Characteristics of patients presenting to the vascular emergency department of a tertiary care hospital: a 2-year study

<p>Abstract</p> <p>Background</p> <p>The structure of health care in Greece is receiving increased attention to improve its cost-effectiveness. We sought to examine the epidemiological characteristics of patients presenting to the vascular emergency department of a Greek tertiary care hospital during a 2-year period. We studied all patients presenting to the emergency department of vascular surgery at Red Cross Hospital, Athens, Greece between 1^stJanuary 2009 and 31st December 2010.</p> <p>Results</p> <p>Overall, 2452 (49.4%) out of 4961 patients suffered from pathologies that should have been treated in primary health care. Only 2509 (50.6%) needed vascular surgical intervention.</p> <p>Conclusions</p> <p>The emergency department of vascular surgery in a Greek tertiary care hospital has to treat a remarkably high percentage of patients suitable for the primary health care level. These results suggest that an improvement in the structure of health care is needed in Greece.</p

Association of cerebral ischaemic lesions during carotid endarterectory with the quality of the atheromatic plaque and the operative technique

Aim: To investigate the incidence of new cerebral ischemic lesions after carotidendarterectomy (CEA) and their correlation with carotid plaque echostructure and the surgical technique of CEA.Patients-Method: 105 patients (81 males, age 69.5±8 years) were included in the study. Carotid plaque echostructure was evaluated with the gray scale median (GSM) score. Brain DW- MRI was performed 24 hours before and 48-72 hours after CEA.Results: Thirty day stroke and mortality was 0.95% (1/105 patients). GSM score for symptomatic patients was 31.8 +/- 16 and for asymptomatic 33.6 +/- 18 (P =.931). Patients were divided in two groups: GSM ≤25 (44 patients) and GSM >26 (61 patients). New lesions were detected in 8 cases (7.6%), 5 located within and 3 outside the treated carotid artery territory. There was no difference on the incidence between the two groups (GSM≤25: 4 patients with new lesions, GSM>25: 4 patients with new lesions, P = .629).Conclusion: New lesions in DW-MRI were detected in 7.6% of the patients after CEA. Plaque echogenicity and surgical technique did not affect their incidence.Σκοπός: Σκοπός της μελέτης μας είναι να διερευνήσουμε την επίπτωση νέων ισχαιμικών εγκεφαλικών βλαβών μετά από ενδαρτηρεκτομή καρωτίδας καθώς και τη συσχέτισή τους με την ηχοδομή της καρωτιδικής πλάκας και την εγχειρητική τεχνική.Ασθενείς-Μέθοδος: 105 ασθενείς (81 άνδρες, μέση ηλικία 69.5±8 έτη) συμμετείχαν στη μελέτη. Η ηχοδομή της καρωτιδικής πλάκας εκτιμήθηκε με υπολογισμό του gray scale median (GSM) score. Μαγνητική τομογραφία εγκεφάλου DW-MRI πραγματοποιήθηκε 24 ώρες πριν και 48-72 ώρες μετά την ενδαρτηρεκτομή καρωτίδας.Αποτελέσματα: Η επίπτωση ΑΕΕ και η θνητότητα στις 30 ημέρες ήταν 0,95% (1/105 ασθενείς). Το GSM score ήταν 31.8 +/- 16 στους συμπτωματικούς ασθενείς και 33.6 +/- 18 στους ασυμπτωματικούς ασθενείς (P =.931). Οι ασθενείς χωρίσθηκαν σε δύο ομάδες: GSM ≤25 (44 ασθενείς) and GSM >26 (61 ασθενείς). Νέες βλάβες εντοπίσθηκαν σε 8 ασθενείς (7.6%), 5 εντός και 3 εκτός της περιοχής άρδευσης της χειρουργηθείσας καρωτίδας. Δεν υπήρχε διαφορά στη συχνότητα εμφάνισης νέων βλαβών στις δύο ομάδες (GSM≤25: 4 ασθενείς με νέες βλάβες, GSM>25: 4 ασθενείς με νέες βλάβες, P = .629).Συμπέρασμα: Νέες βλάβες στη DW-MRI εντοπίσθηκαν σε 7,6% των ασθενών μετά από ενδαρτηρεκτομή καρωτίδας. Η ηχογένεια της καρωτιδικής πλάκας και η εγχειρητική τεχνική δε φαίνεται να επηρεάζουν την επίπτωσή τους

New Cerebral Ischemic Lesions After Carotid Endarterectomy

Background: We sought to investigate the incidence and location of new cerebral ischemic lesions after carotid endarterectomy (CEA) using diffusion-weighted magnetic resonance imaging (DW-MRI). Methods: Sixty-six consecutive patients (50 males with a mean [+/- SD] age of 69 +/- 9 years) who underwent CEA were included in this prospective study. Seventeen patients were symptomatic and 49 patients were asymptomatic. CEA was performed with patch closure without using a shunt. Carotid plaque echostructure was evaluated with the grayscale median (GSM) score. DW-MRI scanning of the brain was performed 24 hours before and 48 to 72 hours after the procedure. Results: Thirty-day stroke and mortality rates were 0%. The mean GSM score for symptomatic patients was 27 +/- 15; for asymptomatic patients, the mean GSM score was 39 +/- 18 (P = 0.006). Patients were divided into 2 groups according to GSM score: GSM scores &lt;= 25 (22 patients) and GSM scores &gt;26 (44 patients). New brain lesions were detected after 6 endarterectomies (8.9%), and all were clinically silent. These lesions were ischemic in 5 cases (7.5%) and micro-hemorrhagic in 1 case (1.4%). In 3 cases, new ischemic lesions were located within the treated carotid artery territory. In 2 cases, new lesions on DW-MRI were located outside of the treated carotid artery territory. There was no significant difference in the incidence of ischemic lesions between the 2 groups (GSM scores &lt;= 25, 2 lesions; GSM scores &gt;26, 3 lesions; P = 0.544). Conclusions: New ischemic lesions on DW-MRI are detected in 7.5% of patients after CEA, and most of these lesions are clinically silent. Plaque echogenicity does not affect their incidence. New lesions seen on DW-MRI may be generated outside of the treated carotid artery territory