23,31,32 One common etiology of mechanical trauma to the bowel is the manipulation and retraction of intra-abdominal EPZ-5676 molecular weight structures by surgical sponges, gauze, and towels. This trauma is believed to arise by at least two specific mechanisms: direct mucosal or serosal abrasion and retained remnant fibers left behind after removal of the surgical sponges, gauze, and towels. There is compelling experimental and clinical evidence linking both Inhibitors,research,lifescience,medical of these etiologies to the increased formation of adhesions.29,33–35 Clear evidence of the role of these foreign bodies in adhesion formation can

be seen in the cross-sectional, multi-institutional study that reported that 26% of patients with adhesions had evidence of associated foreign body granulomas on examination.36 It has also been demonstrated in several animal models that the use of less abrasive gauze, silicone, or foam-composite material may, in fact, result in the formation of fewer postsurgical adhesions.1,33,35 Consequently, it has been postulated that limiting the use of surgical sponges and towels that are abrasive or Inhibitors,research,lifescience,medical known to leave behind foreign fibers or lint may help prevent the formation

of adhesions after abdominal or pelvic surgery. Alternative strategies for bowel retraction need Inhibitors,research,lifescience,medical to be identified in order to replace the use of surgical towels and sponges. An additional avenue of research has focused on the use of anti-adhesive agents that could serve as a barrier to prevent adjacent structures from being linked by forming adhesive bands.23 Although several of these agents have shown some promise in preventing adhesions,37–43 results have often been conflicting and none have been able to demonstrate an ability to reduce the frequency of adverse Inhibitors,research,lifescience,medical clinical outcomes such as small-bowel obstruction, infertility, Inhibitors,research,lifescience,medical or pain in a randomized, controlled trial.23,44–46 Lap Pak The ideal way to avoid the aforementioned problems attributed to sponges

and towels in abdominal surgery is to develop a technique for retraction of the abdominal contents that eliminates the requirement for these foreign bodies. Lap Pak (Seguro Surgical, Columbia, MD) is a disposable radio-opaque device that is made of silicone and retracts the bowels in a cephalad orientation Batimastat without the need for towels or sponges (Figure 1). The device is malleable and has an inverted U cutout that accommodates the root of the mesentery and the sigmoid colon. The inert and atraumatic surfaces of Lap Pak are in direct contact with the intestinal contents. The barrier-like device is secured in place using retractor blades. Initial experience suggests that Lap Pak is easiest to use with a table-mounted Bookwalter Retractor™ (Symmetry Surgical, Nashville, TN) or a table-mounted Bookler Retractor™ (Mediflex Surgical Products, Islip, NY). With experience, Lap Pak also has been successfully used with a Balfour retractor.

Recently, the Valve Academic Research Consortium (VARC) issued a consensus report suggesting definitions for vascular complications to allow standardization and comparison between studies.9 Major bleeding complications occurred in 16.2% of TAVR patients in the PARTNER B trial and 11.0% of TAVR patients in the PARTNER A trial.2, 3

Bleeding complications tend to occur more frequently and be more severe in transapical cases. Follow-up of patients who experience and survive a major bleeding event shows that it has an adverse effect on midterm survival.10 Avoiding major vascular complications requires careful patient screening and selection. Since complications can never be completely Inhibitors,research,lifescience,medical eliminated, it is important for the TAVR implanter to ensure that large occlusion balloons, covered stents, surgical instruments, and blood are readily available and to inform ancillary staff of plans should complications arise. Most importantly, the operator should not hesitate to use non-iliofemoral access if Inhibitors,research,lifescience,medical the iliofemoral vessels are inadequate. Conflict of Interest Disclosure: All authors have

completed and submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and the following was reported: Dr. Reardon is a consultant for Medtronics and is a principal investigator for the CoreValve® US Pivotal Trial. Funding/Support: The authors have no Inhibitors,research,lifescience,medical funding disclosures. Contributor Information Basel Ramlawi, Methodist DeBakey Heart & Vascular Center, The

