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Endovascular Strategies in the Management of Acute Limb Ischemia
Benjamin Lind,Omar Morcos,Hector Ferral,Allen Chen,Thomas Aquisto,Stephen Lee,Cheong Jun Lee 대한혈관외과학회 2019 Vascular Specialist International Vol.35 No.1
Acute limb ischemia (ALI) represents one of the most common emergent scenarios encountered by a vascular specialist. Despite expedient revascularization, high rates of limb loss are reported along with high mortality rates which are second only to ruptured abdominal aortic aneurysms. Surgical revascularization is stan-dard of care. Endovascular techniques as an alternative have emerged to be appro-priate first line therapy when addressing the threatened limb. We review the etiol-ogy and classification of ALI and current endovascular techniques and evidence to date in the management of patients acutely presenting with extremity ischemia.
Contemporary Unplanned Readmission Trends Following Management of Type B Aortic Dissection
Ashley J. Williamson,Seth Sankary,Kristine Marie Kuchta,Sara Gaines,Omar Morcos,Benjamin Lind,Luka Pocivavsek,Anahita Dua,Cheong J. Lee 대한혈관외과학회 2022 Vascular Specialist International Vol.38 No.2
Purpose: Large studies have demonstrated improved survival outcomes with thoracic endovascular aortic repair (TEVAR) at two and five years compared to medical therapy; however, early TEVAR for acute type B aortic dissection (TBAD) remains controversial. We aimed to evaluate trends and clinical predictors of hospital readmissions in patients undergoing medical management and TEVAR for acute TBADs. Materials and Methods: The Nationwide Readmissions Database was queried for all 30-day and 90-day index readmissions (30D-IR and 90D-IR, respectively) after a diagnosis of a TBAD from January 2012 to September 2015. Data on readmission diagnosis, patient demographics, and hospital characteristics were collected from readmitted patients and analyzed. Multivariable logistic regression models were used to identify the predictors of readmission after TEVAR or medical medical management of TBAD. Results: We identified 53,117 patients with acute TBAD. Medical management was the initial treatment modality in 46,985 (88.4%) patients, while 6,132 (11.5%) underwent TEVAR. Factors including older patient age, lower household income, severity of comorbidities, initial hospital length of stay, and urgent procedure demonstrated an increased likelihood of experiencing 30D-IR and 90D-IR (P<0.05). The rate of unplanned readmission for patients undergoing medical management remained stable (11.3% vs. 10.0% for 30D-IR; 19.1% vs. 15.5% for 90D-IR). Reasons for unplanned readmission in the TEVAR cohort were largely related to technical complications. There was no significant difference in readmission costs between medical management and TEVAR. Conclusion: Number of unplanned readmissions in the TEVAR arm decreased significantly over time, whereas the number of readmissions for medical management remained stable.