Abstract:
BACKGROUND:Postopertive troponin elevation may occur without typical or atypical cardiac symptoms and is associated with an increased 30-day morbidity and mortality. The objective of the study was to implement a quality improvement initiative of postoperative troponin surveillance algorithm aimed at intensifying medical management after vascular surgery. METHODS:We conducted a single-center study of postoperative troponin surveillance after vascular surgery (n = 201) at a tertiary care, academic medical center from January to December 2016. Troponin surveillance was performed on postoperative days 1-3 after carotid endarterectomy, endovascular aortic repair, infrainguinal bypass, open abdominal aortic aneurysm repair, peripheral vascular intervention, and suprainguinal bypass, regardless of cardiac symptoms. Patients with troponin I elevation (>0.034 ng/mL) were managed with a treatment algorithm which included single or dual antiplatelet (AP) agent, high-intensity statin therapy, smoking cessation consultation, and outpatient cardiology consultation and stress testing. Patients with troponin elevation ≥1.0 ng/mL received inpatient cardiology consultation. We assessed adherence to the protocol for intensification of best medical therapy defined as high-dose statin therapy, increase in AP therapy, and smoking cessation consultation according to the established algorithm. RESULTS:Troponin elevation was recorded in 17% (34/201) of patients and was associated with cardiac symptoms in 8 patients (24%), while 26 (76%) patients had an asymptomatic abnormal troponin on postoperative surveillance. One patient was excluded due to death immediately after SUPRA, resulting in 200 patients. Troponin elevation ≥1.0 ng/mL occurred in 11 asymptomatic patients (5.5%). Any intensification of medical therapy was instituted in 76% of patients with elevated troponin and included high-intensity statin therapy (58%), increase in AP therapy (18%), and smoking cessation consultation (66%). Once an elevated troponin level was recognized, 52% of our patients received cardiology consultation with an increased likelihood (100%) in patients with troponin ≥1 ng/mL (P < 0.001). Adherence to outpatient stress testing was 66%. Intensification of medical therapy was not significantly different between patients with abnormal troponin values, >0.034-1.0 (n = 23) versus ≥1.0 ng/mL (n = 10); statin therapy (P = 1.0), AP (P = 0.34), and smoking cessation (P = 1.0). One-year mortality was higher in patients with postoperative troponin elevation than those with normal postoperative troponin levels (12% vs. 2.4%; P = 0.03). CONCLUSIONS:Routine postoperative troponin surveillance results in intensification of statin therapy in patients with asymptomatic troponin elevation. Further study is needed to determine if this approach reduces long-term cardiovascular morbidity and mortality.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Shukla M,Callas PW,Lahiri JA,Alef MJ,Keating FK,Stanley AC,Steinthorsson G,Schneider DJ,Bertges DJdoi
10.1016/j.avsg.2019.02.025subject
Has Abstractpub_date
2019-10-01 00:00:00pages
156-164eissn
0890-5096issn
1615-5947pii
S0890-5096(19)30280-8journal_volume
60pub_type
杂志文章abstract::To define the histology of PTFE femoral-popliteal grafts seeded with enzymatically-derived endothelium, we examined light level and selected scanning electron micrographs of 20 graft biopsies. Thirteen grafts were chronically occluded and the midgraft samples had a thin lining of fibrin with scattered erythrocytes and...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)62000-1
更新日期:1989-04-01 00:00:00
abstract::Vascular injury sustained during neurosurgical procedures is surprisingly rare, especially considering the anatomic proximity of major blood vessels to the vertebral column. Mortality rates are high if the injury is not recognized and definitive management is delayed. Case reports include massive hemorrhage, arteriove...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02002344
更新日期:1996-01-01 00:00:00
abstract::Injection drug users frequently present with abscess, cellulitis, and endocarditis. The development of arterial mycotic pseudoaneurysm (AMP) as a sequela of injection drug use, however, is much less frequently reported. We undertook a study to determine the prevalence and presenting clinical characteristics of AMP, ut...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-001-0124-6
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND:Significantly reduced amputation rates for traumatic popliteal artery injuries have been achieved with improved revascularization and resuscitative techniques. Predictive scores have failed to accurately predict outcomes in patients who sustain popliteal artery damage. This study aimed to identify predictors...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2013.06.017
更新日期:2014-01-01 00:00:00
abstract::We describe the technique using high-volume three-dimensional coils to "augment" an insufficient stent-graft landing zone. This was performed to preserve hypogastric artery perfusion in the case of common iliac artery aneurysm which resides next to the internal iliac artery. ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.03.191
更新日期:2017-08-01 00:00:00
