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Intra-aortic balloon pump (IABP) insertion in critically ill patients has been associated with both vascular and nonvascular complications, which have restricted its use. The primary objective for this study was to determine the frequency and predictors of vascular complication in our centre.We conducted a retrospective cohort study of consecutive patients treated with an IABP between January 2014 and June 2018. Baseline clinical characteristics, cannulation details, duration of treatment and management, overall mortality, and complications were extracted from electronic and paper medical records.A total of 187 patients required an IABP; of these, 146 were male (78.1%), the average age was 65.2 ± 11.5 years, and body mass index was 26.8 ± 6.2 kg/mThis single-centre retrospective study demonstrated that more than one third of this patient population died secondary to their primary diagnosis. The incidence of vascular complications secondary to IABP insertion remained low, with less than 3% developing an ischemic limb.L’insertion d’un ballon de contrepulsion intra-aortique (BCPIA) chez les patients dont l’état est critique est associée à des complications à la fois vasculaires et non vasculaires, ce qui limite son utilisation. L’objectif principal de cette étude était de déterminer la fréquence des complications vasculaires dans notre centre ainsi que les facteurs prédictifs de ces complications.Nous avons mené une étude de cohorte rétrospective auprès de patients traités consécutivement par BCPIA entre janvier 2014 et juin 2018. Les caractéristiques cliniques initiales, les détails sur la canulation, la durée du traitement et de la prise en charge, la mortalité globale et les complications ont été extraits des dossiers médicaux électroniques et en format papier.Au total, un BCPIA a été nécessaire chez 187 patients; 146 d’entre eux étaient des hommes (78,1 %), l’âge moyen était de 65,2 ± 11,5 ans, et l’indice de masse corporelle moyen était de 26,8 ± 6,2 kg/mCette étude de cohorte rétrospective unicentrique a permis de démontrer que plus d’un tiers des patients de la population à l’étude sont décédés des suites de leur diagnostic primaire. L’incidence de complications vasculaires secondaires à l’insertion d’un BCPIA est demeurée faible, avec moins de 3 % des patients présentant une ischémie d’un membre.

Objectives Choosing an optimal amputation level requires balance between maximizing limb salvage while minimizing chances of non-healing wounds and re-amputation. Our aim was to assess the long-term outcome for minor amputations in patients with peripheral vascular disease. Methods A retrospective study of minor amputations between January 1, 2005 and December 31, 2015 was performed. Electronic medical records of eligible patients were examined to extract demographics, co morbidities and clinical data. Results Within the study period, 220 patients underwent 296 primary minor amputations in 244 lower extremities. Wound healing was achieved in 18.2% (54 of 296 amputations) and 43.6% (129 of 296 amputations) at 90 days and 365 days, respectively. Rates of progression to major amputation were 16.4% (40 or 244 limbs) and 21.7% (53 of 244 limbs) at 90 days and 365 days, respectively. In the final multivariate model, lower ipsilateral posterior tibial waveforms predicted poor 90-day healing (OR = 2.22, p = 0.01) as well as limb loss (OR = 3.02, p = 0.02) in a dose-response manner. In the final logistic regression model, emergency department admission (OR = 0.20, p Conclusion This study shows that a majority of foot amputees require ongoing care for non-healing wounds and a proportion necessitate conversion to major amputation. Adequate vascularization is essential to promote and maintain healing.

Smoking is the single most important modifiable risk factor for patients with vascular disease. The aim of this study was to determine the prevalence of smoking and cessation rates among patients undergoing vascular surgery in a Canadian center.As part of the Vascular Quality Initiative, a prospectively maintained database was used to identify the patients undergoing vascular surgery between 2010 and 2013. Smoking prevalence data were collated preprocedure, postprocedure, and at year follow-up after intervention at a median of 13 months (mean = 14.4 ± 7.8 months). Cessation rates at 13-month follow-up were assessed to determine any statistically significant univariate factors. These factors were then used to build a model through backwards logistic regression. Multicollinearity was tested by assessing both variance inflation factors and tolerance.Overall, 624 patients had complete follow-up data. Of these, 209 (33.5%) were smokers presurgically. At 1-year follow-up, of those 209 patients who were smokers preoperatively, 87 (41.6%) had stopped smoking while 122 (58.4%) had not. Patients who were male and aged70 years were more likely to be smokers preoperatively (P = 0.001 and P 0.001, respectively). Cessation rates were increased in those aged70 years (P = 0.005) and in those with chronic obstructive pulmonary disease (P = 0.016). Gender was also statistically associated, with cessation rates higher in females (P = 0.011).More than one-third of patients who underwent surgery in a Canadian vascular center continue to smoke. Uniquely, we report a statistically significant association between gender and postoperative cessation rates.

