Inhibitory Effects of Prior Low-dose X-irradiation on Ischemia-reperfusion Injury in Mouse Paw

We have reported that low-dose, unlike high-dose, irradiation enhanced antioxidation function and reduced oxidative damage. On the other hand, ischemia-reperfusion injury is induced by reactive oxygen species. In this study, we examined the inhibitory effects of prior low-dose X-irradiation on ischemia-reperfusion injury in mouse paw. BALB/c mice were irradiated by sham or 0.5 Gy of X-ray. At 4 hrs after irradiation, the left hind leg was bound 10 times with a rubber ring for 0.5, 1, or 2 hrs and the paw thickness was measured. Results show that the paw swelling thickness by ischemia for 0.5 hr was lower than that for 2 hrs. At 1 hr after reperfusion from ischemia for 1 hr, superoxide dismutase activity in serum was increased in those mice which received 0.5 Gy irradiation and in the case of the ischemia for 0.5 or 1 hr, the paw swelling thicknesses were inhibited by 0.5 Gy irradiation. In addition, interstitial edema in those mice which received 0.5 Gy irradiation was less than that in the mice which underwent by sham irradiation. These findings suggest that the ischemia-reperfusion injury is inhibited by the enhancement of antioxidation function by 0.5 Gy irradiation

Brave new world: The role for endovascular aneurysm repair in contemporary vascular surgery

Endovascular abdominal aortic aneurysm repair (EVAR) poses certain challenges to the vascular surgeon. Based upon our 6-year experience, we have highlighted important aspects of patient selection. EVAR can be performed in patients with significant co-morbidities, but technical success may be limited by anatomic criteria. Short to mid-term outcomes report low mortality and morbidity from EVAR. Acute and delayed conversion, rupture, endoleak, limb occlusion, and migration are complications occurring in EVAR; their frequency, presentation and management are described. EVAR has up to 90% success rate at several years follow-up including the use of secondary procedures. Secondary procedures are not infrequent after EVAR; thus close follow-up is of the utmost importance. We predict that EVAR will continue to be a valuable tool in the future

Trends in aortic aneurysm surgical training for general and vascular surgery residents in the era of endovascular abdominal aortic aneurysm repair

AbstractHypothesis: The emergence of endovascular abdominal aortic aneurysm (AAA) repair may negatively impact the open AAA experience of general surgery residents. Methods: Prospectively collected data on general and vascular surgery resident training in AAA repair for a 5-year period (1997 to 2001) at a single institution were retrospectively reviewed. Five general surgery residents and one vascular resident completed training yearly. Institutional volume of open and endovascular repair of AAA was also assessed. Results: The cumulative mean general surgical resident experience with open AAA repair fell significantly over a 5-year period; 9.5 ± 2.5 cases were performed per general surgical resident finishing in 1997, 7.5 ± 0.3 cases in 1998, 4.6 ± 0.4 cases in 1999, 4.0 ± 1.3 cases in 2000, and 4.2 ± 1.0 cases in 2001 (P = .03). The vascular resident experience with open AAA repair did not change significantly over the 5-year period. However, the active development of an endovascular AAA program increased total AAA exposure of the vascular resident from 26 cases in 1997 to a mean of 70 cases in 2000 and 2001. The institution volume of open nonsuprarenal AAA repairs fell 38% during the 5-year period (P = .33) during a period when endovascular AAA repair increased from 9 (1996) to 55 (2000) cases (P <.001). The complexity of open AAA surgery also increased: 23.3% of open cases (7/30) in 2000 were juxta/pararenal versus 2.9% (1/35) in 1996 (P = .05). Conclusion: The introduction of endovascular AAA repair may have negatively impacted general surgical resident training in open AAA repair. The number of open AAA cases declined, and their complexity significantly increased. Many uncomplicated AAAs were managed with endovascular means. At programs with such a paradigm shift in AAA treatment, expectation that general surgery residents gain the proficiency necessary to safely perform AAA repair without additional training may be unrealistic. (J Vasc Surg 2002;36:685-9.