1
|
Riber SS, Clausen LL, Dahl M, Riber LPS, Andersen TE, Lindholt JS. Experimental comparative study of a novel drug-eluting arteriovenous graft in a sheep model. Front Cardiovasc Med 2024; 11:1341154. [PMID: 38468720 PMCID: PMC10925874 DOI: 10.3389/fcvm.2024.1341154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/13/2024] [Indexed: 03/13/2024] Open
Abstract
Background Arteriovenous (AV) grafts often develop severe complications of stenosis due to neointimal proliferation that occurs either at the venous anastomosis site or at the outflow receiving vein. This study compares primary patency during 12 months of follow up for a new experimental Biomodics© interpenetrating polymer network (IPN) drug-eluting graft prototype with state-of-the-art GORE® ACUSEAL (ACUSEAL) in an AV graft model in sheep. Methods and results An end-to-end bypass from the common carotid artery to the jugularis vein was performed bilaterally in 12 sheep. The usage of ACUSEAL or the IPN, both 6.0 mm in diameter, was determined via randomization. The sheep were followed up every 4 weeks with ultrasonic duplex scanning to determine patency; the experienced observer was blinded to the randomization. One sheep died after 11 days, and the final sample accordingly consisted of 11 animals. When comparing neointimal hyperplasia after 12 months in the two grafts, Fisher's exact test showed a significant difference with none out of 11 in the IPN grafts and 9 out of 11 in the ACUSEAL graft (p < 0.001). However, the Biomodics© IPN exhibited severe deterioration over time. Conclusions Almost all of the grafts occluded during the 12 months of follow up. Although the zwitterion-bounded interpenetrating drug eluting polymer network showed signs to impair neointimal hyperplasia and thrombosis, age-related degeneration hindered demonstrating a potential improvement in patency.
Collapse
Affiliation(s)
- Sara Schødt Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Elite Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense, Denmark
| | - Lene Langhoff Clausen
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Elite Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense, Denmark
| | - Marie Dahl
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Peter Schødt Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Emil Andersen
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Jes S. Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Elite Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense, Denmark
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark
| |
Collapse
|
2
|
Hogan SE, Debus ES, Nehler MR, Patel MR, Anand SS, Muehlhofer E, Haskell LP, Berkowitz SD, Bauersachs RM, Bonaca MP. Unplanned Index Limb Revascularization With Rivaroxaban Versus Placebo in Patients With Critical Limb-Threatening Ischemia After Endovascular and Surgical Treatment: Insights From VOYAGER PAD. Circulation 2024; 149:635-637. [PMID: 38377256 DOI: 10.1161/circulationaha.123.065330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Shea E Hogan
- CPC Clinical Research, Aurora, CO (S.E.H., M.R.N., S.D.B., M.P.B.)
- Denver Health, CO (S.E.H.)
- Department of Medicine, University of Colorado, Aurora (S.E.H., S.D.B., M.P.B.)
| | | | - Mark R Nehler
- CPC Clinical Research, Aurora, CO (S.E.H., M.R.N., S.D.B., M.P.B.)
- Department of Surgery, University of Colorado, Aurora (M.R.N.)
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University, Durham, NC (M.R.P.)
| | - Sonia S Anand
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Canada (S.S.A.)
| | | | | | - Scott D Berkowitz
- CPC Clinical Research, Aurora, CO (S.E.H., M.R.N., S.D.B., M.P.B.)
- Department of Medicine, University of Colorado, Aurora (S.E.H., S.D.B., M.P.B.)
| | - Rupert M Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt, Germany (R.M.B.)
- Center for Thrombosis and Hemostasis, University of Mainz, Germany (R.M.B.)
| | - Marc P Bonaca
- Department of Medicine, University of Colorado, Aurora (S.E.H., S.D.B., M.P.B.)
| |
Collapse
|
3
|
Bonnin P, Kuntz S, Caillard S, Chakfé N, Lejay A. Aortobifemoral Bypass in Kidney Transplant Candidates: A Ten-Year Experience. Transpl Int 2024; 37:12085. [PMID: 38379606 PMCID: PMC10878425 DOI: 10.3389/ti.2024.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
In patients with severe aorto-iliac calcifications, vascular reconstructions can be performed in order to allow kidney transplantation. The aim of this study was to analyze the outcomes of kidney transplant candidates who underwent an aortobifemoral bypass (ABFB) for aorto-iliac calcifications. A retrospective study including all kidney transplant candidates who underwent an ABFB between 2012 and 2022 was performed. Primary outcome was 30-day morbidity-mortality after ABFB. Secondary outcome was accessibility to kidney transplant waiting list. Twenty-two ABFBs were performed: 10 ABFBs in asymptomatic patients presenting severe aorto-iliac circumferential calcifications without hemodynamic consequences, and 12 ABFBs in symptomatic patients in whom aorto-iliac calcifications were responsible for claudication or critical limb threatening ischemia. Overall 30-day mortality was 0%. Overall 30-day morbidity was 22.7%: 1 femoral hematoma and 1 retroperitoneal hematoma requiring surgical drainage in the asymptomatic group, and 2 digestive ischemia requiring bowel resection and 1 femoral hematoma requiring surgical drainage in the symptomatic group. Among the 22 patients, 20 patients could access to kidney waiting list and 8 patients underwent a kidney transplantation, including 3 living-donor transplantations. Aorto-iliac revascularization can be an option to overcome severe calcifications contraindicating kidney transplantation.
Collapse
Affiliation(s)
- Pascaline Bonnin
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- Gepromed, Strasbourg, France
| | - Sophie Caillard
- Department of Nephrology and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- Gepromed, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- Gepromed, Strasbourg, France
| |
Collapse
|
4
|
Góes AMDO, de Albuquerque FBA, Feijó MO, de Albuquerque FBA, Corrêa LRDV, de Andrade MC. Prognostic factors for femoropopliteal vascular injuries: surgical decisions matter. J Vasc Bras 2023; 22:e20230050. [PMID: 38021276 PMCID: PMC10647908 DOI: 10.1590/1677-5449.202300502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/04/2023] [Indexed: 12/01/2023] Open
Abstract
Background Lower limbs are frequently involved in vascular trauma, but it is still not clear which factors lead to unfavorable clinical outcomes. Objectives To determine the clinical profile of patients with femoropopliteal injuries, the trauma mechanisms, and treatment and identify which factors led to unfavorable outcomes. Methods A retrospective study based on the medical records of patients treated from 2017 to 2021. The following data were assessed: sex, age, distance to reach the hospital, trauma mechanism, hypovolemic shock, additional injuries, treatment of vascular injuries, whether fasciotomy was needed, inappropriate intraoperative decisions, and injury severity score. Need for surgical reintervention, amputation, and death were defined as unfavorable outcomes. Univariate, bivariate, and logistic regression analyses were conducted. Results The sample comprised 94 patients; 83% were men; mean age was 30.8 years; combined arterial and venous injuries prevailed (57.5%); and superficial femoral vessels were the most affected (61.7%). Penetrating mechanisms prevailed (80.9%). Arterial injuries were most frequently treated with venous graft (59.6%) and venous injuries underwent ligation (81.4%). In 15% of cases, inappropriate surgical decisions were detected; most often use of the ipsilateral great saphenous vein for arterial reconstruction. Unfavorable outcomes occurred in 44.7%: surgical reintervention was necessary in 21.3% and limb amputation in 25.5%, while 9.5% of the patients died. Conclusions These injuries mainly involved young men, victims of gunshot wounds. Superficial femoral vessels were the most injured; concomitant non-vascular trauma was frequent, mainly fractures. Inappropriate surgical decisions increased the need for reinterventions by 34 times. Need for fasciotomy, presence of fracture/dislocation, blunt trauma mechanism, and popliteal artery injury increased the risk of amputation.
Collapse
|
5
|
Cicek SK, Simsek B, Gundogdu C. Right Common Femoral Vein Invasion: A Unique Case of Inguinal Ectopic Breast Cancer. Vasc Endovascular Surg 2023; 57:914-918. [PMID: 37300453 DOI: 10.1177/15385744231183489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Ectopic breast cancer may present anywhere in the milk line, from the axilla to the groin which is extremely rare in the inguinal region. Despite morphologic differences, ectopic breast tissue presents characteristics related to orthotopic breast tissue in terms of function and pathologic degeneration. The case report describes the treatment of a unique ectopic breast carcinoma which was located in the inguinal region with a common femoral vein invasion. METHODS We present a unique case of an ectopic breast carcinoma presenting in an unusual anatomic location along the milk line. The study was approved by the local Ethics Committee (protocol no: 12.01.2023-2023/02) Informed consent was obtained from the patient. RESULTS The patient is surgically treated and supplemented with neoadjuvant chemotherapy,radiotherapy and endocrine therapy. Histopathological examination revealed the diagnosis of invasive ductal carcinoma. The right common femoral vein was reconstructed with bovine pericardial patch after totally removal of the mass. CONCLUSIONS This report alerts the reader to be cognizant of the unusual location of an ectopic breast cancer which was detected in the inguinal region with a common femoral vein invasion and discusses the treatment, suggesting novel therapeutic advice that could bring considerable clinical advantages. A multidisciplinary approach should be warranted in such cases to confirm a complete remission.
Collapse
Affiliation(s)
- Sevim Kuslu Cicek
- Department of General Surgery, Medicana International Hospital, Istanbul, Turkey
| | - Baran Simsek
- Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey
| | - Cemal Gundogdu
- Department of Pathology, Medicana International Hospital, Istanbul, Turkey
| |
Collapse
|
6
|
Roosendaal LC, van Os TEK, van Es N, Hoebink M, Wiersema AM, Blankensteijn JD, Jongkind V. The Effect of Smoking on the Activated Clotting Time and the Incidence of Complications in Noncardiac Arterial Procedures. J Endovasc Ther 2023:15266028231207027. [PMID: 37887702 DOI: 10.1177/15266028231207027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE Smoking is a well-known risk factor for developing arterial diseases and for an increase of complications during and after vascular procedures. Although smoking has a proven effect on hemostasis, no literature is available on the effect of smoking on the activated clotting time (ACT), which is used to monitor the effect of heparin during noncardiac arterial procedures (NCAP). The aim of this study was to examine the effect of smoking on ACT values and the incidence of complications during the same admission or 30 day follow-up of NCAP. MATERIALS AND METHODS A post hoc analysis of a prospective multicenter cohort study was performed. Patients older than 18 years, who underwent NCAP between December 2016 and April 2021, were enrolled. Patients were divided into 2 groups based on smoking status: never/former smokers and current smokers. Two heparin dosing protocols were used: an initial bolus of 5000 IU or 100 IU/kg bodyweight. RESULTS In total, 773 patients met the inclusion criteria. Five minutes after administration of 5000 IU of heparin, mean ACT values were 190 and 196 seconds for nonsmokers and smokers, respectively (p=0.078). After 100 IU/kg of heparin, mean ACT values were 229 and 226 seconds for nonsmokers and smokers, respectively (p=0.37). Incidence of complications in the whole study cohort was not significantly different for nonsmokers compared with smokers (arterial thrombo-embolic complication [ATEC] 4.7% vs 5.7% p=0.55; hemorrhagic complications 15% vs 18% p=0.29). In subgroup-analysis, a significant difference between smoking groups was found for hemorrhagic complications after open aneurysm repair (p=0.024). However, after adjusting for confounders, the difference between the smoking groups annulled. CONCLUSION The results of this study suggest that smoking does not have a significant effect on ACT values or on the incidence of complications in NCAP. Large-scale studies are required to further analyze potential factors having an effect on the ACT and perioperative and postoperative complications, which could help individualize heparinization strategy. CLINICAL IMPACT There is high variance between patients in their response on administration of heparin, this is not yet fully understood. This study investigated the effect of smoking in a large prospective multicentre cohort. The results suggests that active smoking does not have an effect on the activated clotting time after administration of heparin. Also no significant effect of smoking could be found on the incidence of all registered complications. Monitoring of the effect of heparin remains important to provide patients with safe anticoagulation during vascular procedures.