Methodist Hospital, Houston, Texas. Javier E. Anaya-Ayala, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas. Michael J. Reardon, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas.
Medical scientists and cardiologists in particular have Inhibitors,research,lifescience,medical always been excited about breakthrough technologies Inhibitors,research,lifescience,medical that offer new modalities for treating common diseases. In cardiac surgery, the advent of the heart-lung machine led to groundbreaking procedures such as valve repair and replacement, www.selleckchem.com/products/ipi-145-ink1197.html coronary artery bypass, and heart transplantation. Interventional cardiology as a field began in 1977 when Andreas Gruntzig first began the practice of balloon coronary angioplasty. Coronary stent placement in the 1990s and drug-eluting CP-673451 molecular weight stent implantation in the 2000s took center stage in this field — and in cardiology in general. As complication rates declined precipitously and the indications for stent placement narrowed somewhat, interventional cardiologists searched elsewhere for new frontiers. The refinement of new imaging modalities such as echocardiography and magnetic resonance imaging focused attention on structural abnormalities of the heart. At the same time, an aging population made degenerative aortic stenosis a prime target for further therapeutic advances. In an often-cited statement in his 1931 textbook of cardiology, Paul Dudley White wrote: “There is no treatment for aortic stenosis.

35

These hints may imply that the problem of animal transmissible spongiform encephalopathies (TSEs) could be more widespread than generally assumed, and may call for drastic measures in the realm of farming. It is not impossible that humans carrying the agent may transmit it horizontally.36 The risks associated with the latter possibility can be met competently only if knowledge is accrued about the mode of transmission of the agent and the mechanism Inhibitors,research,lifescience,medical by which prions reach the brain upon peripheral inoculation into extracerebral sites. The rest of this review article is devoted to the analyzing the progress that has been made in these fields. The making of prions A noncommittal, operational definition37 says that the prion is the infectious agent that causes scrapie, BSE, CJD, other TSEs, such as chronic wasting disease

of mule deer and elk, and other less common diseases that affect, for example, exotic ungulates and captive felids. Obviously, although this definition is useful in that it facilitates understanding, it says nothing about the true Inhibitors,research,lifescience,medical physical nature of the agent. A very different definition that Inhibitors,research,lifescience,medical has become rather popular among yeast geneticists centers around the structural biology of prions. According to this second definition, prions are proteins that can exist in at least two different conformations, one of which is capable of inducing the conversion of further individual prion molecules from one conformation into the other. Therefore, prion proteins can serve as true genetic elements even if they do not contain informational nucleic acids, in Inhibitors,research,lifescience,medical that they are self-perpetuating and heritable.38 Nineteen years after the original formulation of the prion hypothesis by Stanley Prusiner (Figure 2), and 4 years after he was awarded the Nobel Prize in 1997, there continues to be uncertainty about the question of whether these two definitions coincide in the case of mammalian prions. One further problem is that all amyloids and their precursors

would fit the second definition, yet amyloid proteins themselves Inhibitors,research,lifescience,medical do not appear to be transmissible or infectious in vivo or in cell cultures. In the last few months, we have witnessed breathtaking advances in the understanding of prion phenomena in yeast, and there is no doubt that at least two yeast proteins exist that fulfill GSK-3 the above definition. It is generally believed that the ultimate experiment proving that a given protein is a prion is “in vitro conversion”: this term defines a cell-free manipulation by which the noncontagious conformation is transformed into a transmissible agent. Ideally, this manipulation should occur without participation of the pathological, transmissible prion, in order to formally exclude the possibility of cross-contamination. Two recent papers have shown that these conditions can be met in the case of the yeast prions identified so far, Sup3539,40 and Ure2p.41,42 Figure 2.

26 An arbitrary “1-year rule” is frequently used to “separate” them by proposing that onset, of dementia within 12 months of parkinsonism qualifies as DLB and more than 12 months of parkinsonism before dementia qualifies as Parkinson’s disease dementia (PDD).This is certainly helpful

in individual clinical case diagnosis and management, but is increasingly hard to justify from a neurobiological point of view. There do not seem to be major neuropathological differences between DLB and PDD, and it is not. possible to make a confident retrospective clinical diagnosis based on autopsy findings alone. A Task Force of the Movement. Inhibitors,research,lifescience,medical Disorders Society is presently addressing the issues of PD dementia, and its recommendations should help to Selleck LY2157299 clarify this complex and currently problematic