The impact of aneurysm thrombus characteristics on type 2 endoleak rate following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is unclear. The purpose of this study is to determine the impact of pre-operative aneurysm thrombus volume and density on the incidence of type 2 endoleak following EVAR for infrarenal AAA.A retrospective analysis was completed on all patients who underwent standard EVAR at an academic medical institution between May 1, 2010 and June 1, 2016 with a minimum follow-up period of 12 months. The final analysis included 170 patients. Thrombus volume and density were determined by analyzing pre-operative computed tomography angiography (CTA) scans using the TeraRecon plaque analysis module. The number and diameter of patent infrarenal aortic branch vessels were also identified. Type 2 endoleak was diagnosed by post-operative CTA, duplex ultrasound, or angiography.Over a median follow-up period of 29 months, 88 (51.8%) of 170 patients had a type 2 endoleak. The thrombus volume as a proportion of the infrarenal aorta volume was significantly lower in patients with type 2 endoleak (odds ratio [OR] 0.034, 95% confidence interval [CI] 0.005-0.291, P = 0.002). The number of patent lumbar arteries was significantly greater in patients with type 2 endoleak (OR 1.45, 95% CI 1.16-1.56, P 0.0005). Both variables independently predicted the incidence of type 2 endoleak in a multivariate analysis. Thrombus density was not related to the incidence of type 2 endoleak.A lower ratio of thrombus volume/infrarenal aorta volume and a higher number of patent lumbar arteries were associated with an increased incidence of type 2 endoleak. A multivariate logistic regression model was generated to pre-operatively predict the risk of type 2 endoleak. This model can guide the stratification of patients for intensity of endoleak surveillance following EVAR and consideration of pre-operative treatment.

Vascular complications (VCs) remain a significant cause of morbidity in transcatheter aortic valve implantation (TAVI) patients and are associated with worse outcomes. This research analysed the incidence, impact, and predictors of VCs in transfemoral cases.A retrospective chart review was performed of 388 consecutive TAVI patients between January 2007 and April 2015, which included 237 transfemoral cases. Major and minor VCs were characterised according to the Valve Academic Research Consortium (VARC) guidelines. Logistic regression was completed to identify predictors of VCs.While VCs occurred in 68 (28.7%) cases, only seven (3.38%) were classified as major complications. Twenty-six (10.9%) of these complications occurred intra-operatively, with four being major (1.6%) and 22 minor (9.3%). Post-operative VCs occurred in 42 cases (17.2%), with three (1.3%) being major. Procedures to correct VCs occurred in 10 (4.2%) cases, with the majority (90%) being surgical and the remainder being treated by endovascular techniques. Nine surgical procedures, predominantly embolectomy, were performed to correct post-operative complications. Female gender was a predictor of all major VCs (B = -2.1, p .006). Further, a logistic regression analysis found that when the largest sheath was located on the left side, there were increased minor post-operative complications (B = -0.99, p = .007). Dissections and haematomas made up the majority of VCs. Thirty day mortality was six patients (n = 2.5%), and peri-operative VCs were significantly correlated with 30 day mortality (p = .001, R = 0.21). The 30 day readmission rate comprised nine patients (3.8%), with three (1.3%) due to VCs, including haematomas and groin infections.VCs contribute to operative morbidity in TAVI patients. This study demonstrated low major VC rates over an eight year period. Left sided location of largest sheath size and female gender were predictors of VC.

Objectives: This study assessed the safety and efficacy of cyanoacrylate glue embolization (CGE) for the treatment of refluxing varicose veins. Methods: A prospective registry was created starting January 2014 for all patients with refluxing varicose veins undergoing CGE at a single center. Neither tumescent anesthesia nor postinterventional compression stockings were incorporated into the treatment. All patients underwent clinical examination and duplex ultrasound evaluation at 2 and 6 months postprocedure. Results: CGE was performed in 67 patients or 103 extremities with 108 vein segments. Target vein segments included 82.4% (89 of 108) great saphenous veins, 12.0% (13 of 108) short saphenous veins, and 5.6% (6 of 108) accessory saphenous veins. The treated segment lengths had a range from 12 cm to 63 cm. Technical success, defined as complete closure of the refluxing vein immediately after the procedure diagnosed by duplex ultrasound, occurred in 100% (108 of 108) of vein segments. The procedure was well tolerated, with only 10.4% (7 of 67) of patients experiencing venospasm. Ultrasound results were available for 80.6% (54 of 67) and 46.3% (31 of 67) of patients at 2 and 6 months, respectively. Only one of 108 target vein segments demonstrated recanalization. The target vein segment occlusion rate at 6 months was 96.8% (30 of 31). No cellulitis or postprocedural paresthesia was reported. No serious adverse events, including deep vein thrombosis, occurred. Conclusions: CGE of refluxing varicose veins is safe and effective without the use of compression stockings or tumescent anesthesia at 6 months.

Objectives Postoperative stump pain after major lower limb amputation is a significant impediment to the recovery of amputees. The vast majority of patients require opioid analgesics following surgery, which are associated with opioid-related side-effects. Here, we investigate whether intraoperative placement of a peripheral nerve stump catheter followed by continuous infusion of local anesthetic is as effective at pain control as current analgesic practices. If beneficial, this procedure could potentially reduce post-amputation opioid consumption and opioid-related adverse effects. Methods A retrospective chart review was conducted of 198 patients over a 4-year period who had undergone a major lower limb amputation for indications related to peripheral vascular disease. Postoperatively, 102 patients received a perineural catheter were compared to 96 patients who did not. The primary outcomes of this study were the amount of morphine equivalents used in the first 72 hours postoperatively and postoperative pain intensity in the first 24 hours. Results A total of 198 lower-limb amputations were selected for analyses. Multiple regression analyses indicated that perineural catheter use was associated with a lower cumulative postoperative opioid consumption over the first 72 hours but not postoperative pain scores at 24 hours. Perineural catheter use led to a 40% reduction in opioid use during the first 72 hours postoperatively. Mixed model repeated measures analysis demonstrated that this opioid reduction was consistent over time. Other variables related to total opioid use included age, pre-surgical chronic pain, pre-surgical opioid use, patient-controlled analgesia. Conclusions Continuous perineural infusions of local anesthetic are a safe and effective method for reducing post-amputation opioid analgesic medications after major lower limp amputation.