Collapse
Affiliation(s)
- Liliane C Roosendaal
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
- Department of Vascular Surgery, Amsterdam University Medical Center, VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Tristan E K van Os
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | - N van Es
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Pulmonary Hypertension & Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - M Hoebink
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
- Department of Vascular Surgery, Amsterdam University Medical Center, VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arno M Wiersema
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
- Department of Vascular Surgery, Amsterdam University Medical Center, VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jan D Blankensteijn
- Department of Vascular Surgery, Amsterdam University Medical Center, VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Vincent Jongkind
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
- Department of Vascular Surgery, Amsterdam University Medical Center, VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Bobadilla-Rosado LO, Lopez-Pena G, Verduzco-Vazquez AT, Laparra-Escareno H, Anaya-Ayala JE, Azcorra H, Mendez-Dominguez N, Hinojosa CA. Five-year survival after retroperitoneal oncologic resection with and without vascular surgeon intervention. Vascular 2023; 31:868-873. [PMID: 35492002 DOI: 10.1177/17085381221093855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVES Retroperitoneal tumor resection commonly disturbs major vessels; therefore, surgical teams can recruit vascular surgeons to prevent injuries and improve the prognosis of oncologic patients. The objective of the present study is to establish long-term survival after retroperitoneal tumor resection surgery with an emphasis on the potential impact of preventing or repairing major vessel injuries when tumors are adjacent to the aorta or vena cava. METHODS Retrospective case series including all cases of surgical removal of retroperitoneal tumors between 2007 and 2020 in a highly specialized hospital in Mexico City. Long-term survival was defined as 5 years after surgical intervention. Descriptive statistics, group-comparison tests, and regression analysis were performed using Stata 16. RESULTS From a total of 70 cases, vascular injury occurred in 30 (42.8%) and the vascular surgeon intervened in 19 (27.1%) of them, 4 (21%) were performed by a vascular surgeon with planned intervention, and in 9 (47.3%) cases the vascular surgeon was called to join the surgery due to emergency. Intraoperative bleeding was 2-fold greater in the group with an emergent participation of vascular surgery in contrast with the planned intervention group (4, 235 mL vs 2, 035 mL, p = 0.04). The regression model revealed a significant association between the intervention of a vascular surgeon and long-term survival (OR 59.3, p = 0.03) after adjusting for sociodemographic and characteristics of oncologic nature. CONCLUSIONS Planned intervention of vascular surgeons in retroperitoneal tumor resection may have a positive impact not only in trans-operatory period, but also on long-term survival.
Collapse
Affiliation(s)
- Luis O Bobadilla-Rosado
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Gabriel Lopez-Pena
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Ana T Verduzco-Vazquez
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Hugo Laparra-Escareno
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Javier E Anaya-Ayala
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Hugo Azcorra
- Centro de Investigaciones Silvio Zavala, Universidad Modelo de Merida, Mexico
| | - Nina Mendez-Dominguez
- Vice Direction of Research and Learning, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida, Mexico
| | - Carlos A Hinojosa
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| |
Collapse
|
8
|
Roosendaal LC, Hoebink M, Wiersema AM, Yeung KK, Blankensteijn JD, Jongkind V. Perprocedural Heparinization in Non-cardiac Arterial Procedures: The Current Practice in the Netherlands. J Endovasc Ther 2023:15266028231199714. [PMID: 37746826 DOI: 10.1177/15266028231199714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
PURPOSE Heparin is the most widely-used anticoagulant to prevent thrombo-embolic complications during non-cardiac arterial procedures (NCAP). Unfortunately, there is a lack of evidence and consequently non-uniformity in guidelines on perprocedural heparin management. Detailed insight into the current practice of antithrombotic strategies during NCAP in the Netherlands is important, aiming to identify potential optimal protocols and local differences concerning perprocedural heparinization. MATERIALS AND METHODS A comprehensive online survey was distributed electronically to vascular surgeons of every hospital in the Netherlands in which NCAP were performed. Data were collected from September 2020 to October 2021. RESULTS The response rate was 90% (53/59 hospitals). During NCAP, all surgeons generally administered heparin before arterial clamping. In 74% (39/54) of hospitals, a single heparin dosing protocol was used for all types of patients and vascular procedures. In 40%, there was no uniformity in heparin dosing between vascular surgeons. Depending on the procedure, a fixed bolus heparin, predominantly 5000 IU, was administered in 73% to 93%. In the remaining hospitals (7%-27%), a bodyweight-based heparin protocol was used, with an initial dose of 70 or 100 IU/kg. A minority (28%) monitored the effect of heparin in patients using the activated clotting time add (ACT) after activated clotting time. Target values varied between 180 and 250 seconds or 2 times the baseline ACT. CONCLUSION This survey demonstrates considerable variability in perprocedural heparinization during NCAP in the Netherlands. Future research on heparin dosing is needed to harmonize and optimize heparin dosage protocols and contemporary guidelines during NCAP, and thereby improve vascular surgical care and patient safety. CLINICAL IMPACT This survey demonstrated persisting intra- and inter-hospital variability in perprocedural heparinization during non-cardiac arterial procedures (NCAP) in the Netherlands. The observed variability in heparinization strategies highlights the need for high quality evidence on perprocedural anticoagulation strategies. This is needed in order to harmonize and optimize heparin dosage protocols and contemporary guidelines and thereby improve vascular surgical patient care. Based on the current results, an international survey will be conducted by the authors to gain additional insight into the antithrombotic strategies used during NCAP, aiming to harmonize anticoagulation protocols worldwide.
Collapse
Affiliation(s)
- Liliane C Roosendaal
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
- Department of Vascular Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Max Hoebink
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
- Department of Vascular Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arno M Wiersema
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
- Department of Vascular Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Kak K Yeung
- Department of Vascular Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jan D Blankensteijn
- Department of Vascular Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Vincent Jongkind
- Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
- Department of Vascular Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Microcirculation, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Xia Y, Chandran AS, Hockley J, Jansen S, Lam M. Prone thoracic endovascular aortic repair via the popliteal artery for inadvertent vascular injury during spondylectomy: a case report. J Spine Surg 2023; 9:342-347. [PMID: 37841790 PMCID: PMC10570636 DOI: 10.21037/jss-23-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/30/2023] [Indexed: 10/17/2023]
Abstract
Background Vascular injury during spinal surgery is a dreaded complication associated with high morbidity and mortality. Repositioning the patient following such an injury could result in significant time delays and haemorrhage. Endovascular repair via popliteal access has never previously been described in the literature. A novel prone thoracic endovascular aortic repair (TEVAR) technique is described here as a safe alternative to manage vascular injury during posterior spinal surgery. Case Description Here we describe a 63-year-old male where endovascular repair of vascular injury to the aorta by intercostal artery avulsion was performed via popliteal artery access in the prone position during T11 en bloc spondylectomy and posterior fusion. The patient remained haemodynamically unstable following the vascular injury precluding immediate transfer to the angiography suite. Identification of vascular injury to deployment of TEVAR graft was 90 minutes. The spondylectomy was able to be completed without repositioning the patient. Radiological and clinical follow-up revealed no complications at 1 and 2 months respectively following surgery. Conclusions TEVAR placement via this novel popliteal access route was able to halt the haemorrhage allowing stabilisation of the patient and completion of the spinal procedure. Clinical teams should be made aware this is a viable technique to address vascular injuries during spinal surgery.
Collapse
Affiliation(s)
- Yang Xia
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Joseph Hockley
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia
- Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, Perth, WA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Shirley Jansen
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia
- Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, Perth, WA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
- Faculty Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Mark Lam
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
| |
Collapse
|
10
|
Cunha MJS, Teivelis MP, Mendes CDA, Baptistella CDPA, Sant´Anna PVH, Wolosker N. Shared decision-making and specific informed consent in patients with aortic aneurysms. Einstein (Sao Paulo) 2023; 21:eAO0197. [PMID: 37585885 PMCID: PMC10421603 DOI: 10.31744/einstein_journal/2023ao0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/16/2022] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To analyze the refusal rate of elective aortic aneurysm surgery in asymptomatic patients after the presentation of a detailed informed consent form followed by a meeting where patient and their families can analyze each item. METHODS We conducted a retrospective analysis of 49 patients who had aneurysms and were offered surgical treatment between June 2017 and February 2019. The patients were divided into two groups: the Rejected Surgery Group, which was composed of patients who refused the proposed surgical treatment, and the Accepted Surgery Group, comprising patients who accepted the proposed surgeries and subsequently underwent them. RESULTS Of the 49 patients, 13 (26.5%) refused surgery after reading the informed consent and attending the comprehensive meeting. We observed that patients who refused surgery had statistically smaller aneurysms than those who accepted surgery (9% versus 26%). These smaller aneurysms were above the indication size, according to the literature. CONCLUSION One-quarter of patients who were indicated for elective surgical repair of aortic aneurysms rejected surgery after shared decision-making, which involved presenting patients with an informed consent form followed by a clarification meeting for them and their families to analyze each item. The only factor that significantly influenced a rejection of the procedure was the size of the aneurysm; patients who rejected surgery had smaller aneurysms than those who accepted surgery. Up to 26% of patients with aortic aneurysms refused surgical repair. The proposed technique, whether open or endovascular, did not influence patients' decisions. Patients with smaller aneurysms were more likely to refuse aortic aneurysm treatment.
Collapse
Affiliation(s)
- Marcela Juliano Silva Cunha
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de CarvalhoBrazilHospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Marcelo Passos Teivelis
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de CarvalhoBrazilHospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Cynthia de Almeida Mendes
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de CarvalhoBrazilHospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Conrado Dias Pacheco Annicchino Baptistella
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de CarvalhoBrazilHospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Pedro Vasconcelos Henry Sant´Anna
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de CarvalhoBrazilHospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Nelson Wolosker
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| |
Collapse
|
11
|
Wolosker N, Louzada ACS, Portela FSO, da Silva MFA, Schettino GDPP, Corrêa LH, Juniordata EA, Teivelis MP. Proposed public policies to improve outcomes in vascular surgery: an experts' forum. Einstein (Sao Paulo) 2023; 21:eAE0241. [PMID: 37585883 PMCID: PMC10421605 DOI: 10.31744/einstein_journal/2023ae0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/18/2022] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To evaluate outcomes of vascular surgeries and identify strategies to improve public vascular care. METHODS This was a descriptive, qualitative, and cross-sectional survey involving 30 specialists of the Hospital Israelita Albert Einstein via Zoom. The outcomes of vascular procedures performed in the Public Health System extracted through Big Data analysis were discussed, and 53 potential strategies to improve public vascular care to improve public vascular care. RESULTS There was a consensus on mandatory reporting of some key complications after complex arterial surgeries, such as stroke after carotid revascularization and amputations after lower limb revascularization. Participants agreed on the recommendation of screening for diabetic feet and infrarenal abdominal aortic aneurysms. The use of Telemedicine as a tool for patient follow-up, auditing of centers for major arterial surgeries, and the concentration of complex arterial surgeries in reference centers were also points of consensus, as well as the need to reduce the values of endovascular materials. Regarding venous surgery, it was suggested that there should be incentives for simultaneous treatment of both limbs in cases of varicose veins of the lower limbs, in addition to the promotion of ultrasound-guided foam sclerotherapy in the public system. CONCLUSION After discussing the data from the Brazilian Public System, proposals were defined for standardizing measures in population health care in the area of vascular surgery. Notification of complications of arterial surgeries is essential in identifying strategies to improve surgical outcomes. Screening of prevalent and/or morbid diseases allows early intervention and prevention of complications. Use of telemedicine in vascular follow-up allows optimizing the use of resources and reducing the burden on health services. Concentrating complex cases in reference hospitals leads to improved surgical outcomes.
Collapse
Affiliation(s)
- Nelson Wolosker
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | | | | | - Lucas Hernandes Corrêa
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Edson Amaro Juniordata
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Marcelo Passos Teivelis
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| |
Collapse
|
12
|
Castro IF, Nunes PHS, Lopes ACX, Lima MC, Conrado RP, Leal RMLV, Goes ACADM, Costa MLV. Surgical resection of retrohepatic inferior vena cava leiomyosarcoma without vascular reconstruction: case report. J Vasc Bras 2023; 22:e20220108. [PMID: 37576732 PMCID: PMC10421572 DOI: 10.1590/1677-5449.202201081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/31/2022] [Indexed: 08/15/2023] Open
Abstract
Inferior vena cava leiomyosarcoma (IVCL) is a rare malignant mesenchymal tumor. Surgical treatment is a challenge because it must combine free surgical margins with vascular reconstruction, using prosthetic or autologous grafts, primary suture, or simple ligation without vein reconstruction. The ligation option is possible thanks to the slow growth of the tumor, allowing collateral venous circulation to develop. We present a case of an IVCL treated with radical resection without vascular reconstruction. The patient was a 48-year-old female with abdominal pain in the right upper quadrant, asthenia, and postprandial dyspeptic symptoms. Abdominal tomography revealed a mass with an expansive formation located in the infrahepatic segment of the inferior vena cava and reduced vessel lumen. During surgery, vein clamping did not provoke hemodynamic repercussions, suggesting sufficient collateral circulation formation. It was decided to perform a radical resection of the entire portion of the retrohepatic vena cava and ligate the vena cava without vascular reconstruction. The patient recovered without complications.