area. Clinical criteria for DLB The core clinical features of DLB, as defined by consensus criteria (Table II.);27 are fluctuating cognitive Inhibitors,research,lifescience,medical impairment, recurrent, visual hallucinations, and parkinsonism. The specificity of a clinical diagnosis of “probable DLB” (two or more core features present) is high at >80%,but sensitivity is generally limited to around 50%. 28 The use of the more lenient, “possible DLB” criteria, which require the presence of only one core feature, increases case detection rates Inhibitors,research,lifescience,medical at the cost of reduced diagnostic accuracy and may be useful in Inhibitors,research,lifescience,medical clinical practice for screening purposes.29 Table II. Consensus guidelines for the clinical diagnosis of probable

and possible dementia with Lewy bodies (DLB).27 Clinical presentation and course of DLB In general terms, the onset of DLB tends to be insidious, although reports of a period of increased confusion, the onset of hallucinations, or a significant fall may give the impression of a sudden onset. The main differential diagnoses of DLB are AD, vascular Inhibitors,research,lifescience,medical dementia, PDD, atypical parkinsonian syndromes, such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD), and also Creutzfeld-Jakob disease (CJD).27 The course of DLB is progressive, with cognitive test scores declining about. 10% per annum, similar to AD.30 Cognitive fluctuations may contribute to large variability in Ispinesib clinical trial repeated test scores, eg, five Mini-Mental State Examination (MMSE) points difference over the course of a few days or weeks,31 making it difficult, to be sure of the severity of cognitive impairment by single examination. Survival times from onset, until death are similar to AD,32 although a minority of DLB patients have a very rapid disease course.33,34 The clinical diagnosis of DLB rests on obtaining a detailed history of symptoms from the patient and an informant, mental state examination, appropriate cognitive testing, and neurological examination. Systemic and pharmacological causes of delirium need to be excluded.

This has led some to suggest that regions involved in the default network are actually suppressed

by the active task. In other words, the appearance of increased activity in the passive task is really better conceived as a suppression of activity by the active task. In a thoughtful description of one such form of hypothesized suppression, Corbetta and colleagues14 proposed that “deactivation” of certain regions overlapping the default network may be party caused by high tonic activity associated with the locus coeruleus/noradrenergic system. The locus coeruleus is a small midbrain nucleus that modulates cortical Inhibitors,research,lifescience,medical and subcortical brain activity through diffuse excitatory monoaminergic (norepinephrine) projections. Selleckchem Dactolisib During task-focused Inhibitors,research,lifescience,medical states, a decrease in tonic activity of the locus coeruleus to moderate levels, combined with an increase in task-locked transient activity, may promote optimal engagement in the immediate task.15 During passive task states, the system is characterized by a high tonic baseline. Deactivation of certain regions within the default network may be linked to activity modulation of the locus coeruleus

as a mechanism of modulating the locus of attention. It has been difficult to rule out the possibility that certain networks are actively suppressed by focused, attentionally demanding tasks and further that such suppression is the central Inhibitors,research,lifescience,medical cause of the observation of a “default network.” Adding a further complexity, studies of the monkey using intrinsic optical imaging of visual cortex suggest

that anticipatory arousal can modulate blood flow (the basis of positron emission tomography, [PET], and functional Inhibitors,research,lifescience,medical MRI [fMRI] measures) via neuronal mechanisms that are distinct from the transient activity modulations, which are the target of task-based neuroimaging studies.16 While it is unclear how such Inhibitors,research,lifescience,medical a physiological observation relates to the default network observed in the human imaging studies, the observation of a sustained anticipatory signal raises the possibility of a class of attentional effects that are insufficiently understood and that may be the source of the default network’s activity pattern during passive task states. Nonetheless, there is a favorably-alternative hypothesis that extends the ideas of Andreasen buy Bosutinib and colleagues.8 Internal mentation During passive moments, when demands to engage the external environment are relaxed, the mind wanders.17,18 Self-report data from neuroimaging tasks that activate the default network reveal that mind wandering and spontaneous thoughts occur frequently.8,19,20 When probed, the participants report that they are often thinking about future plans or about recent personal events. Rarely do they report attending to stimuli in the environment. Imagined events tend to be practical and free of fantasy-like qualities.

