82 research outputs found
Carotid ultrasound findings as a predictor of long-term survival after abdominal aortic aneurysm repair: a 14-year prospective study
AbstractPurposeSeveral factors have been related to long-term survival after open abdominal aortic aneurysm (AAA) repair. The effect of carotid stenosis on outcome has not yet been examined. We performed an open prospective study to evaluate the prognostic significance of carotid stenosis on long-term survival of patients who had undergone elective operative repair of AAA.MethodsTwo hundred eight patients who underwent elective open AAA repair in our department between March 1987 and December 2001 were included in the study. All patients were evaluated preoperatively with color duplex ultrasound (US) scanning of the carotid arteries, and were followed up with clinical examination and carotid duplex US scanning 1 month after the operation and every 6 months thereafter. Median duration of follow-up was 50 months (range, 5-181 months). Cardiovascular morbidity and mortality, as well as all causes of mortality, were recorded and analyzed with regard to traditional risk factors and carotid US findings.ResultsTwenty-seven fatal and 46 nonfatal cardiovascular events were recorded. Both univariate and multivariate analysis showed that carotid stenosis 50% or greater and echolucent plaque were significantly associated with cardiovascular mortality and morbidity. Carotid stenosis was a stronger predictor of cardiovascular death than was ankle/brachial index. Age, hypercholesterolemia, coronary artery disease, and diabetes mellitus were also associated with higher mortality and morbidity from cardiovascular causes.ConclusionPatients electively operated on for AAA repair and with stenosis 50% or greater and echolucent plaque at duplex US scanning are at significantly increased risk for cardiovascular mortality and morbidity. Carotid US can therefore be used to select a subgroup of patients with AAA who might benefit from medical intervention, including antiplatelet and lipid-lowering agents
European training requirements in vascular surgery
The Union Europénne des Médecins Spécialistes (UEMS) is a non-governmental organization representing national associations of medical specialists (over 1.6 million) at the European level. It has strong links and relations with European institutions (Commission and Parliament), the other independent European medical or-ganizations and the European medical/scientific societies. With a current membership of 40 national associations and 43 specialist sections and European boards, the UEMS promotes the free movement of medical specialists across Europe while ensuring the highest level of training which will pave the way to the improvement of quality of care for the benefit of all European citizens. The UEMS areas of expertise notably encompass Continuing Medical Education, Post-Graduate Training and Quality Assurance. It is the UEMS conviction that the quality of medical care and expertise is directly linked to the quality of train-ing provided to the medical professionals. Therefore, the UEMS committed itself to contribute to the improvement of medical training at the European level through the de-velopment of European standards in the different medical disciplines. One of the added values of the UEMS is the development of new harmonized models for the training of the next generation of medical specialists, and of high standards of clinical practice, hence improved care for pa-tients throughout Europe. It is not important where doc-tors are trained, they should have at least the same core competencies.peer-reviewe
Layer-dependent wall properties of abdominal aortic aneurysms: Experimental study and material characterization
Mechanical testing and in-depth characterization of the abdominal aortic
aneurysm wall from fifteen patients undergoing open surgery was
performed to establish the layer-dependent tissue properties that are
non-available in the literature. Quantitative microscopic evaluation was
performed to identify the spatial organization of collagen-fiber
network. Among a number of candidate models, the four-fiber family
(microstructure-motivated) model, especially that including dispersions
of fiber angles about the main directions, was superior to the Fung- and
Gasser-type models in the fitting quality allowed, though it presented a
practical difficulty in parameter estimation, so that an analysis was
conducted aiding the identification of a more specific diagonal- and
circumferential-fiber family model for all three layers. The adventitia
was stiffer and stronger than the other layers, owing to its increased
collagen content, and its contribution to the response of the intact
wall was augmented being under greater residual tension than the media,
whereas the intima was under residual compression. All layers were
stiffer circumferentially than longitudinally, due to preferential
collagen arrangement along that axis. The histologically-guided material
characterization of layered wall presented herein is expected to assist
clinical decision, by developing reliable criteria to predict the
rupture risk of abdominal aortic aneurysms, and optimize endovascular
interventions. (C) 2015 Elsevier Ltd. All rights reserved
What a vascular surgeon should know and do about atherosclerotic risk factors
Atherosclerosis is a systematic disease presenting with a significant
overlapping of cardiovascular disorders implicating coronary heart
disease and its equivalents, peripheral arterial disease, carotid
arterial disease, and aneurysm disease. Evaluating patient’s
atherosclerotic risk profile is essential to guide primary and secondary
prevention. Atherosclerotic risk factor modifications reduce,
significantly, cardiovascular disease mortality and morbidity,
particularly in high-risk patients. This article provides a reference
guide for all conventional (eg, smoking, dyslipidemia, hypertension) and
evolving (eg, homocysteine, C-reactive protein, fibrinogen, inflammatory
markers) risk factors of atherosclerosis and recommends the currently
effective strategies for an overall cardiovascular risk reduction. As
vascular surgeons, by definition, conduct the overall management of
patients with vascular disease understanding of the development,
assessment, and management of atherosclerotic risk factors should remain
among their highest priorities. (J Vasc Surg 2009;49:1348-54.
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