Collapse
|
13
|
Watanabe S, Morimoto H, Futagami D, Kitaura J, Mukai S, Kobayashi T. Superficial femoral artery-anterior tibial artery bypass with great saphenous vein grafting via the lateral femoropopliteal route for infection after Viabahn placement. Clin Case Rep 2023; 11:e7629. [PMID: 37397585 PMCID: PMC10307988 DOI: 10.1002/ccr3.7629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 05/28/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023] Open
Abstract
We report a case involving an elderly man who successfully underwent superficial femoral artery-anterior tibial artery bypass via the lateral femoropopliteal route following development of a stent infection after placement of a small-diameter covered stent for a ruptured superficial femoral artery pseudoaneurysm. This report suggests that appropriate treatment strategies for device infection subsequent to device removal are paramount for the prevention of reinfection and preservation of the affected extremity.
Collapse
Affiliation(s)
- Saeki Watanabe
- Department of Cardiovascular SurgeryFukuyama Cardiovascular HospitalFukuyama‐shi, HiroshimaJapan
| | - Hironobu Morimoto
- Department of Cardiovascular SurgeryFukuyama Cardiovascular HospitalFukuyama‐shi, HiroshimaJapan
| | - Daisuke Futagami
- Department of Cardiovascular SurgeryFukuyama Cardiovascular HospitalFukuyama‐shi, HiroshimaJapan
| | - Junya Kitaura
- Department of Cardiovascular SurgeryFukuyama Cardiovascular HospitalFukuyama‐shi, HiroshimaJapan
| | - Syogo Mukai
- Department of Cardiovascular SurgeryFukuyama Cardiovascular HospitalFukuyama‐shi, HiroshimaJapan
| | - Taira Kobayashi
- Department of Cardiovascular SurgeryJA Hiroshima General HospitalHatsukaichi, HiroshimaJapan
| |
Collapse
|
14
|
Abstract
Lower limb amputation (LLA) is a major surgical procedure with a significant impact on quality of life and mortality rates as well. Previous studies have shown that mortality rates following LLA can range from 9-17% within 30 days in the UK. This study systematically evaluates and reviews the published literature on life expectancy, mortality, and survival rates following lower extremity amputation (LEA). We have conducted a comprehensive search on Medline, CINAHL, and Cochrane Central databases resulting in 87 full-text articles. After a thorough review, only 45 (52.9%) articles met the minimum inclusion criteria for the study. Our analysis indicated 30-day mortality rates following LEA ranged from 7.1% to 51.4%, with an average mortality rate of 16.45% (SD 14.35) per study. Furthermore, 30-day mortality rates following below-knee amputation (BKA) and above-knee amputation (AKA) were found to be between 6.2% to 51.4%, X= 17.16% ± 19.46 SD and 12.7 to 21.7%, X= 16.15% ± 4.17 SD, respectively. Our review provides a comprehensive insight into the life expectancy, mortality, and survival rates following LEA. These findings highlight the importance of considering various factors, including patient age, presence of comorbidities such as diabetes, heart failure, and renal failure, and lifestyle factors such as smoking, in determining prognosis following LLA. Further research is necessary to determine strategies for improving outcomes and reducing mortality in this patient population.
Collapse
|
15
|
Osztrogonacz P, Lumsden AB. The SAFE-AAA Study: Is One Limb at a Time Better Than Two? Circulation 2023; 147:1277-1280. [PMID: 37093968 DOI: 10.1161/circulationaha.123.064497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- Peter Osztrogonacz
- Department of Cardiovascular Surgery, Houston Methodist Hospital, TX (P.O., A.B.L.)
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary (P.O.)
| | - Alan B Lumsden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, TX (P.O., A.B.L.)
| |
Collapse
|
16
|
Abstract
BACKGROUND The bovine pericardium is a good alternative material to the autogenous vein in vascular reconstruction. This study aimed to evaluate the results of angioplasty in venous reconstruction using bovine pericardium and identify the risk factors for significant complications. MATERIAL AND METHODS A retrospective review was performed of the demographic data, clinical characteristics, and complications of patients who underwent vessel repair using bovine pericardium between February 2012 and December 2020. Univariate analysis was used to compare complication frequencies within several categories. RESULTS There were 36 cases of patch angioplasty using bovine pericardium. The median age was 65 years; 61% of them were men. Of the 36 venous repairs, 31 (86.1%) were from cancer surgery and five (13.9%) were from iatrogenic injury. Patch shape was used in 27 cases (75.0%), while tube shape was used in nine cases (25.0%). The incidence of occlusion and partial thrombus was five (13.9%) and three (8.3%) cases, respectively. Of the nine tube-shaped angioplasties, four (44.4%) required reoperation due to early thrombosis (three cases) and hematoma (one case). CONCLUSION The use of a bovine pericardial patch in the reconstruction of a damaged vein from tumor invasion or iatrogenic injury is feasible. However, the complication rate of vessel patency remains substantial, especially in cases of iatrogenic injury or when a tube-shaped form is used for repair.
Collapse
Affiliation(s)
- Jong-Sung Ahn
- Division of Vascular Surgery, Department of Surgery, 58927Seoul National University College of Medicined, Jongno-gu, South Korea
| | - Hyejin Mo
- Department of Surgery, Seoul Metropolitan Government - 58927Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sanghyun Ahn
- Division of Vascular Surgery, Department of Surgery, 58927Seoul National University College of Medicined, Jongno-gu, South Korea
| | - Ahram Han
- Division of Vascular Surgery, Department of Surgery, 58927Seoul National University College of Medicined, Jongno-gu, South Korea
| | - Sangil Min
- Division of Vascular Surgery, Department of Surgery, 58927Seoul National University College of Medicined, Jongno-gu, South Korea
| | - Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, 58927Seoul National University College of Medicined, Jongno-gu, South Korea
| | - Jongwon Ha
- Division of Vascular Surgery, Department of Surgery, 58927Seoul National University College of Medicined, Jongno-gu, South Korea.,Transplantation Research Institute, 58927Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
17
|
McGuinness B, Goel A, Chen J, Szalay D, Ladha K, Mittleman MA, Harlock J. The Association of Cannabis Use Disorder with Acute Limb Ischemia and Critical Limb Ischemia. Vasc Endovascular Surg 2022; 56:480-494. [PMID: 35503434 PMCID: PMC9163779 DOI: 10.1177/15385744221085382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Heavy cannabis use has been associated with the development of acute myocardial infarction and stroke. The objective of this study was to determine if heavy, chronic cannabis use is associated with the development of acute limb ischemia (ALI) or critical limb ischemia (CLI). METHODS We conducted a retrospective cohort study within the National Inpatient Sample (2006-2015). Patients without cannabis use disorder (CUD) were matched to patients with CUD in a 2:1 ratio using propensity scores. Our primary outcomes were incidence of ALI and CLI. Secondary outcomes included incidence of acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), frequency of open or endovascular interventions, length of stay, and total costs. Sensitivity analyses were performed with alternative models, including in the entire unmatched cohort with regression models utilizing survey weights to account for sampling methodology. RESULTS We identified a cohort of 46,297 857 unmatched patients. Patients with CUD in the unmatched cohort were younger, with less cardiovascular risk factors, but higher rates of smoking and substance abuse. The matched cohort included 824,856 patients with CUD and 1,610,497 controls. Those with CUD had a higher incidence of ALI (OR 1.20 95% CI: 1.04-1.38 P=.016). Following multiple sensitivity analyses, there was no robust association between CLI and CUD. We observed no robust association of CUD with AMI, CMI, procedures performed, frequency of amputation, costs, or total length of stay. CONCLUSIONS Cannabis use disorder was associated with a significantly higher incidence of admission for acute limb ischemia. CUD was not associated with an increased risk of critical limb ischemia following sensitivity analysis. Given CUD is often seen in younger, less co-morbid patients it provides an important target for intervention in this population.
Collapse
Affiliation(s)
- Brandon McGuinness
- Division of Vascular Surgery, Department of Surgery, McMaster University, Burlington, ON, Canada
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Akash Goel
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Anesthesiology, St. Michael’s Hospital and University of Toronto, Toronto, ON, Canada
| | - Jerry Chen
- Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - David Szalay
- Division of Vascular Surgery, Department of Surgery, McMaster University, Burlington, ON, Canada
| | - Karim Ladha
- Department of Anesthesiology, St. Michael’s Hospital and University of Toronto, Toronto, ON, Canada
| | - Murray A Mittleman
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John Harlock
- Division of Vascular Surgery, Department of Surgery, McMaster University, Burlington, ON, Canada
| |
Collapse
|
18
|
Corsi T, Ciaramella MA, Palte NK, Carlson JP, Rahimi SA, Beckerman WE. Female Sex Is Associated With Reintervention and Mortality Following Elective Endovascular Abdominal Aortic Aneurysm Repair. J Vasc Surg 2022; 76:1494-1501.e1. [PMID: 35705120 DOI: 10.1016/j.jvs.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/15/2022] [Accepted: 05/01/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE While sex differences in endovascular abdominal aortic aneurysm repair (EVAR) outcomes are increasingly reported, but contributing factors remain without consensus. We investigated disparities in sex-specific outcomes following elective EVAR at our institution and evaluated factors that may predispose females to increased morbidity and mortality. METHODS A retrospective chart review of all patients undergoing elective EVAR from 2011 to 2020 at a suburban tertiary care center was performed. The primary outcomes were five-year survival and freedom from reintervention. Fisher's exact test, t-tests, and Kaplan-Meier analysis using the rank-log test investigated associations between sex and outcomes. A multivariable Cox proportional hazard model controlling for age and common comorbidities evaluated the effect of sex on survival and freedom from reintervention. RESULTS Two hundred and seventy-three patients underwent elective EVAR during the study period, including 68 (25%) females and 205 (75%) males. Females were older on average than males (76 years vs. 73 years, p= <0.01) and were more likely to have chronic obstructive pulmonary disease (COPD; 38% versus 23%, p=0.01), require home oxygen therapy (9% versus 2%, p=0.04) or dialysis preoperatively (4% versus 0%, p=0.02). Distribution of other common vascular comorbidities was similar between the sexes. Thirty-day readmission was greater in females than males (18% versus 8%, p=0.02). Females had significantly lower survival at five years (48% ± 7.9% versus 65% ± 4.3%, p<0.01) and significantly lower one-year (89% ± 4.1% for females vs. 94% ± 1.7% for males, p=0.01) and five-year freedom from reintervention (69% ± 8.9% versus 84% ± 3.3%, p=0.02). On multivariable analysis, female sex (hazard ratio [HR]: 1.8, 95% confidence interval [CI]: 1.1-2.9), congestive heart failure (HR: 2.2, 95% CI: 1.2-3.9) and age (HR: 1.1, 95% CI: 1.0-1.1) were associated with 5-year mortality. Female sex remained as the only variable with a statistically significant association with five-year reintervention (HR: 2.4, 95% CI: 1.1-4.9). CONCLUSIONS Female sex was associated with decreased five-year survival and increased one and five-year reintervention following elective EVAR. Data from our institution suggests factors beyond patient age and baseline health risk likely contribute to greater surgical morbidity and mortality for females following elective EVAR.