Importantly, however, the gains were not maintained after a 90-day period of non-juggling, providing important evidence that there are many constraints on plasticity, and that the familiar “use or lose it” adage was disappointingly relevant in this particular study. Other evidence shows that older men who played a demanding spatial navigational game every other day for 4 months exhibited stability of hippocampal volume over a 4-month period, whereas control subjects declined.34 Additionally, these trained subjects showed an increase in structural integrity

of the hippocampus which was maintained when training ceased. Overall, however, the evidence that one can improve volume of neural structures Inhibitors,research,lifescience,medical through training is relatively sparse. The limited data available suggest that gains that are realized from

a sustained training program most likely need to be maintained with continued performance. An important question is whether continuous improvement and challenge Inhibitors,research,lifescience,medical on a task is required to maintain gains, or whether mere maintenance of a high level of improved but asymptotic performance would be sufficient to preserve gains. It seems likely that it will be important for individuals to enjoy the Inhibitors,research,lifescience,medical tasks they are performing over the very long term so that the behavior can be sustained and gains maintained. This may be the greatest challenge associated with training the aging human brain. From a clinical perspective, daily “brain training” could become a boring and effortful task, such that gains realized might be offset by the negative consequences of performing a task that over time could become a dreaded obligation rather than a pleasurable and stimulating activity. Changes in neural activity A more common finding Inhibitors,research,lifescience,medical than volumetric increase is a change in neural activity with training. The change can be in the form of activation of new regions, or decreases or

increases in neural activity in task related structures that were activated before the training. Inhibitors,research,lifescience,medical The neural differences between pretest and post-test can be quite hard to interpret, and may or may not reflect a fundamental change in brain function or organization. Noack et al35 argue that many changes in activation as a result of training reflect flexibility in deployment of resources due to strategy change rather than a manifestation of plasticity resulting Batimastat in an increase in intrinsic neural or cognitive capacity. They argue that the rich knowledge base that accrues as we age provides an excellent mechanism for utilizing wisdom and knowledge to facilitate performance, rather than a true change in the neurocognitive system. They suggest that younger adults have more neural plasticity than old, and that the young are most likely to show an increase in intrinsic neural apply for it capacity with training, whereas the old are more likely to recognize gains due to flexibility in strategy use.

1% (HoLEP) and 38.6% (OP)

of patients at 3-month follow-up, whereas dysuria was significantly more frequent in the HoLEP group (68.2 vs 41.0%; P < .001).15 In contrast, the reported rate of transitory urge incontinence showed no significant difference in a multicenter RCT comparing HoLEP and TURP. Dysuria occurred significantly more often in patients after HoLEP (58.9% vs 29.5%; P = .0002).25 Hemorrhage requiring coagulation is reported in 0% to 6%31 and clot retention in 0%32 to 3.6%.22,33 Two meta-analyses have demonstrated that, Inhibitors,research,lifescience,medical in comparison with TURP and OP, patients undergoing HoLEP have a shorter catheterization time and hospital stay, reduced blood loss, and a smaller likelihood of blood transfusions, but comparable functional outcomes.11,12 In the meta-analysis by Tan and colleagues11 there were no statistically significant differences between pooled estimates between HoLEP and TURP for urethral stricture (2.6% vs 4.4%), blood transfusion (0% vs 2.2%), and re-intervention (4.3% vs 8.8%). However, the overall complication rate was 8.1% in Inhibitors,research,lifescience,medical the HoLEP group and 16.2% in the TURP group. Inhibitors,research,lifescience,medical Pooled data suggest that catheterization time, hospital stay, and blood loss were

significantly lower in the HoLEP group compared with TURP. In one meta-analysis, postoperative urgency was slightly higher in HoLEP patients and occurred in 5.6% and 2.2% of cases after HoLEP and TURP, respectively.13 Of note, in contradiction to the majority of comparative RCTs, more early and transient dysuria and urgency after HoLEP compared with TURP or OP may be encountered.15,17 An extensive review showed low complication rates, including Inhibitors,research,lifescience,medical perioperative mortality (0.05%), transfusion (1%), urinary tract infection (UTI; 2.3%), urethral stricture/bladder neck contracture (3.2%), and reoperation (2.8%).34 In addition, RCTs indicated that HoLEP was better than OP for blood loss, catheterization, and hospitalization Inhibitors,research,lifescience,medical time.15,35 Late Complications and Durability In a meta-analysis, no statistically significant differences were noted between HoLEP and TURP for urethral

