The results of this study show that: (1) colonic ischemia after rAAA may be predicted with the presence of two or more specific perioperative factors, (2) the lack of a guaiac-positive bowel movement may be misleading for the early diagnosis of colonic ischemia, and (3) more than 50% of the patients with colonic ischemia will require a colonic resection. We recommend that any patient with rAAA with more than two perioperative factors undergo sigmoidoscopy every 12 hours after surgery for 48 hours to rule out colonic ischemia without waiting for early or guaiac-positive bowel movement.

No abstract

Predisposing factors for a lung abscess in infancy include prematurity, assisted ventilation, congenital lung anomaly and aspiration. Given the range of potential pathogens, direct culture by CT-guided fine needle aspiration is recommended to direct appropriate intravenous medical therapy provided the abscess is located peripherally.

wire. After endograft predilation, an Atrium ICAST 8-to 10-mm stent is deployed approximately one-quarter into the lumen and three-quarters into the branch vessel. The endograft portion of the covered stent is then flared and a completion angiogram performed.Results: Six patients (3 men, 3 women), mean age of 50 years, underwent left SCA laser fenestration with TEVAR. All had hypertension, and four (67%) had a history of smoking, hypercholesterolemia, or congestive heart disease. Two patients had Marfan syndrome and two patients had previous aortic root replacement. Five patients had acute dissections, two with an intramural hematoma. One patient had a penetrating aortic ulcer distal to the left SCA after previous ascending aortic repair. Mean aortic size was 43 mm (range, 28-80 mm). Mean contrast volume was 101 Ϯ 51 mL. Mean operative time was 180 Ϯ 38 minutes. Technical success was 83% (n ϭ 5). One fenestration attempt was abandoned secondary to the acute angle of the SCA and a type III aortic arch. The SCA stent in this case was snorkeled into the aorta proximal to the endograft, revascularizing the SCA with no clinical consequences. Mean length of hospital stay was 9 Ϯ 3 days. At the mean follow-up of 5.2 months (range, 1-11 months), all SCA stents were patent with no fenestration-related endoleaks. There were also no fenestration-related complications. One patient underwent aortic root replacement of a retrograde aortic dissection. Mortality for our patient population was zero.Conclusion: In situ retrograde laser fenestration is an innovative, feasible, and effective option for revascularizing the SCA during TEVAR.

The management of cosmetic vein problems requires a very different approach than that for the majority of most other vascular disorders that occur in a vascular surgery practice. This article focuses on the business aspects of a cosmetic vein practice, with particular attention to the uniqueness of these issues. Managing patient expectations is critical to the success of a cosmetic vein practice. Maneuvering within the insurance can be difficult and frustrating for both the patient and the practice. Practices should use cost accounting principles to evaluate the success of their vein work. Vein surgery--especially if performed within the office--can undergo an accurate break-even analysis to determine its profitability.