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were independent predictors of amputation and functional limb at follow-up in our logistic regression model (P < .05). The median length of stay was 11 days, and 25% of patients were discharged to a skilled nursing facility. Follow-up was available for 59% of patients, and for UE injuries, 57% of patients had no or minimal functional deficits, 33% had major functional deficits, and 10% had undergone amputation. For LE injuries, 68% of patients had no or minimal functional deficits, 6% had major functional deficits, and 26% had undergone amputation. Conclusions: Revascularization for traumatic ALI yields high LS in patients with Rutherford classification 1 and 2 ischemia and in patients with UE injuries. However, LS does not necessarily equate to good functional outcomes, likely signifying the complex injuries in these patients requiring multiple operations to attain LS.

Objective: The objective of this study was to assess the durability of multibranched endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms by examining the rates of late-occurring (beyond 30 days) complications.Methods: There were 146 patients who underwent endovascular TAAA repair using a stent graft, with a total of 538 caudally oriented self-expanding branches. Four patients died in the perioperative period and were excluded, leaving 142 patients (mean age, 73 6 8 years; 35 [24.7%] women). Follow-up included clinical examination and computed tomography angiography at 1 month, 6 months, and 12 months and yearly thereafter.Results: Mean aneurysm diameter was 67 6 9 mm. Sixty-seven TAAAs (47.2%) were Crawford type I, II, III, or V; 75 (52.8%) were type IV or pararenal. Three patients (2.1%) died >30 days after operation from perioperative complications. During a mean follow-up of 36 months (628 months), there were four additional aneurysm-related deaths: one (0.7%) as a result of aneurysm rupture in the presence of untreatable type I endoleak, one (0.7%) after conversion to open repair for stent graft infection, one (0.7%) after occlusion of superior mesenteric artery and celiac branches, and one (0.7%) due to bilateral renal branch occlusion. There was one additional open conversion for stent graft infection (0.7%). Nineteen patients (13.3%) underwent 20 reinterventions for late-occurring complications, including 11 (7.7%) for renal branch occlusion or stenosis, 1 (0.7%) for mesenteric branch stenosis, 4 (2.8%) for graft limb occlusion, 1 (0.7%) for type IB endoleak (distal stent graft migration), and 1 (0.7%) for type III endoleak (fabric erosion); 2 (1.4%) open conversions were performed for stent graft infection. There were no late type IA endoleaks. By Kaplan-Meier analysis, freedom from aneurysm-related death was 91.1% and freedom from aneurysm-related death or reintervention was 76.8% at 5 years. The 5-year overall survival rate of 49.1% reflects the high rate of cardiopulmonary comorbidity. Although renal branch occlusion (23 occlusions of 256 renal branches [8.9%]) was the most common late complication, only five patients required permanent dialysis.Conclusions: Total endovascular repair of TAAAs and pararenal aortic aneurysms using axially oriented cuffs is safe, effective, and durable in the long term.

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WHAT THIS PAPER ADDS This observational cohort study shows that controlling blood glucose levels with an intravenous insulin infusion after branched endovascular aneurysm repair is associated with a decreased risk of post-operative lower extremity weakness. Tight control of blood glucose should be considered in patients undergoing extensive endovascular aortic procedures to minimise the risk of post-operative lower extremity weakness. Objective/background: It has previously been shown that post-operative lower extremity weakness (LEW) is associated with elevated blood and cerebrospinal fluid (CSF) glucose levels after branched endovascular aneurysms repair (BEVAR) of extensive aortic aneurysms. The purpose of this study was to determine whether a post-operative insulin infusion protocol (IIP) to achieve tight blood glucose control decreases the rate of LEW. Methods: From October 2013, blood and CSF samples were collected pre-operatively, immediately postoperatively, and on post-operative day one in asymptomatic patients undergoing BEVAR. In July 2016, an IIP was initiated to maintain post-operative blood glucose levels <120 mg/dL for 48 h. Data on demographics, operative repair, complications, and outcomes were collected prospectively. Results: Between October 2013 and April 2018, 43 patients underwent BEVAR. Twenty-two (group A) underwent BEVAR before initiation of the IIP. Of these, seven (32%) developed LEW within 48 h of repair. This was temporary in five (23%) and permanent in two (9%) patients. Post-operative blood glucose levels were significantly higher in patients with LEW compared with those without LEW (140 AE 27 mg/dL vs. 117 AE 16 mg/dL; p ¼ .02). Postoperative CSF glucose levels were significantly higher in patients with LEW compared with those without LEW (102 AE 15 mg/dL vs. 77 AE 15 mg/dL; p ¼ .001). The subsequent 21 patients (group B) underwent BEVAR after initiation of the IIP. No patient in group B developed LEW while on the IIP, but one (5%) developed paraplegia on post-operative day four. The rate of early LEW (<48 h post-operatively) was significantly lower after initiation of the IIP (32% in group A vs. 0% in group B; p ¼ .009). There was no difference in demographics, comorbidities, or operative time between the groups. Conclusion: An IIP to control blood glucose after BEVAR is associated with a decreased rate of post-operative LEW. Tight control of blood glucose should be considered after any extensive aortic reconstruction to minimise the risk of post-operative LEW.