stricture (2.6% vs 4.4%; P = .944), stress incontinence (1.5% vs 1.5%; P = .980), blood transfusion (0 vs 2.2%; P = .14), and reintervention (4.3% vs 8.8%; P = .059). No obvious publication bias was noted (P = 0.170, Egger test).11 In a Selleckchem TG101348 6-year follow-up analysis, urge incontinence was reported in 7.9%, mixed incontinence in 10.5%, and stress incontinence in 2.6% of patients. Reoperation was necessary in 1.4% after 5 years and one patient underwent learn more urethrotomy at 6 months.36 Comparable long-term results were reported from other studies with a reoperation rate of 4.2% due to residual adenoma, urethral strictures (1.7%), meatal stenosis (0.8%), and bladder neck contracture (0.8%), resulting in a 5-year surgical retreatment rate of 8%. The earlier group of patients showed a higher retreatment rate (8% vs 1.4%).22 Another study observed a reoperation rate of 2.7% during 36-month follow-up.

8,12 -15 Consequently, in the absence of bacteriologic confirmation, a presumptive diagnosis can be made

on the basis of a single high or rising titer of specific antibodies.6,8 ,12 Among serological methods, serum agglutination test (SAT) is the most widely-used one. It is the standard and highly sensitive method for the diagnosis of diseases.11,16 In a study in which the sensitivity of enzyme linked Inhibitors,research,lifescience,medical immunosorbent assay (ELISA) IgG vs positive culture was 81.3%, the sensitivity of SAT was 93.7%.17 The higher sensitivity of SAT was also demonstrated in other studies, especially in studies from Saudi Arabia, which demonstrated that the SAT sensitivity was 100%.18-19 Despite the high yields of SAT, it has some limitations like false positive and negative results.19 -22 When SAT is used to diagnose brucellosis, Inhibitors,research,lifescience,medical false-positive reactions occasionally result from cross-reactions with antibodies to Salmonella spp., Yersinia spp., Vibrio cholera, Francisella tularencis or

Escherichia coli O:157. False-positive and false-negative reactions can be avoided by routinely diluting the serum above 1/320.12,23 -25 Another problem with using Inhibitors,research,lifescience,medical SAT is difficult interpretation of the test results. In various regions, different threshold titers, varying from 1:40 to 1:320, have been taken as an indicator of active Brucellosis. In Saudi Arabia, where brucellosis is endemic, a titer of 1:320 or higher has been found to be indicative of active Brucellosis.19,26 Based on a study by Karimi Inhibitors,research,lifescience,medical et al. in Iran, a positive SAT titer of 1:80 was present in 2.4% of the 17-DMAG Phase 2 general population, and a 2-mercaptoethanol (2ME) test titer of 1:20 was present in less than 1% of the general population. Accordingly, in Iran Inhibitors,research,lifescience,medical a

single titer of SAT 1:80 or more in the presence of a 2ME titer of 1:20 or more can be taken as a positive test result for brucellosis in the general population.27 This would increase the overall diagnostic specificity at the cost of sensitivity. The recently-introduced test, ELISA, can determine specific class Drug_discovery of IgG, IgM and IgA antibodies against brucella. The assay is a sensitive, simple and rapid test with less limitation, and might be an acceptable alternative to SAT.11,25 ,28 Nevertheless, there are some contradictory reports regarding the diagnostic ability of ELISA in acute brucellosis. Therefore, it is reasonable to further evaluate and standardize the test according to the various geographical regions and populations. The objective of the present study was to determine an optimal cut-off point for ELISA and compare the test outcome with that of SAT. The optimal cut-off was defined as a point at which, the sum of the sensitivity and specificity are the uppermost. Materials and Methods The study was approved by the Ethics Committee of the Shahid Beheshti University of Medical Sciences.

Unfortunately, CRS is invariably long and patients often lose significant quantities of blood as a result of microvascular bleeding from the extensive raw surfaces that remain after peritoneum stripping (3,5,14). Consequently,

transfusion of red blood cells is usually necessary. This has significant clinical implications. Verwaal et al. demonstrated that after massive blood loss (>5 L) the chance of complicated recovery increased sharply to 100% (15). Other studies in CRS identified blood loss as a predictor of extra-abdominal complications (14), and overall complications (3,5). Transfusion of RBC is an expensive solution to intraoperative blood loss, which is associated Inhibitors,research,lifescience,medical with substantial risk. These include infectious risks

