Short-term predictors and long-term outcome after ruptured abdominal aortic aneurysm repair.

Few data exist in regard to long-term and functional outcome after ruptured abdominal aortic aneurysm (rAAA) repair. The present study provides such follow-up and defines the impact of variables used to grade resuscitation efforts [base deficit (BD) and core temperature (cT)]. One hundred forty-seven patients presenting with rAAA were retrospectively reviewed. Overall perioperative mortality was 35 per cent (51/147) and mean age was 72 years. Survival data were available for 99 per cent of patients with a mean and median follow-up of 45 months. Life table analysis revealed one-, 2-, and 5-year survival to be 81, 75, and 58 per cent, respectively. Eighty-three per cent of patients reported a quality of life equal to that of their preoperative status. Both initial cT (P = 0.02) and BD (P = 0.03) were significantly associated with perioperative mortality. Using a logistic regression model cT remained a significant factor (P = 0.006) associated with survival. Smoking, hypertension, diabetes, chronic obstructive pulmonary disease, mode of transportation, and surgeon's training were not significant. Despite the advanced age of the present cohort, acceptable perioperative mortality and long-term survival rates were attained. The majority of patients resumed a lifestyle comparable to that of their preoperative state; therefore, long-term longitudinal follow-up suggests that aggressive management with rapid correction of BD and cT results in excellent functional outcome.

Femoral artery pseudoaneurysms: risk factors, prevalence, and treatment options.

Femoral artery pseudoaneurysms (PSA or false aneurysm) develop in about 1% of patients undergoing procedures that require femoral artery cannulation. PSA prolong hospitalization, consuming health-care resources, and result in significant morbidity. We designed a study to review the prevalence, risk factors, and treatment of PSA. We performed a retrospective, case-controlled study of patients diagnosed with PSA at a large, urban, tertiary-care teaching hospital. We reviewed 48 patients with PSA for our study. The estimated prevalence of PSA was 0.28%, with identical rates found for procedures done in the interventional radiology department and in the cardiac catheterization suite. Logistic regression identified three independent risk factors for developing PSA: being female (odds ratio 2.62), having an intervention performed (odds ratio 3.22), and not having a closure device used (odds ratio 10.2). Patients with PSA had longer hospital length of stay than that of patients without PSA. We found no statistically significant difference in failure or complication rates for the four treatment options and that spontaneous resolution of PSA does not correlate with its size. Thrombin injection and observation are effective, low-complication treatment options.

Opioid growth factor inhibits intimal hyperplasia in balloon-injured rat carotid artery.

OBJECTIVE: The endogenous opioid [Met(5)]-enkephalin (opioid growth factor [OGF]) is a tonically active, receptor-mediated inhibitory growth peptide in developing and adult vasculature. This study was designed to determine the role of OGF in neointimal hyperplasia. METHODS: The carotid artery in adult male Sprague-Dawley rats was denuded with balloon catheterization. OGF (10 mg/kg), the opioid antagonist naltrexone (NTX; 30 mg/kg), or saline solution (0.2 mL) was injected intraperitoneally daily for 28 days into the rats, and restenosis of the carotid artery was examined with morphometric analysis using Optimas software. Proliferation of the neointima and media was measured by radioactive thymidine incorporation over 3 hours. The presence of OGF and its receptor, OGFr, were examined with immunofluorescence microscopy. RESULTS: OGF depressed DNA synthesis in the intima and media from 16% to 78% of control levels in the first 2 weeks after deendothelialization, whereas NTX exposure elevated DNA synthesis by 21% to 89%. OGF action was receptor-mediated. In the month after injury the thickness of the intima in OGF-treated rats was decreased by 18% to 31% from control values, whereas intimal thickness was increased in the NTX group by 10% to 31%. Luminal area was almost 25% greater than control values in the OGF group, but was reduced 17% by NTX. OGF and the OGF receptor were detected in the carotid artery with immunohistochemistry. CONCLUSIONS: These results demonstrate for the first time that a native opioid system modulates repair of vascular injury. OGF is a constitutively active peptide that has a receptor-mediated action in the negative regulation of neointimal growth, a major cause of restenosis.