Collapse
Affiliation(s)
- Taylor Corsi
- Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | | | - Nadia K Palte
- Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | - John P Carlson
- Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | - Saum A Rahimi
- Division of Vascular Surgery and Endovascular Therapy, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - William E Beckerman
- Division of Vascular Surgery and Endovascular Therapy, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ.
| |
Collapse
|
19
|
Meulenbroek AL, Faes MC, van Mil SR, Buimer MG, de Groot HGW, Veen EJ, Ho GH, Boonman-de Winter LJM, de Vries J, van Gorkom R, Toonders F, van Alphen R, van Overveld K, Verbogt N, Steyerberg EW, van der Laan L. Multicomponent Prehabilitation as a Novel Strategy for Preventing Delirium in Older Chronic Limb Threatening Ischemia Patients: A Study Protocol. Clin Interv Aging 2022; 17:767-776. [PMID: 35586779 PMCID: PMC9109801 DOI: 10.2147/cia.s357812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Chronic limb threatening ischemia is the final stage of peripheral arterial disease. Current treatment is based on revascularization to preserve the leg. In the older, hospitalized chronic limb threatening ischemia patient, delirium is a frequent and severe complication after revascularization. Delirium leads to an increased length of hospital stay, a higher mortality rate and a decrease in quality of life. Currently, no specific guidelines to prevent delirium in chronic limb threatening ischemia patients exist. We aim to evaluate the effect of a multicomponent, multidisciplinary prehabilitation program on the incidence of delirium in chronic limb threatening ischemia patients ≥65 years. Design A prospective observational cohort study to investigate the effects of the program on the incidence of delirium will be performed in a large teaching hospital in the Netherlands. This manuscript describes the design of the study and the content of this specific prehabilitation program. Methods Chronic limb threatening ischemia patients ≥65 years that require revascularization will participate in the program. This program focuses on optimizing the patient's overall health and includes delirium risk assessment, nutritional optimization, home-based physical therapy, iron infusion in case of anaemia and a comprehensive geriatric assessment in case of frailty. The primary outcome is the incidence of delirium. Secondary outcomes include quality of life, amputation-free survival, length of hospital stay and mortality. Exclusion criteria are the requirement of acute treatment or patients who are mentally incompetent to understand the procedures of the study or to complete questionnaires. A historical cohort from the same hospital is used as a control group. Discussion This study will clarify the effect of a prehabilitation program on delirium incidence in chronic limb threatening ischemia patients. New insights will be obtained on optimizing a patient's preoperative mental and physical condition to prevent postoperative complications, including delirium. Trial This protocol is registered at the Netherlands National Trial Register (NTR) number: NL9380.
Collapse
Affiliation(s)
| | - Miriam C Faes
- Department of Geriatrics, Amphia Hospital, Breda, the Netherlands
| | | | - M G Buimer
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | | | - Eelco J Veen
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Gwan H Ho
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Leandra J M Boonman-de Winter
- Department of Scientific Research, Amphia Hospital, Breda, the Netherlands
- Admiraal de Ruyter Ziekenhuis, Goes, the Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Board, Admiraal de Ruyter Hospital, Goes, the Netherlands
| | | | - Fleur Toonders
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Rene van Alphen
- Department of Physical Therapy, Amphia Hospital, Breda, the Netherlands
| | | | | | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - Lijckle van der Laan
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
- Department of Cardiovascular Science, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
20
|
Trenner M, Knappich C, Bohmann B, Heuberger S, Eckstein HH, Kuehnl A. Utilization and Regional Differences of In-Patient Services for Peripheral Arterial Disease and Acute Limb Ischemia in Germany: Secondary Analysis of Nationwide DRG Data. J Clin Med 2022; 11:2116. [PMID: 35456207 DOI: 10.3390/jcm11082116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/02/2022] [Accepted: 04/09/2022] [Indexed: 01/02/2023] Open
Abstract
Background: Peripheral arterial disease (PAD) and acute limb ischemia (ALI) pose an increasing strain on health care systems. The objective of this study was to describe the German health care landscape and to assess hospital utilization with respect to PAD and ALI. Methods: Secondary data analysis of diagnosis-related group statistics data (2009–2018) provided by the German Federal Statistical Office. Inclusion of cases encoded by the International Classification of Diseases (ICD-10) codes for PAD and arterial embolism or thrombosis. Construction of line diagrams and choropleth maps to assess temporal trends and regional distributions. Results: A total of 2,589,511 cases (median age 72 years, 63% male) were included, of which 2,110,925 underwent surgical or interventional therapy. Overall amputation rate was 17%, with the highest rates of minor (28%) and major amputations (15%) in patients with tissue loss. In-hospital mortality (overall 4.1%) increased in accordance to Fontaine stages and was the highest in patients suffering arterial embolism or thrombosis (10%). Between 2009 and 2018, the annual number of PAD cases with tissue loss (Fontaine stage IV) increased from 97,092 to 111,268, whereby associated hospital utilization decreased from 2.2 million to 2.0 million hospital days. Hospital incidence and hospital utilization showed a clustering with the highest numbers in eastern Germany, while major amputation rate and mortality were highest in northern parts of Germany. Conclusions: Increased use of endovascular techniques was observed, while hospital utilization to treat PAD with tissue loss has decreased. This is despite an increased hospital incidence. Addressing socioeconomic inequalities and a more homogeneous distribution of dedicated vascular units might be advantageous in reducing the burden of disease associated with PAD and ALI.
Collapse
|
21
|
Deng P, Yang J, Hacquebord JH, Qin B, Wang H, Li P, Gu L, Qi J, Zhu Q. Degree of Soft Tissue Injury is a Major Determinant of Successful Arterial Repair in the Extremity: A New Classification of Extremity Arterial Injury? J INVEST SURG 2022; 35:1562-1570. [PMID: 35361053 DOI: 10.1080/08941939.2022.2055237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aimed to investigate outcomes after extremity arterial injury repair and examined the association between outcomes and the degree of soft tissue injury and vascular repair methods. METHODS A retrospective study was conducted on 106 patients (108 cases) who underwent emergent microsurgical repair of extremity arterial injury due to trauma and non-perfusion of the affected extremity. The cases were divided into three groups by degree of associated soft tissue injuries: (A) adequate soft tissue coverage over the injured major vessels after radical debridement, (B) inadequate soft tissue coverage over the injured major vessels after radical debridement, and (C) radical debridement was not feasible due to unclear extent of injured soft tissue. Differences in vascular repair methods and outcomes among the three groups were analyzed. RESULTS In Group A (n = 61), microvascular suture and vessel graft achieved 95.1% and 85.0% successful limb reperfusion, respectively. In Group B (n = 31), vessel reconstruction with flap coverage achieved 100% successful reperfusion. Vessel graft achieved 28.6% successful limb reperfusion, while there were no cases of successful reperfusion using microvascular sutures. In Group C (n = 16), no vascular repair method achieved successful reperfusion. There were significant differences among the three groups in successful reperfusion (p < 0.001) and limb salvage (p < 0.001). CONCLUSION The extent of associated soft tissue injury was associated with different vascular repair methods and outcomes. We propose a new system for classifying these injuries according to the degree of associated soft tissue injury.
Collapse
Affiliation(s)
- Peijun Deng
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Jiantao Yang
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Jacques Henri Hacquebord
- Department of Orthopedic Surgery and Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, USA
| | - Bengang Qin
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Honggang Wang
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Ping Li
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Liqiang Gu
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Jian Qi
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| | - Qingtang Zhu
- Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China
| |
Collapse
|
22
|
Luo J, Wang C, Dai Y, Chen X, Tian X, Lin Y, Qu X. Efficacy and safety of endovascular therapy versus surgical clipping for patients with unruptured middle cerebral artery bifurcation aneurysms. J Investig Med 2022; 70:1273-1279. [PMID: 35338094 DOI: 10.1136/jim-2021-002230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/04/2022]
Abstract
This study aims to evaluate the efficacy and safety of endovascular therapy versus neurosurgical clipping carried out for patients with unruptured middle cerebral artery bifurcation aneurysms (MCABAs). Patients diagnosed with MCABAs were enrolled in this prospective study according to the inclusion and exclusion standard. Enrolled patients were divided into a study group (endovascular therapy) and a control group (neurosurgical clipping), with 65 cases in each group. In terms of efficacy, we found that the proportion of Glasgow Outcome Scale (GOS) grade 1 after treatment in the study group was significantly higher than in the control group (p<0.001), while the proportion of GOS grades 2, 3, and 4 after treatment was significantly lower in the study group than in the control group (p<0.05). The postoperative brain injury indicators neuron-specific enolase and S100β in the study group were significantly lower than in the control group (p<0.001), and the postoperative life activity score of patients in the study group was significantly higher than in the control group (p<0.001). In terms of safety, the postoperative hospital stay of patients in the study group was significantly shorter than in the control group (p<0.001), and the incidence rate of postoperative pulmonary and intracranial infections in the study group was significantly lower than in the control group (p<0.05). Endovascular therapy for patients with unruptured MCABAs may be effective in improving outcomes and has better safety profile compared with neurosurgical clipping, but may increase the risk of postoperative recurrence.
Collapse
Affiliation(s)
- Junjie Luo
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China
| | - Chengmou Wang
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China
| | - Yongjian Dai
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China
| | - Xin Chen
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China
| | - Xuecheng Tian
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China
| | - Yi Lin
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China
| | - Xinguo Qu
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, People's Republic of China
| |
Collapse
|
23
|
Affiliation(s)
- Jason H Anderson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester MN.(J.H.A., A.K.C., N.W.T.).,Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN. (J.H.A., A.K.C., R.P.F., N.W.T.)
| | - Allison K Cabalka
- Division of Pediatric Cardiology, Mayo Clinic, Rochester MN.(J.H.A., A.K.C., N.W.T.).,Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN. (J.H.A., A.K.C., R.P.F., N.W.T.)
| | - Robert P Frantz
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN. (J.H.A., A.K.C., R.P.F., N.W.T.)
| | - Hector R Cajigas
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester MN. (H.R.C.)
| | - Nathaniel W Taggart
- Division of Pediatric Cardiology, Mayo Clinic, Rochester MN.(J.H.A., A.K.C., N.W.T.).,Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN. (J.H.A., A.K.C., R.P.F., N.W.T.)
| |
Collapse
|
24
|
Lee HN, Hyun D, Park KB, Do YS, Kim DI, Kim HJ, Heo NH. CT findings after left renal vein division during abdominal aortic surgery. Acta Radiol 2021; 62:1679-1686. [PMID: 33176430 DOI: 10.1177/0284185120971845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The rationale behind left renal vein division (LRVD) is the assumption that adequate collateral draining channels will develop. PURPOSE To describe computed tomography (CT) findings after LRVD during aortic surgery. MATERIAL AND METHODS Among 61 consecutive patients who underwent LRVD during aneurysm repair or revascularization for aortic occlusive disease between January 2003 and December 2017, 51 patients (40 men, mean age 71.4 ± 8.4 years) were enrolled. Contrast-enhanced CT images were analyzed to evaluate collateral drainage, patency, left renal vein diameter, and left renal parenchymal thickness. A total of 115 radiologic reports were reviewed to check whether these findings were accurately mentioned. RESULTS The median time period of the first postoperative follow-up CT was 36 days (range 7-1351 days). The gonadal vein (n = 47) was the most common collateral draining channel, followed by the retroperitoneal veins (n = 42) and adrenal vein (n = 33). Thrombosis occurred in five patients between postoperative days 7 and 17 in the remnant renal vein (n = 3), remnant renal vein plus gonadal and adrenal veins (n = 1), and gonadal vein (n = 1). There was a significant decrease in renal vein diameter (-0.48 ± 2.12 mm, P = 0.006). There was no significant difference in parenchymal thickness (-0.25 ± 1.27 mm, P = 0.193). Neither LRVD nor any associated findings were correctly stated on radiologic reports. CONCLUSION Postoperative contrast-enhanced CT can delineate collateral draining channels and complications following LRVD. However, these findings tend to be either missed or misinterpreted.