abstract::Advanced complicated atherosclerotic lesions have been related to many factors, including inflammation, infectious agents, and growth factors. Mycoplasma pneumoniae (MP) and Chlamydia pneumoniae (CP), inflammation, and growth factors have been associated with severe atherosclerotic lesions in necropsy material in rece...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-006-9076-1
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:Fully implantable catheters are important for oncology treatments. They can be functionally categorized as valved or nonvalved. Theoretically, a valve prevents spontaneous blood reflux into the catheter, reducing the incidence of complications. We sought to compare the results from the implantation of valved...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2013.01.025
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:Crossed-fused renal ectopia is a rare anomaly that poses a therapeutic challenge in the management of abdominal aortic aneurysms (AAAs). Such challenges include preservation of renal blood flow in the setting of multiple aberrant renal arteries and ureteral anomalies. Several surgical approaches to this dile...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.05.016
更新日期:2011-10-01 00:00:00
abstract::Stable coil placement is an imperative when treating arterial pathology at branch points. Coil kick and escape threaten distal organs, particularly as the pack tightens. Before the development of the VBX balloon-expandable stent graft (W.L. Gore, Flagstaff, AZ), vessel caliber change often precluded straightforward st...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2020.05.026
更新日期:2020-11-01 00:00:00
abstract::Cervical aortic arch (CAA) is a rare vascular malformation which sometimes accompanies other cardiovascular malformations. Surgical approaches such as a lateral thoracotomy and a median sternotomy are selected depending on the position and type of aneurysm and other associated malformations. We herein report the case ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2007.07.028
更新日期:2008-01-01 00:00:00
abstract::Isolated arterial thrombi complicating inflammatory bowel disease occurs rarely. We encountered a case of a 28-year-old man with Crohn disease who presented with abdominal pain and severe claudication and was found to have an isolated aortoiliac thrombus. Bilateral aortoiliac thromboembolectomies were performed with s...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2012.02.022
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:Hereditary hemorrhagic telangiectasia (HHT) is a rare disease consistent in vascular dysplasias affecting different organs. Liver involvement includes telangiectases, arteriovenous shunting, and ischemic cholangitis, and its prevalence ranges from 8% to 31%. Spontaneous pseudoaneurysms have never been report...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.12.022
更新日期:2017-10-01 00:00:00
abstract::Treatment of infected aneurysms consists of operation, which depends on the location and pathologic type, and antibiotic therapy, before and at least six weeks following operation. The authors present a case of two consecutive aneurysms occurring in a patient with Salmonella infection. Full recovery was obtained after...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)60783-8
更新日期:1988-01-01 00:00:00
abstract:BACKGROUND:Transcarotid artery revascularization (TCAR) has been shown to have half the rates of transient ischemic attack (TIA), stroke, and death compared with transfemoral carotid artery stenting (TFCAS). Successful outcomes of TFCAS require careful patient selection. The aim of this study was to determine the outco...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.04.016
更新日期:2020-08-01 00:00:00
abstract::True and false aneurysms of veins are very rare conditions and only few cases have been described in the literature. We present a case of a 56-year-old female with personal history of primary arterial hypertension and connective tissue disease. Ultrasound of the neck showed a saccular, compressible, hypoechoic structu...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.09.017
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:The aim of the study is to determine whether performing endovascular aortic aneurysm repair (EVAR) in a dedicated vascular hybrid operating room (OR) is associated with a decreased patient radiation and contrast dose compared with mobile C-arm imaging in a conventional OR. METHODS:This is a retrospective st...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.04.019
更新日期:2019-11-01 00:00:00
abstract::From 1981 to 1995 a total of 14 patients with a mean age of 52 years (range: 23-71) underwent surgery for 15 aneurysms of the extracranial internal carotid artery. Fusiform aneurysms of the carotid bifurcation were not included in this study. Aneurysm led to brain ischemia in 10 cases and rupture in one case. In the r...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900079
更新日期:1997-09-01 00:00:00
abstract::We present a case of totally robotic ligation of the inferior mesenteric artery (IMA) for treatment of a persistent endoleak from the IMA into the aneurysm sac after endovascular aneurysm repair (EVAR). An 84-year-old male underwent EVAR with a Gore Excluder stent graft for an asymptomatic infrarenal abdominal aortic ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2008.02.019
