion based on urgency of repair and access site options for branch fenestration. A 2.3 mm Spectranetics laser was used, with access site determined at surgeon discretion. Covered balloon expandable stent-grafts were deployed with 0-10% oversizing.

In 24 patrch pathology and prohibitive open surgical risk.
LISF for branch revascularization in TEVAR is technically feasible for treating various aortic arch pathologies, demonstrating practicality in both elective and emergent settings. With a morbidity and mortality profile that is favorable compared to that of open repair, LISF with TEVAR is a promising potential option for patients with complex arch pathology and prohibitive open surgical risk.
Cerebrospinal fistulas of the clivus region often result from previous surgical intervention at the skull base. The localization and size of the fistula determine the appropriate treatment strategy. When flap closure is not possible, the microsuture technique with autograft placement provides a favorable outcome.

We present a technical report on the application of the microsuture technique for clivus region cerebrospinal fluid fistula closure in a patient with previous chordoma treatment and nonspecific coronavirus disease 2019 complications.

The application of the microsuture technique resulted in stable remission of the fistula and complete regression of the clinical manifestations.

The microsuture technique for clivus region fistula closure is a potentially valuable alternative to vascularized flap closure.
The microsuture technique for clivus region fistula closure is a potentially valuable alternative to vascularized flap closure.
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