Collapse
Affiliation(s)
- Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Republic of Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Ik Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun-joo Kim
- Department of Radiology, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Republic of Korea
| |
Collapse
|
25
|
Matthay ZA, Flanagan CP, Sanders K, Smith EJ, Lancaster EM, Gasper WJ, Kornblith LZ, Hiramoto JS, Conte MS, Iannuzzi JC. Risk Factors for Venous Thromboembolism after Vascular Surgery and Implications for Chemoprophylaxis Strategies. J Vasc Surg Venous Lymphat Disord 2021; 10:585-593.e2. [PMID: 34637952 PMCID: PMC9056001 DOI: 10.1016/j.jvsv.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/03/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Venous thromboembolism (VTE) is an important cause of postoperative morbidity and mortality, but the reported incidence after major vascular surgery ranges from as low as 1% to upwards of 10%. Further, little is known about optimal chemoprophylaxis regimens or rates of post-discharge VTE in this population. This study aimed to better characterize in-hospital and post-discharge VTE after major vascular surgery, the role of chemoprophylaxis timing, and the association of VTE with mortality. METHODS A single center retrospective study of 1,449 major vascular operations (2013-2020) was performed, and included 189 EVARs (13%), 169 TEVARs (12%), 318 open aortic operations (22%), 640 lower extremity bypasses (44%), and 133 femoral endarterectomies (9%). Baseline characteristics, anticoagulant/antiplatelet medications, and outcomes were abstracted from an electronic data warehouse with medical chart auditing. Post-operative VTE (pulmonary embolism [PE] and deep vein thrombosis [DVT]) within 90-days of surgery was classified based on location, symptoms, and treatment. Cut point analysis using Youden's index identified the most VTE discriminating timing of chemoprophylaxis (including therapeutic/prophylactic anticoagulant and antiplatelet medications) and Caprini score. Multivariable logistic regression tested the association of VTE with chemoprophylaxis timing, Caprini score, and additional risk factors. Cox proportional hazard modeling measured the association between VTE and mortality. RESULTS Overall VTE incidence was 3.4% (65% DVTs, 25% PEs, 10% both) and 37% were post-discharge. The rate of symptomatic VTE was 2.4%, which was lowest for EVAR (0.0%) and highest for open aortic operations (4.1%, p=0.02). Individuals who developed VTE had longer length of stay, higher rates of end-stage renal disease, prior VTE, and higher Caprini scores (8 vs 5 points) (all p<0.01). Individuals who developed VTE were also more likely to receive >2 units of blood postoperatively, have an unplanned return to the operating room, have delayed chemoprophylaxis/anticoagulation/antiplatelet initiation >4 days postoperatively, and had increased 90-day mortality (all p<0.01). Caprini score >7 (29% of patients) was associated with post-discharge VTE (2.6% vs 0.7%, p=0.01), and chemoprophylaxis/anticoagulation/antiplatelet timing >4 days was associated with increased adjusted odds of VTE (odds ratio 2.4 [1.1-4.9]). Although no fatal VTEs were identified, VTE was an independent predictor of 90-day mortality (adjusted hazard ratio 2.7 [1.3-5.9]). CONCLUSIONS These data highlight that patients undergoing major vascular surgery are particularly prone to VTE with frequent hypercoagulable comorbidities and earlier initiation of chemoprophylaxis is associated with reduced risk of development of VTE. Furthermore, post-discharge VTE rates may reach thresholds warranting post-discharge chemoprophylaxis, particularly for patients with Caprini scores >7.
Collapse
Affiliation(s)
- Zachary A Matthay
- Department of Surgery, University of California, San Francisco. San Francisco, CA, USA.
| | - Colleen P Flanagan
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, San Francisco. San Francisco, CA, USA
| | - Katherine Sanders
- Department of Surgery, University of California, San Francisco. San Francisco, CA, USA
| | - Eric J Smith
- Department of Surgery, University of California, San Francisco. San Francisco, CA, USA
| | - Elizabeth M Lancaster
- Department of Surgery, University of California, San Francisco. San Francisco, CA, USA
| | - Warren J Gasper
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, San Francisco. San Francisco, CA, USA
| | - Lucy Z Kornblith
- Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco; San Francisco, California
| | - Jade S Hiramoto
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, San Francisco. San Francisco, CA, USA
| | - Michael S Conte
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, San Francisco. San Francisco, CA, USA
| | - James C Iannuzzi
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, San Francisco. San Francisco, CA, USA
| |
Collapse
|
26
|
Filho JELP, Tustumi F, Coelho FF, Júnior SS, Honório FCC, Henriques AC, Dias AR, Waisberg J. The impact of venous resection in pancreatoduodectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27438. [PMID: 34622858 PMCID: PMC8500612 DOI: 10.1097/md.0000000000027438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/02/2021] [Accepted: 09/17/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Vein resection pancreatoduodenectomy (VRPD) may be performed in selected pancreatic cancer patients. However, the main risks and benefits related to VRPD remain controversial. OBJECTIVE This review aimed to evaluate the risks and survival benefits that the VRPD may add when compared with standard pancreatoduodenectomy (PD). METHODS A systematic review and meta-analysis of studies comparing VRPD and PD were performed. RESULTS VRPD was associated with a higher risk for postoperative mortality (risk difference: -0.01; 95% confidence interval [CI] -0.02 to -0.00) and complications (risk difference: -0.05; 95% CI -0.09 to -0.01) than PD. The length of hospital stay was not different between the groups (mean difference [MD]: -0.65; 95% CI -2.11 to 0.81). In the VRPD, the operating time was 69 minutes higher on average (MD: -69.09; 95% CI -88.4 to -49.78), with a higher blood loss rate (MD: -314.04; 95% CI -423.86 to -195.22). In the overall survival evaluation, the hazard ratio for mortality during follow-up on the group of VRPD was higher compared to the PD group (hazard ratio: 1.13; 95% CI 1.03-1.23). CONCLUSION VRPD is associated with a higher risk of short-term complications and mortality and a lower probability of survival than PD. Knowing the risks and potential benefits of surgery can help clinicians to properly manage pancreatic cancer patients with venous invasion. The decision for surgery with major venous resection should be shared with the patients after they are informed of the risks and prognosis.
Collapse
Affiliation(s)
| | - Francisco Tustumi
- Hospital Estadual Mario Covas, Santo Andre, SP, Brazil
- Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Fabricio Ferreira Coelho
- Hospital Estadual Mario Covas, Santo Andre, SP, Brazil
- Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Sérgio Silveira Júnior
- Hospital Estadual Mario Covas, Santo Andre, SP, Brazil
- Universidade de São Paulo, Sao Paulo, SP, Brazil
| | | | | | - André Roncon Dias
- Hospital Estadual Mario Covas, Santo Andre, SP, Brazil
- Universidade de São Paulo, Sao Paulo, SP, Brazil
| | | |
Collapse
|
27
|
Domenighi LHH, Quoos GP, Braun SK, Vogel AAD, Dos Santos RB, Menegola VM. Alternative treatment for patent ductus arteriosus: a therapeutic challenge. J Vasc Bras 2021; 20:e20210085. [PMID: 34527037 PMCID: PMC8421033 DOI: 10.1590/1677-5449.210085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/20/2021] [Indexed: 11/21/2022] Open
Abstract
The ductus arteriosus is a fetal structure that spontaneously closes in 90% of newborns. Patency 3 months after birth is considered a congenital heart disease that, if untreated, can progress to serious cardiovascular complications. This report aims to review an alternative treatment with an aortic endoprosthesis in a 49-year-old man who presented with dyspnea on moderate exertion associated with a heart murmur. He was diagnosed with persistent ductus arteriosus (PDA) with cardiac complications. Clinical management was unsuccessful and surgical treatment was indicated. Endovascular treatment with a thoracic endoprosthesis was indicated and performed successfully. Percutaneous closure is the preferred method in adult patients. Endovascular intervention using an endoprosthesis is a safe and effective option, in addition to being applicable regardless of the anatomy of the PDA. This case demonstrates the natural history of the pathology and presents a safe and effective alternative for its management.
Collapse
Affiliation(s)
| | | | - Stela Karine Braun
- Universidade Franciscana - UFN, Santa Maria, RS, Brasil.,Hospital Universitário de Santa Maria - HUSM, Santa Maria, RS, Brasil.,Universidade Federal de Santa Maria - UFSM, Santa Maria, RS, Brasil
| | | | | | - Vinícius Matos Menegola
- Universidade Franciscana - UFN, Santa Maria, RS, Brasil.,Universidade Federal de Santa Maria - UFSM, Santa Maria, RS, Brasil
| |
Collapse
|
28
|
Velayudhan BV, Idhrees AM. Alternatives to the frozen elephant trunk in acute type A aortic dissection. Asian Cardiovasc Thorac Ann 2021. [PMID: 32436716 DOI: 10.11852/zgetbjzz2020-0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Acute type A aortic dissection remains one of the most challenging condition in cardiothoracic surgery, with a high mortality rate. Various improvements and innovations have happened over the years to better the outcome of this lethal condition. The frozen elephant trunk prosthesis has been developed to negate the long-term complications of acute type A aortic dissection, but at the cost of increased morbidity compared to hemiarch replacement. Although hemiarch and total arch replacement seem have less morbidity than the frozen elephant trunk technique, they do not address the long-term complications of the distal dissected aorta. Few surgeons now suggest hybrid aortic arch repair as a solution for acute type A aortic dissection. The long-term results need to be studied in all procedures before standardizing them. Although multiple strategies are evolving, the short-term goal of acute type A aortic dissection has not changed: to save the patient's life. The surgical strategy has to be tailored according to the patient's condition and the surgeon's experience.
Collapse
Affiliation(s)
- Bashi V Velayudhan
- Institute of Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
| | - A Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
| |
Collapse
|
29
|
Takabayashi K, Takebayashi S, Sakurai J, Gotoh S, Takizawa K. A case of catastrophic epistaxis from the internal carotid artery due to multiple surgeries and irradiations for pituitary tumor: Rescued utilizing high-flow bypass and simultaneous skull base reconstruction. Clin Case Rep 2021; 9:e04697. [PMID: 34466253 PMCID: PMC8385459 DOI: 10.1002/ccr3.4697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Revascularization for internal carotid artery rupture should be considered immediately under the situation where endovascular treatment is not indicated. Revascularization can prevent the risk of hemorrhage during skull base reconstruction.
Collapse
Affiliation(s)
- Kosuke Takabayashi
- Department of Otorhinolaryngology Japanese Red Cross Asahikawa Hospital Hokkaido Japan
| | - Seiji Takebayashi
- Department of Neurosurgery Japanese Red Cross Asahikawa Hospital Hokkaido Japan
| | - Juro Sakurai
- Department of Neurosurgery Japanese Red Cross Asahikawa Hospital Hokkaido Japan
| | - Shuho Gotoh
- Department of Neurosurgery Japanese Red Cross Asahikawa Hospital Hokkaido Japan
| | - Katsumi Takizawa
- Department of Neurosurgery Japanese Red Cross Asahikawa Hospital Hokkaido Japan
| |
Collapse
|
30
|
Valle CED, Miyamotto M, Timi JRR. Experimental comparative assay of tensile resistance of greater saphenous vein from ankle and groin. J Vasc Bras 2021; 20:e20190117. [PMID: 34249114 PMCID: PMC8244984 DOI: 10.1590/1677-5449.190117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022] Open
Abstract
Background The great saphenous vein is used as patch material in several types of arterial reconstruction, including trauma and carotid and femoral endarterectomy. There have been reports of saphenous patch blowout, particularly of patches constructed with veins harvested from the ankle. There is a need for objective measurement of the resistance of saphenous vein tissues. Objectives To measure the tensile strength of the great saphenous vein harvested at the ankle and groin and analyze the correlation between diameter and tissue strength. Methods Venous samples were harvested during elective saphenous stripping in patients with symptomatic varicose veins. Only segments without reflux were included. Ten limbs from eight patients were studied, providing 20 samples in total. Venous segments were opened along their longitudinal axis and fitted to electronic traction assay equipment to obtain values for material maximum tension in kilograms-force per square centimeter (kgf/cm2; the maximum force resisted by the segment, divided by its cross-sectional area). Results The average maximum tension in the ankle saphenous vein group ranged from 74.02 to 190.10 kgf/cm2 and from 13.53 to 69.45 kgf/cm2 in the groin saphenous vein group (p < 0.0001). The Pearson coefficient for the correlation between vein diameter and maximum tension was -0.852 (moderate to strong inverse correlation). Conclusions Ankle saphenous vein tissue from female patients operated for varicose veins has significantly higher resistance than saphenous vein tissue from the groin and there is an inverse relation between vein diameter and resistance of tissue from the same population.