更新日期:2009-03-01 00:00:00
abstract::Situs inversus is a rare congenital defect defined by a mirror image anatomic variation of the thoracic and abdominal organs. In this situation, abdominal aortic surgery may become particularly challenging. This is the case of a 51-year-old man, who presented with an incapacitating lower limb claudication. On his work...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.02.023
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:Acute type B aortic dissection (AoD) with malperfusion is a rare and complex disease. In this specific setting, invasive treatment is generally required to improve aortic branch vessel flow. Thoracic aorta stent grafting (TEVAR) of the proximal descending thoracic aorta to cover/exclude the proximal intimal ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.avsg.2019.01.030
更新日期:2019-08-01 00:00:00
abstract::Between 1982 and 1991 we performed eight operations on seven patients with carotid artery aneurysms. Their mean age was 52.8 years (range: 20-67 years). Five aneurysms were atherosclerotic, one was associated with Marfan's syndrome, and two were pseudoaneurysms, one occurring after Dacron patch angioplasty and the oth...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02015273
更新日期:1991-11-01 00:00:00
abstract:BACKGROUND:Endovascular management of complex aortoiliac occlusive disease (AIOD) has been described as a viable alternative to open surgical reconstruction. To date, few studies have directly compared the 2 techniques. We therefore, evaluated short and mid- term outcomes of open and endovascular therapy in TASC II D A...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.06.005
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Patient-centered quality outcomes such as disposition after surgery are increasingly being scrutinized. Preoperative factors predictive of nonhome discharge (DC) may identify at-risk patients for targeted interventions. This study examines the association among preoperative risk factors, frailty, and nonhome...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.01.052
更新日期:2016-08-01 00:00:00
abstract::The purpose of this review is to define animal models of chronic venous disease and to demonstrate how animal studies can impact our understanding and treatment of this disorder. To this end an extensive literature search was conducted highlighting potential animal models of chronic lower extremity venous disease. Sci...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1007/s100169900190
更新日期:1998-09-01 00:00:00
abstract::Compression of adjacent anatomic structures by an abdominal aortic aneurysm (AAA) can result in a variety of symptoms. We describe the case of an 88-year-old Caucasian woman with jaundice, elevated laboratory parameters for extrahepatic and intrahepatic cholestasis, and concomitant juxtarenal AAA compressing the liver...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.04.080
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Infection of a renal artery stent and pseudoaneurysm is extremely uncommon, with four reports in the literature. We present a fifth case and the complex management resulting in kidney salvage. METHODS AND RESULTS:A 56-year-old female underwent right renal artery stenting for hypertension. Postoperatively, s...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2009.06.018
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:We report a rare case of severe spinal cord ischemia with neurological consequences in a patient who presented after endovascular treatment of a type II endoleak following endovascular aneurysm repair. METHODS AND RESULTS:An enlarging abdominal aortic aneurysm post-endovascular aneurysm repair was detected ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.12.018
更新日期:2012-08-01 00:00:00
abstract::Serefeddin Sabuncuoğlu, a pioneer of surgery, is known to be the author of first illustrated surgery textbook, Cerrahiyyetu'l Haniyye (Imperial Surgery), which was written in Turkish in 1465 AD at the age of 80 years. The purpose of this article is to describe his contributions to varicose vein surgery. In addition to...
journal_title:Annals of vascular surgery
pub_type: 传,历史文章,杂志文章
doi:10.1007/s10016-003-0012-3
更新日期:2003-07-01 00:00:00
abstract::From February 1985 through November 1988, we performed 159 transluminal angioplasty in 135 patients with arterial occlusive disease of the lower limb. The indications were claudication, 114 cases (72%) and limb salvage, 45 cases (28%). Lesions consisted of one or more critical stenoses in 142 cases (61 iliac, 69 femor...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)60832-7
更新日期:1990-11-01 00:00:00
abstract::Twenty-four patients who underwent surgery for pararenal aortic aneurysms between January 1992 and April 1997 are reviewed. Eighteen patients had primary atherosclerotic aneurysms, three patients had symptomatic infected aneurysms, two patients had an aneurysm proximal to a prior aortic repair, and one patient had a p...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900164
更新日期:1998-07-01 00:00:00