such as HIV, hepatitis B and hepatitis C and non-infectious risks such as hemolytic reactions, acute lung injury and graft versus host disease (7). Most concerning for peritonectomy patients is that transfusion impairs various functions of cellular immunity (16). The key implication of this is an increased risk Inhibitors,research,lifescience,medical of postoperative infections and greater cancer recurrence. In 2002, a meta-analysis established Inhibitors,research,lifescience,medical association between ABT and postoperative bacterial infections (17). Four years later, a meta-analysis of 36 studies showed a consistently detrimental association between blood transfusion and colorectal cancer recurrence (18). Outcome of changed anaesthetic approach Inhibitors,research,lifescience,medical In our first ten years of experience with this procedure, 70% of patients with high disease volume required massive red blood cell transfusion as a result of blood loss. We observed that these patients, who were managed by transfusion of RBC and crystalloid, often developed significant blood loss in the latter half of the surgical intervention. Once massive blood loss had occurred (>6 units) or laboratory parameters demonstrated abnormal coagulation, procoagulant factors (FFP, cryoprecipitate, platelets) were aggressively delivered in an ad-hoc manner. A significant amount

of time and resources were spent on Inhibitors,research,lifescience,medical ensuring hemostasis independent of any surgical procedure. Given the deleterious effects of massive transfusion, we initiated an aggressive anaesthetic program to reduce transfusion in patients with high volume disease in June 2006. The primary selleck chemical intervention was the early and aggressive administration of FFP and restriction of fluid administration to prevent rather than treat coagulopathy and blood loss. We have since observed a significantly Entinostat reduced rate of not only massive red blood cell transfusion but also transfusion of other blood products. Moreover, there has been a significant shift in the timing of blood product transfusion. Treatment period II was associated with an increased transfusion of both FFP and RBC during the first half of the surgical intervention relative to the second half (P<0.001). There was a simultaneous decrease in the amount of crystalloid and colloid administered (P<0.001).

In patients with Marfan syndrome, there is degeneration of elastin

tissue and replacement of microfibrils in the media of the aorta with mucopolysccharides (myxoid degeneration). Marfan syndrome involves the cardiovascular, ocular, and skeletal systems.3 Cardiovascular manifestations include thoracic aortic aneurysm/dissection, aortic insufficiency from the aortic root distortion, and the mitral Inhibitors,research,lifescience,medical insufficiency from the mitral valve prolapsed.2 The most feared complication of Marfan syndrome is a type A dissection. The differential diagnosis for Marfan syndrome includes Loeys-Dietz syndrome and Ehlers-Danlos syndrome3. The current American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend annual imaging for patients with Marfan syndrome if the stability of aortic diameter is documented (Class I indication).3 If the maximum diameter is greater than 4.5 cm, Inhibitors,research,lifescience,medical more frequent imaging (every 6 months) should be performed. The ACC/AHA guidelines recommend aortic imaging of first-degree relatives in patients with familial aortic selleckchem aneurysms (class I).3 If one or more first-degree relatives have thoracic aortic aneurysm, then imaging of second-degree relatives is reasonable (class IIa).3 The guidelines also recommend surgical repair of the dilated aortic root/ascending aorta in patients with Marfan

Inhibitors,research,lifescience,medical syndrome at 5.0 cm (external diameter measured by CT or MRI). 2, 3 The factors that would lead to surgical repair at a diameter less than 5 cm include rapid aneurysm growth

(>0.5 cm/year), significant aortic insufficiency, or a family history of dissection at diameter <5 cm.2, 3 Our patient had an aortic diameter >5 cm and had severe aortic insufficiency; he therefore underwent resection of the aortic root/ascending aorta Inhibitors,research,lifescience,medical and the aortic valve. A 31-mm St. Jude conduit valve was placed with reimplantation Inhibitors,research,lifescience,medical of coronary arteries. Conflict of Interest Disclosure: All authors have completed and submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and none were reported. Funding/Support: The authors have no funding disclosures.
Introduction Limb salvage in patients with peripheral vascular disease, especially those who suffer from critical limb ischemia (CLI), requires more than just adequate revascularization. Aggressive wound care, debridement, and the appropriate use of antibiotics Batimastat may also be necessary as part of a comprehensive treatment. Autologous greater saphenous vein (AGSV) is the conduit of choice for peripheral revascularizations. However, there are some patients in whom autologous vein is not available or adequate. Other patients may have severe comorbid conditions and would benefit from an expeditious operation that avoids the time and trauma of vein harvesting. Lastly, surgeon preference or judgment may be another consideration in the use of a conduit other than vein.