Collapse
Affiliation(s)
- Carlos Eduardo Del Valle
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Unidade de Cardiologia e Pneumologia, Curitiba, PR, Brasil
| | - Marcio Miyamotto
- Pontifícia Universidade Católica do Paraná - PUC-PR, Curitiba, PR, Brasil.,Hospital Universitário Cajuru - HUC, Serviço de Cirurgia Vascular e Endovascular, Curitiba, PR, Brasil.,Instituto VESSEL de Aperfeiçoamento Endovascular, Curitiba, PR, Brasil.,Hospital Nossa Senhora das Graças - HNSG, Serviço de Cirurgia Vascular e Endovascular Elias Abrão, Curitiba, PR, Brasil
| | - Jorge Rufino Ribas Timi
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Unidade de Cardiologia e Pneumologia, Curitiba, PR, Brasil.,Núcleo Integrado de Cirurgia Endovascular do Paraná - NICEP, Curitiba, PR, Brasil
| |
Collapse
|
31
|
Balzan SMP, Gava VG, Magalhaes MA, Rieger A, Roman LI, Dos Santos C, Marins MP, Rabaioli B, Raupp IT, Kunzler VB. Complete and partial replacement of the inferior vena cava with autologous peritoneum in cancer surgery. J Surg Oncol 2021; 124:665-668. [PMID: 34159613 DOI: 10.1002/jso.26558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/07/2022]
Abstract
Resection of the inferior vena cava may be required in the courses of oncological surgeries for the tumors originating from or invading it. Management of the remaining defect depends on the extension of the resection. Partial or complete replacement of the inferior vena cava, with a patch or interposition graft, may be required. Standard techniques for the reconstruction with a prosthetic material or the autologous veins can be associated with the prosthetic graft infection, high cost, long-standing anticoagulation, technical difficulties, and/or need for extra incisions. The use of the autologous peritoneum represents an easy and inexpensive alternative for the partial and complete inferior vena cava reconstructions.
Collapse
Affiliation(s)
- Silvio M P Balzan
- Postgraduate Program in Health Promotion (PPGPS) and Life Sciences Department, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil.,Oncological Center Lydia Wong Ling, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Saint Gallen Ações e Terapias em Saúde, Santa Cruz do Sul, Brazil.,Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Vinicius G Gava
- Oncological Center Lydia Wong Ling, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Alexandre Rieger
- Postgraduate Program in Health Promotion (PPGPS) and Life Sciences Department, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil.,Biotechnology and Genetics Laboratory, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Luiz I Roman
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Caroline Dos Santos
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Morgana P Marins
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Bruna Rabaioli
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Isabela T Raupp
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Vanessa B Kunzler
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| |
Collapse
|
32
|
Grillo VTRDS, Jaldin RG, Sertório ND, Bertanha M, Sobreira ML, Yoshida RDA, Yoshida WB. True isolated deep femoral artery aneurysm associated with peripheral artery disease: case report. J Vasc Bras 2021; 20:e20200220. [PMID: 34211539 PMCID: PMC8218824 DOI: 10.1590/1677-5449.200220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
True deep femoral artery aneurysms are extremely rare, accounting for about 0.5% of all peripheral aneurysms. In this report, we describe a 79-year-old male patient with a history of prior abdominal aortic aneurysm surgery via a conventional approach who was admitted to the vascular surgery service at the Hospital das Clínicas with intermittent claudication of the lower limbs. Arterial color-Doppler ultrasonography of the right lower limb was performed, revealing peripheral arterial disease of the femoral--popliteal and infrapatellar segments. Computed tomography angiography identified aortoiliac and bifurcated graft occlusion from the infrarenal segment of the aorta, in addition to a deep femoral artery aneurysm with diameters of 3.7 cm x 3.5 cm and length of 7 cm. Resection of the aneurysm was followed by revascularization of the deep femoral artery by interposition of a Dacron® graft and reimplantation of the superficial femoral artery into the graft. In cases of deep femoral artery aneurysms with concomitant peripheral arterial disease, it is important to ensure revascularization and adequate perfusion of the lower limb.
Collapse
Affiliation(s)
- Vinicius Tadeu Ramos da Silva Grillo
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Hospital das Clínicas da Faculdade de Medicina de Botucatu - HC-FMB, Serviço de Cirurgia Vascular e Endovascular, Botucatu, SP, Brasil
| | - Rodrigo Gibin Jaldin
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Hospital das Clínicas da Faculdade de Medicina de Botucatu - HC-FMB, Serviço de Cirurgia Vascular e Endovascular, Botucatu, SP, Brasil
| | - Nathália Dias Sertório
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Hospital das Clínicas da Faculdade de Medicina de Botucatu - HC-FMB, Serviço de Cirurgia Vascular e Endovascular, Botucatu, SP, Brasil
| | - Matheus Bertanha
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Hospital das Clínicas da Faculdade de Medicina de Botucatu - HC-FMB, Serviço de Cirurgia Vascular e Endovascular, Botucatu, SP, Brasil
| | - Marcone Lima Sobreira
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Hospital das Clínicas da Faculdade de Medicina de Botucatu - HC-FMB, Serviço de Cirurgia Vascular e Endovascular, Botucatu, SP, Brasil
| | - Ricardo de Alvarenga Yoshida
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Hospital das Clínicas da Faculdade de Medicina de Botucatu - HC-FMB, Serviço de Cirurgia Vascular e Endovascular, Botucatu, SP, Brasil
| | - Winston Bonetti Yoshida
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Hospital das Clínicas da Faculdade de Medicina de Botucatu - HC-FMB, Serviço de Cirurgia Vascular e Endovascular, Botucatu, SP, Brasil
| |
Collapse
|
33
|
Trintinalha PDO, Sarquis LM, Michaelis W, Santos AL, Yokoyama RA, Miguel MT, Smaniotto AP, de Oliveira MS. Axillary-iliac bypass to protect a transplanted kidney during abdominal aortic aneurysm repair: case report. J Vasc Bras 2021; 20:e20200082. [PMID: 34163534 PMCID: PMC8191185 DOI: 10.1590/1677-5449.200082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Abdominal aortic aneurysms (AAA) are the most common type, even when compared to those involving other segments of the aorta. The prevalence and natural history of arterial aneurysms in abdominal organ transplant recipients remain uncertain. We report a case of abdominal aortic aneurysm in a kidney transplant patient with contrast allergy. Conventional abdominal aortic aneurysm repair was performed, constructing a bi-iliac aortic bypass. A temporary bypass was constructed from the right axillary artery to the right common iliac artery to maintain the renal graft. The patient was transferred to the intensive care unit, where he remained hemodynamically stable, and he was discharged on the 2nd postoperative day. Conventional open surgery with temporary extra-anatomic bypass is an alternative option for treatment of AAA in patients with transplanted kidneys.
Collapse
Affiliation(s)
| | | | - Wilson Michaelis
- Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brasil
| | | | | | | | | | | |
Collapse
|
34
|
Góes AMDO, Chaves RHDF, Furlaneto IP, Rodrigues EDM, de Albuquerque FBA, Smit JHA, de Oliveira CP, Abib SDCV. Comparative angiotomographic study of swine vascular anatomy: contributions to research and training models in vascular and endovascular surgery. J Vasc Bras 2021; 20:e20200086. [PMID: 34093675 PMCID: PMC8147709 DOI: 10.1590/1677-5449.200086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Medium and large animal models allow researchers to evaluate the efficacy and safety of cardiovascular procedures in systems that resemble human anatomy and can be used to simulate scenarios for training purposes. Although porcine models have been used extensively, many physiological and anatomical features remain unknown or only superficially described. Objectives To describe the normal porcine vascular anatomy on computed tomography scans, compare it to human vascular anatomy, and discuss the application of porcine models for open and endovascular procedures. Methods Three male Landrace pigs underwent computed tomography. The vascular anatomy of the neck, thorax, abdomen, and limbs was analyzed and described; relevant similarities and differences between porcine and human vascular anatomies and the implications for vascular procedures in pigs are highlighted. Results The carotid territory, aortic arch, and terminal aorta branches all show marked differences in pigs compared to their human counterparts. Compressions of both left renal and common iliac veins were detected, analogous to those seen in human Nutcracker and May-Thurner syndromes. Vascular measurements (diameters, lengths, and angles) of several different porcine territories are presented. Conclusions The data presented should be useful for planning preclinical trials and basic research and for refining surgical training using porcine models in vascular fields.
Collapse
Affiliation(s)
- Adenauer Marinho de Oliveira Góes
- Centro Universitário do Estado do Pará - CESUPA, Curso de Medicina, Belém, PA, Brasil.,Universidade Federal de São Paulo - UNIFESP, Programa de Ciência Cirúrgica Interdisciplinar, São Paulo, SP, Brasil
| | | | | | | | | | | | | | - Simone de Campos Vieira Abib
- Universidade Federal de São Paulo - UNIFESP, Programa de Ciência Cirúrgica Interdisciplinar, São Paulo, SP, Brasil
| |
Collapse
|
35
|
Weissler EH, Aboyans V, Bauersachs R, Brodmann M, Nikol S, Debus S, Patel MR, Jones WS. The Role for Combined Antithrombotic Therapy With Platelet and Coagulation Inhibition After Lower Extremity Revascularization. JACC Cardiovasc Interv 2021; 14:796-802. [PMID: 33826501 DOI: 10.1016/j.jcin.2021.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 01/22/2023]
Abstract
Evidence for antithrombotic treatment following lower extremity revascularization (LER) for peripheral artery disease (PAD) is limited, leading to weak and conflicting guideline recommendations and heterogeneous practice patterns. This variability in post-LER antithrombotic treatment raises quality-of-care issues that have long been under-studied. This Viewpoint reviews the most updated guidelines, currently-available evidence, and contemporary data about practice patterns and practitioner opinions in this area. Particular attention is paid to distinctions between antiplatelet therapy, anticoagulant therapy, and combination therapy in light of the recent VOYAGER-PAD (Vascular Outcomes Study of ASA [acetylsalicylic acid] Along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD) trial. The implications of VOYAGER-PAD pertaining to various subgroups of patients undergoing LER are explored. Overall, this Viewpoint argues for consideration of post-LER therapy targeted at both platelet function and the coagulation cascade, though further LER-specific analyses, including expected VOYAGER-PAD sub-analyses, are needed.
Collapse
|
36
|
Bárdos D, Nagy Z, Pekli D, Fülöp A, Szijártó A. Vena cava inferior leiomyosarcoma kezelése cavotomiával és a jobb vena renalis neoimplantatiójával. Magy Seb 2021; 74:22-26. [PMID: 33729993 DOI: 10.1556/1046.74.2021.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. A vena cava inferior leiomyosarcomája a vena tunica mediájából kiinduló igen ritka rosszindulatú daganat. Tünetei és radiomorfológiai jelei nem mindig juttatnak pontos kórisméhez, szövettani mintavétele pedig elhelyezkedése miatt veszélyes lehet. Diagnózisa ezért sokszor jelent kihívást a klinikusok számára. Kezelése elsősorban sebészi, amelyet együtt vagy monoterápiában alkalmazott radioterápia és kemoterápia egészít ki. Esetünkben egy 74 éves nőbeteg tünetmentes, a v. cava inferior jobb v. renalis fölötti részének jobb mellékvesével összefüggő tumorát találtuk. Endokrinológiai kivizsgálása során a szérum kortizol, adrenalin, noradrenalin, adenocorticotrop hormon (ACTH), teljes és szabad tesztoszteron, dehidroepiandroszteron-szulfát (DHEA-S), nemi hormon kötőfehérje (sex hormone binding globulin, SHBG) normál tartományban volt, a tumor hormonszekréciót nem mutatott. A tumor sebészi eltávolítása mellett döntöttünk. Preoperatív biopsziát annak kockázatai miatt nem végeztünk. A műtét során a v. cava inferior daganatát találtuk, a tumor eltávolítását végeztük a vena falának resectiójával, a jobb mellékvese eltávolításával és a jobb v. renalis neoimplantatiójával. A jobb feltárás érdekében a műtét elején cholecystectómiát is végeztünk. A műtét után szövődmény nem jelentkezett. A beteg adjuváns radioterápiában részesült. A tumor korai diagnózisának és en bloc resectiójának köszönhetően jelentősen növeltük a beteg gyógyulási esélyeit, az elvégzett radioterápiával pedig csökkentettük a recidíva valószínűségét. Summary. Leiomyosacroma of the inferior vena cava is an extremely rare malignancy originating from the tunica media of the venous wall. Its symptoms and radiomorphological signs do not always lead to an accurate diagnosis. Histological sampling can be dangerous due to its location. Therefore the diagnosis is often a challenge for clinicians. Its treatment is primarily surgical, supplemented by radiotherapy and chemotherapy applied together or in monotherapy. In our case, an asymptomatic 74-year-old female patient was diagnosed with a tumor of the inferior caval vein located just above the right renal vein and involving the right adrenal gland. As serum cortisol, epinephrine, norepinephrine, adrenocorticotropic hormone (ACTH), total and free testosterone, dehydroepiandrosterone sulfate (DHEA-S), sex hormone binding globulin (SHBG) was at normal level, the tumor showed no hormone secretion. Primary surgical resection was planned. Preoperative biopsy was not performed due to its high risk of complications. During operation, tumor resection was performed by resection of the venous wall, removal of the right adrenal gland and neoimplantation of the right renal vein. For better exposure, cholecystectomy was also performed at the beginning of surgery. There were no postoperative complications. The patient received adjuvant radiation therapy. Thanks to the early diagnosis of the tumor and the complete resection, we significantly increased the patient's chances of total recovery. With the radiotherapy performed, we reduced the likelihood of tumor recurrence.
Collapse
Affiliation(s)
- Dávid Bárdos
- 1 Semmelweis Egyetem, I. sz. Sebészeti és Intervenciós Gasztroenterológiai Klinika, 1085 Budapest, Üllői út 78
| | - Zoltán Nagy
- 1 Semmelweis Egyetem, I. sz. Sebészeti és Intervenciós Gasztroenterológiai Klinika, 1085 Budapest, Üllői út 78
| | - Damján Pekli
- 1 Semmelweis Egyetem, I. sz. Sebészeti és Intervenciós Gasztroenterológiai Klinika, 1085 Budapest, Üllői út 78
| | - András Fülöp
- 1 Semmelweis Egyetem, I. sz. Sebészeti és Intervenciós Gasztroenterológiai Klinika, 1085 Budapest, Üllői út 78
| | - Attila Szijártó
- 1 Semmelweis Egyetem, I. sz. Sebészeti és Intervenciós Gasztroenterológiai Klinika, 1085 Budapest, Üllői út 78
| |
Collapse
|
37
|
Matsumoto R, Shimamura K, Kuratani T, Masada K, Yokota J, Sawa Y. Successful treatment of graft-duodenal fistula after renovisceral debranching thoracic endovascular aortic repair with limited graft resection based on 18F-fluorodeoxyglucose positron emission tomography with computed tomography. J Vasc Surg Cases Innov Tech 2021; 7:286-290. [PMID: 33997575 PMCID: PMC8095122 DOI: 10.1016/j.jvscit.2021.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/24/2021] [Indexed: 11/28/2022]
Abstract
We present the case of a patient with a graft-duodenal fistula after renovisceral debranching thoracic endovascular aortic repair. 18F-fluorodeoxyglucose positron emission tomography with computed tomography showed that the infection was localized to the renovisceral bypass grafts and the right kidney. Based on the preoperative imaging findings, a limited surgery with resection was performed in the fistula, right kidney, and fluorodeoxyglucose-positive bypass grafts, while preserving the fluorodeoxyglucose-negative grafts. No signs of reinfection were reported 2 years after the surgery. Accurate assessment of infection with 18F-fluorodeoxyglucose positron emission tomography with computed tomography may be useful for performing adequate excision of infected lesions.
Collapse
Affiliation(s)
- Ryota Matsumoto
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuo Shimamura
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenta Masada
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Junki Yokota
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
38
|
Osman F, Ravendren A, Mohammed I, Bashir M. The fundamentals of health economics and its application in the provision of vascular surgery in the UK. Asian Cardiovasc Thorac Ann 2021; 29:677-681. [PMID: 33455409 DOI: 10.1177/0218492320988461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health economics offers a lifeline to policymakers as a way of improving health outcomes in the face of increased monetary constraints. Doctors are uniquely placed in healthcare delivery where they have a pertinent influence on both supply and demand for healthcare provisions. Every clinical decision made by doctors is also an economic decision, and the true cost of offering a scarce healthcare resource includes not being able to fund alternative therapies and hence, foregoing its benefit. Technology and innovation in medicine is seeing an increase in potential therapies; however, how well do they perform against the current gold standard and are they worth the additional cost? A personalized and patient-centered approach to medicine has paved the way for a holistic health outcome measure, quality-adjusted life years, which is predominately used by United Kingdom resource allocators. Aortic surgical interventions are resource-intensive, and recent trends have shown the growing economic burden as yearly costs continue to climb. Health economic models are not without their weaknesses and it is important that future analyses assess the impact on society, distributional consequences, and the value of collecting more information to reduce the uncertainty of the economic result.
Collapse
Affiliation(s)
- Fatima Osman
- School of Medicine, Imperial College London, London, UK
| | | | - Idhrees Mohammed
- Institute of Cardiac and Aortic Surgery, SIMS Hospital, Chennai, India
| | | |
Collapse
|
39
|
Munir W, Chong JH, Harky A, Bashir M, Adams B. Type A aortic dissection: involvement of carotid artery and impact on cerebral malperfusion. Asian Cardiovasc Thorac Ann 2020; 29:635-642. [PMID: 33375820 DOI: 10.1177/0218492320984329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Acute type A aortic dissection is a surgical emergency and management of such pathology can be complex with poor outcomes when there is organ malperfusion. Carotid artery involvement is present in 30% of patients diagnosed with acute type A aortic dissection, and given its emergency and complex nature, there is much controversy regarding the approach, extent of treatment, and timing of the intervention. It is clear that the occurrence of cerebral malperfusion adds an extra layer of complexity to the decision-making framework for treatment. Standardization and validation of the optimal management approach is required, and this should ideally be addressed with large-scale studies. Nonetheless, current literature supports the need for rapid recognition and diagnosis of acute type A aortic dissection with cerebral malperfusion, immediate and extensive surgical repair, and the appropriate use of cerebral perfusion techniques. This paper aims to discuss the current evidence regarding the impact of carotid artery involvement in both the management and outcomes of acute type A aortic dissection.
Collapse
Affiliation(s)
- Wahaj Munir
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jun Heng Chong
- GKT School of Medical Education, King's College London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mohamad Bashir
- Vascular Surgery Department, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Benjamin Adams
- Aortovascular Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| |
Collapse
|
40
|
Abe N, Okada K, Tanaka H, Okita Y. Valve-sparing aortic root replacement after type A aortic dissection repairs. Asian Cardiovasc Thorac Ann 2020; 29:381-387. [PMID: 33249852 DOI: 10.1177/0218492320977981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Aortic root reoperation after aortic dissection repair sometimes requires aortic root replacement. A valve-preserving technique should be applied when the aortic cusp is normal. Valve-sparing aortic root reconstruction using the reimplantation technique resolves aortic valve regurgitation, root dilatation, and pseudoaneurysm in the proximal anastomosis. Our experience in aortic root reoperation is presented. METHODS From January 2000 to March 2019, 26 patients underwent reoperative valve-sparing aortic root reconstruction using the reimplantation technique. The time from the initial operation to reoperation was 69.3 ± 51.6 months. Aortic root reoperation was required for a fragile wall at the previous proximal anastomosis or aortic root dilatation. We aimed to stabilize the aortic root without valve regurgitation. The native aortic cusp was aggressively preserved when nearly normal. Indications included root dilatation (n = 13), pseudoaneurysm of the previous proximal anastomosis (n = 11), and aortic valve regurgitation (n = 4). RESULTS There was no early postoperative mortality. Follow-up was 49 ± 47 months (range 4-161 months). The 3, 5, and 10-year survival was 88.9% ± 7.4%, 88.9% ± 7.4%, and 77.8% ± 12.2%, respectively. Freedom from recurrence of a greater than moderate degree of aortic valve regurgitation at 3, 5, and 10 years was 86.5% ± 8.9%, 86.5% ± 8.9%, and 86.5% ± 8.9%, respectively. One patient underwent aortic valve replacement for recurrent aortic valve regurgitation 15 months after the valve-sparing reoperation. CONCLUSIONS Midterm outcomes of reoperative valve-sparing aortic root reconstruction using the reimplantation technique and postoperative aortic valve performance were satisfactory.
Collapse
Affiliation(s)
- Noriyuki Abe
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Okada
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Tanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
41
|
Abstract
OBJECTIVES Trans-catheter aortic valve replacement is a commonplace procedure for patients with aortic valvular stenosis who are at a high risk for surgery, evidenced by the 34,892 trans-catheter aortic valve replacements performed in 2016. Trans-catheter aortic valve replacement's rate of major vascular complications with second-generation closure devices is 4.5% according to a meta-analysis of 10,822 patients. To manage those complications, percutaneous approaches to arterial repairs show shorter length of stay, higher rate of direct to home discharge and equivalent outcomes at long-term follow-up. This study's goal is to show that one center's vascular access strategy can decrease open repairs and improve patient outcomes. METHODS Our team began accessing the mid-common femoral artery at least 1-2 cm proximal to the takeoff of the profunda femoris. This allowed an endovascular stent to be deployed if necessary via contralateral femoral access. We performed a completion angiogram following every trans-catheter aortic valve replacement to ensure no arterial complications. We conducted a retrospective review of a prospectively maintained database for all trans-catheter aortic valve replacement cases at a tertiary care center from 1 January 2016 to 30 June 2018. RESULTS A total of 699 trans-catheter aortic valve replacement procedures were performed with 25/31 (80.6%) cases met inclusion criteria. An increase was noted in the number of stent procedures versus cutdown procedures over time (P < 0.001). A decrease was noted in the number of vascular surgery team activations following trans-catheter aortic valve replacement (P = 0.004). A non-significant trend was noted toward a shorter median length of stay for the stent group (P = 0.149). There was no increase in 30-day mortality rate (0.0% for both groups) or 30-day readmissions (4/15 (26.7%) for stents vs. 2/10 (20.0%) for open repairs; P > 0.999). CONCLUSIONS This strategy is safe and feasible to implement and reduces the number of open repairs following trans-catheter aortic valve replacement, activation of surgical resources, and possibly the length of stay.
Collapse
Affiliation(s)
- Michael H Parker
- Department of Surgery, General Surgery, Inova Fairfax, Fairfax, VA, USA
| | - Dipankar Mukherjee
- Department of Surgery, Vascular Surgery, Inova Fairfax, Fairfax, VA, USA
| | - Liam Ryan
- Department of Surgery, Cardiothoracic Surgery, Inova Fairfax, Fairfax, VA, USA
| |
Collapse
|
42
|
Murphy GA, Singh-Moon RP, Mazhar A, Cuccia DJ, Rowe VL, Armstrong DG. Quantifying dermal microcirculatory changes of neuropathic and neuroischemic diabetic foot ulcers using spatial frequency domain imaging: a shade of things to come? BMJ Open Diabetes Res Care 2020; 8:8/2/e001815. [PMID: 33219118 PMCID: PMC7682192 DOI: 10.1136/bmjdrc-2020-001815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/06/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The use of non-invasive vascular and perfusion diagnostics are an important part of assessing lower extremity ulceration and amputation risk in patients with diabetes mellitus. Methods for detecting impaired microvascular vasodilatory function in patients with diabetes may have the potential to identify sites at risk of ulceration prior to clinically identifiable signs. Spatial frequency domain imaging (SFDI) uses patterned near-infrared and visible light spectroscopy to determine tissue oxygen saturation and hemoglobin distribution within the superficial and deep dermis, showing distinct microcirculatory and oxygenation changes that occur prior to neuropathic and neuroischemic ulceration. RESEARCH DESIGNS AND METHODS 35 patients with diabetes mellitus and a history of diabetic foot ulceration were recruited for monthly imaging with SFDI. Two patients who ulcerated during the year-long longitudinal study were selected for presentation of their clinical course alongside the dermal microcirculation biomarkers from SFDI. RESULTS Patient 1 developed a neuropathic ulcer portended by a focal increase in tissue oxygen saturation and decrease in superficial papillary hemoglobin concentration 3 months prior. Patient 2 developed bilateral neuroischemic ulcers showing decreased tissue oxygen saturation and increased superficial papillary and deep dermal reticular hemoglobin concentrations. CONCLUSIONS Wounds of different etiology show unique dermal microcirculatory changes prior to gross ulceration. Before predictive models can be developed from SFDI, biomarker data must be correlated with the clinical course of patients who ulcerate while being followed longitudinally. TRIAL REGISTRATION NUMBER NCT03341559.
Collapse
Affiliation(s)
- Grant A Murphy
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | | | - Amaan Mazhar
- Department of Research and Development, Modulim, Irvine, California, USA
| | - David J Cuccia
- Department of Research and Development, Modulim, Irvine, California, USA
| | - Vincent L Rowe
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - David G Armstrong
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| |
Collapse
|
43
|
Harada N, Yoshizumi T, Matsuura T, Taguchi T, Mori M. Usefulness of microsurgical back-table angioplasty for multiple hepatic arteries in living donor liver transplantation. Ann Gastroenterol Surg 2020; 4:735-740. [PMID: 33319164 PMCID: PMC7726678 DOI: 10.1002/ags3.12370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/31/2020] [Accepted: 06/14/2020] [Indexed: 11/09/2022] Open
Abstract
The graft hepatic artery orifice is tiny in living donor liver transplantation, and therefore, it is more difficult to reconstruct the hepatic artery than in deceased donor liver transplantation. In situ, multi-vessel hepatic artery reconstruction in living donor liver transplantation is time-consuming, and reconstructions are often complicated if the hepatic graft has several stumps. We describe two living donor liver transplants using back-table microsurgical angioplasty to combine two hepatic artery stumps to create a single orifice, and sequential single-vessel hepatic artery reconstruction in the recipient. Briefly, we used double-needle interrupted sutures for the two hepatic artery stumps with a biangular stay-suture method in back-table microsurgical angioplasty. Each suture was placed from the inner side of the arterial wall to the outer side, which allowed for safe and reliable suturing. After placing the interrupted sutures in the anterior wall, we turned over the vessels in the cold storage on the back table and placed interrupted sutures in the posterior wall. In the recipient, the single stump of the graft was anastomosed to the recipient's hepatic artery using an interrupted pattern and a surgical microscope. The postoperative courses of the donors and recipients were uneventful. Back-table hepatic artery angioplasty is a feasible option to overcome the complexities of multi-vessel arterial reconstruction in living donor liver transplantation. We recommend performing secure multi-vessel hepatic arterial reconstruction adapted to the clinical scenario. Using simple appropriate anastomosis, back-table microsurgical angiography may provide good results in living donor liver transplantation.
Collapse
Affiliation(s)
- Noboru Harada
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Tomoharu Yoshizumi
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Toshiharu Matsuura
- Department of Pediatric SurgeryGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Tomoaki Taguchi
- Department of Pediatric SurgeryGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Masaki Mori
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| |
Collapse
|
44
|
Fuchigami T, Nishioka M, Shimabukuro A, Takefuta K, Nagata N. Arterial switch operation for Taussig-Bing anomaly with aortic arch obstruction. Asian Cardiovasc Thorac Ann 2020; 29:179-185. [PMID: 33115256 DOI: 10.1177/0218492320966444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The short-term survival rate after single-stage correction of Taussig-Bing anomaly with aortic arch obstruction remains favorable. However, some cases are encountered occasionally in which single-stage correction was not performed during the neonatal period. Accordingly, we evaluated the midterm outcomes of different surgical strategies. METHODS Seven patients who underwent an arterial switch operation and intraventricular rerouting as definitive surgery between 2007 and 2017 were investigated. Of these 7 patients, 3 had undergone previous pulmonary artery banding and aortic arch reconstruction. RESULTS The median body weight at definitive surgery was 3.3 kg (range 2.9-8.3 kg). At definitive surgery, the arrest time for single-stage correction (162.3 ± 21.7 min) was significantly shorter than that of staged repair (206.3 ± 5.1 min, p = 0.020). There was no hospital or late death. One patient in both strategy groups underwent aortic reintervention 54 months and 7.1 months after the definitive operation. Neoaortic valve (perinatal pulmonary valve) diameter decreased significantly from the perinatal valve diameter following definitive surgery (median +4.94z and +2.12z, respectively, p = 0.016) but there was no significant difference in the neopulmonary valve (perinatal aortic valve) diameter. Both single-stage correction and staged repair patients showed a similar trend. At the last follow-up, no patient had greater than mild neoaortic or neopulmonary valve regurgitation. CONCLUSION The surgical outcomes of both single-stage correction and staged correction for Taussig-Bing anomaly with aortic arch obstruction are excellent. Both strategies produce similar changes in the diameter and regurgitation grade of the neoaortic and neopulmonary valves.
Collapse
Affiliation(s)
- Tai Fuchigami
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Masahiko Nishioka
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Atsuya Shimabukuro
- Department of Pediatric Cardiology, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Kiyotaka Takefuta
- Department of Pediatric Cardiology, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Nobuhiro Nagata
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| |
Collapse
|
45
|
Mohammed R, Dandekar U. Large sinus of Valsalva aneurysm presenting as acute coronary syndrome. Asian Cardiovasc Thorac Ann 2020; 29:411-413. [PMID: 33115259 DOI: 10.1177/0218492320970006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A sinus of Valsalva aneurysm is a rare defect that is usually asymptomatic. We report a sinus of Valsalva aneurysm arising from the left coronary sinus with compression of the left main coronary artery in a 56-year-old man who presented with worsening chest pain. Coronary imaging revealed a 4.6-cm sinus of Valsalva aneurysm with compression of the left main stem, left anterior descending, and proximal circumflex arteries. He underwent aortic root and ascending aortic replacement. Large sinus of Valsalva aneurysms can be life-threatening and can be managed safely surgically.
Collapse
Affiliation(s)
- Rayhaan Mohammed
- Department of Cardiothoracic Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Uday Dandekar
- Department of Cardiothoracic Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| |
Collapse
|
46
|
Polok K, Górka J, Fronczek J, Iwaniec T, Górka K, Szczeklik W. Perioperative cardiovascular complications rate and activity of coagulation and fibrinolysis among patients undergoing vascular surgery for peripheral artery disease and abdominal aortic aneurysm. Vascular 2020; 29:134-142. [PMID: 32600160 DOI: 10.1177/1708538120937127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare preoperative coagulation and fibrinolysis activity and incidence of perioperative complications between patients undergoing vascular procedures for peripheral artery disease and abdominal aortic aneurysm. METHODS This is a substudy of a prospective observational cohort study (VISION; NCT00512109) in which we recruited patients aged ≥45 years, undergoing surgery for peripheral artery disease and abdominal aortic aneurysm. Blood samples were obtained 24 h preoperatively to measure platelet count, concentrations of coagulation coagulation (fibrinogen, factor VIII, von Willebrand factor:Ristocetin cofactor, antithrombin III), fibrinolysis (dimer D, plasmin-antiplasmin complexes, tissue plasminogen activator) markers and level of soluble CD40 ligand. Incidence of myocardial infarction, stroke, and death (composite endpoint) was assessed in 30-day follow-up. RESULTS The study group included 131 patients at the mean age of 68.3 years among whom reason for surgery was peripheral artery disease in 77 patients (58.8%) and abdominal aortic aneurysm in 54 patients (41.2%). Peripheral artery disease group was characterized by higher platelet count (250.5 versus 209.5 (×103/µl), p = 0.001), concentrations of fibrinogen (5.4 versus 4.1 (g/l), p < 0.001), factor VIII (176.9 versus 141.9 (%), p < 0.001), von Willebrand factor:Ristocetin cofactor (188.9 versus 152.3 (%), p = 0.009), and soluble CD40 ligand (9016.0 versus 7936.6 (pg/ml), p = 0.005). The dimer D level was higher (808.0 versus 2590.5 (ng/ml), p < 0.001) in the abdominal aortic aneurysm group. Incidence of major cardiovascular events (death, myocardial infarction, stroke) within 30 days from surgery did not differ between the groups (39.0% versus 29.6%, p = 0.27). CONCLUSIONS The study suggests higher activation of coagulation and relatively lower fibrinolytic activity in peripheral artery disease group compared to patients undergoing surgery for abdominal aortic aneurysm without a significant difference in cardiovascular outcomes.
Collapse
Affiliation(s)
- Kamil Polok
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.,Department of Pulmonology, II Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Górka
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Fronczek
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Teresa Iwaniec
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Karolina Górka
- Department of Pulmonology, II Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
47
|
Abstract
Acute type A aortic dissection remains one of the most challenging condition in cardiothoracic surgery, with a high mortality rate. Various improvements and innovations have happened over the years to better the outcome of this lethal condition. The frozen elephant trunk prosthesis has been developed to negate the long-term complications of acute type A aortic dissection, but at the cost of increased morbidity compared to hemiarch replacement. Although hemiarch and total arch replacement seem have less morbidity than the frozen elephant trunk technique, they do not address the long-term complications of the distal dissected aorta. Few surgeons now suggest hybrid aortic arch repair as a solution for acute type A aortic dissection. The long-term results need to be studied in all procedures before standardizing them. Although multiple strategies are evolving, the short-term goal of acute type A aortic dissection has not changed: to save the patient's life. The surgical strategy has to be tailored according to the patient's condition and the surgeon's experience.
Collapse
Affiliation(s)
- Bashi V Velayudhan
- Institute of Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
| | - A Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
| |
Collapse
|
48
|
Kreibich M, Rylski B, Beyersdorf F, Siepe M, Czerny M. Endo-Bentall for proximal aortic dissection: from conception to application. Asian Cardiovasc Thorac Ann 2020; 29:697-700. [PMID: 32436718 DOI: 10.1177/0218492320929211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The endovascular treatment of pathologies of the ascending aorta has not been incorporated into routine clinical practice. The aim of this article is to provide an overview of the endovascular treatment of pathologies of the ascending aorta, particularly type A aortic dissection. A thorough analysis and discussion of anatomical, physiological, clinical and technical challenges, and obstacles is performed. Conventional straight stent-grafts alone are not capable of fixing the entire complex underlying problem in the vast majority of patients with acute type A aortic dissection. An endovascular valve-carrying conduit consisting of a proximal transcatheter aortic valve connected to a covered stent-graft would be able to close a primary entry tear in the ascending aorta, ensure coronary perfusion, initiate true lumen expansion, treat malperfusion, treat aortic regurgitation, drain any pericardial effusion through a transapical approach, and possibly stabilize the distal aorta. Two thirds of all patients with acute aortic dissection are potential candidates for endovascular treatment, and the concept may help to significantly improve survival in patients with acute aortic dissection.
Collapse
Affiliation(s)
- Maximilian Kreibich
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
49
|
Lee SS, Lee JH. Surgical treatment of asymptomatic epithelioid hemangioendothelioma originating from the superior vena cava: A case report. Medicine (Baltimore) 2020; 99:e19859. [PMID: 32312011 PMCID: PMC7220394 DOI: 10.1097/md.0000000000019859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Epithelioid hemangioendothelioma is a rare endothelial tumor with a low-grade malignancy. This tumor can be treated with complete resection. PATIENT CONCERNS A 20-year-old Korean man visited our hospital due to an abnormal finding on standing chest PA X-ray. He did not have any past medical history. DIAGNOSIS Chest computed tomography shows a well-defined, oval-shaped tumor invading the brachiocephalic vein and superior vena cava. A malignant tumor of vascular origin was diagnosed by a percutaneous needle biopsy. INTERVENTIONS We performed en-bloc resection including the great vessels for complete resection of the tumor. Histologic evaluation confirmed the lesion to be a hemangioendothelioma and the surgical margins were free from tumor invasion. OUTCOMES Fourteen days later, the patient was discharged without any complication. Thirty months after surgery, recurrences, or metastasis were not detected. LESSONS Epithelioid hemangioendothelioma is a rare malignant endothelial tumor in the central vein. Surgery is the treatment of choice and shows good results. We introduce and appropriate surgical method to ensure successful treatment for rare disease.
Collapse
Affiliation(s)
- Seok Soo Lee
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University Medical Center
| | - Jang Hoon Lee
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University college of Medicine, Daegu, Republic of Korea
| |
Collapse
|
50
|
Abstract
Popliteal artery aneurysms are the most frequent type of peripheral aneurysm, accounting for 85% of the all of these aneurysms. Usually asymptomatic, they are generally diagnosed during clinical examination. Incidence is higher among males and seniors. They are bilateral in 50% of the cases and 60% are associated with abdominal aortic aneurysms. This paper describes a 72-year-old male patient who presented with two bilateral pulsatile masses, one in each popliteal region, was otherwise asymptomatic, and had a history of hypertension and dyslipidemia. Clinical examination and ultrasound imaging confirmed a diagnosis of bilateral aneurysms of the popliteal arteries. Popliteal artery aneurysms can be treated with open bypass surgery, with or without aneurysm resection, or with endovascular surgery. This Therapeutic Challenge discusses these possibilities.
Collapse
Affiliation(s)
- José Aderval Aragão
- Universidade Federal de Sergipe - UFS, Aracaju, SE, Brasil.,Universidade Tiradentes - UNIT, Aracaju, SE, Brasil
| | | | | | | | | |
Collapse
|