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Potts MB, Horbinski CM, Jahromi BS. Rapid Development of an Aneurysm at the Anastomotic Site of a Superficial Temporal Artery to Middle Cerebral Artery Bypass: Case Report and Literature Review. World Neurosurg 2019; 128:314-319. [PMID: 31125771 DOI: 10.1016/j.wneu.2019.05.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Direct extracranial to intracranial (EC-IC) bypass is a valuable treatment option for symptomatic occlusive cerebrovascular disease and complex intracranial aneurysms. Aneurysm formation at or near the anastomotic site is a rarely reported phenomenon, and the pathophysiology and appropriate management of such de novo aneurysms are not clear. CASE DESCRIPTION Here we present the case of a superficial temporal to middle cerebral artery (STA-MCA) anastomosis that was complicated by aneurysm formation at the anastomotic site. This was treated with microsurgical clipping with preservation of the bypass. Pathologic analysis of the lesion was consistent with a pseudoaneurysm. We provide a literature review of this phenomenon, which is most often associated with low-flow STA-MCA bypasses, including review of the pathologic findings associated with it. CONCLUSION Pseudoaneurysm formation at the site of an EC-IC bypass is a rare phenomenon that should be recognized and treated to prevent further growth and rupture.
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Long A, Mahoney P. TAVR Complicated by Thoracic Aortic Perforation and Intussusception of the Right Iliac: Report of Successful Emergent Management With Endovascular Techniques. THE JOURNAL OF INVASIVE CARDIOLOGY 2019; 31:E97. [PMID: 31034445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Percutaneous approaches have become routine in transcatheter aortic valve replacement (TAVR). Despite numerous advantages, vascular complications associated with percutaneous access can occur during and after TAVR, and increase morbidity and mortality significantly. Effective management of potentially catastrophic vascular complications often requires prompt recognition, diagnosis, and management by multidisciplinary teams.
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Yokoya S, Hino A, Echigo T, Oka H. Place-and-Clip Method for Fixing the Suture Thread in Deep-Brain Vascular Lesions: A Technical Case Report. World Neurosurg 2019; 128:11-13. [PMID: 31009785 DOI: 10.1016/j.wneu.2019.04.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intracranial vascular injury incurred during surgery must be repaired as quickly as possible. The standard repair procedure is surgical suturing. However, the narrow and deep working space may obstruct creating a knot with the suture thread. CASE DESCRIPTION Resection of an olfactory groove meningioma was performed in a 73-year-old woman via the right lateral supraorbital approach. Tumor retraction caused an injury to the pericallosal artery. After temporary clipping of the vessel, a 10-0 nylon thread was placed on the vascular lesion and the end of the thread was fixed with an aneurysm clip. CONCLUSIONS Fixing the suture thread with an aneurysm clip can be a rescue technique in suturing procedures on deeply located vascular lesions.
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Wang Y, Liu ZQ, Xu MD, Chen SY, Zhong YS, Zhang YQ, Chen WF, Qin WZ, Hu JW, Cai MY, Yao LQ, Zhou PH, Li QL. Clinical and endoscopic predictors for intraprocedural mucosal injury during per-oral endoscopic myotomy. Gastrointest Endosc 2019; 89:769-778. [PMID: 30218646 DOI: 10.1016/j.gie.2018.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Mucosal injury (MI) is one of the most common perioperative adverse events of per-oral endoscopic myotomy (POEM). Severe undertreated MI may lead to contamination of the tunnel and even mediastinitis. This study explored the characteristics, predictors, and management approaches of intraoperative MI. METHODS A retrospective review of the prospectively collected database at a large tertiary referral endoscopy unit was conducted for all patients undergoing POEM between August 2010 and March 2016. MI was graded according to the difficulty of repair (I, easy to repair; II, difficult to repair). The primary outcomes were the incidence and predictors of intraoperative MI. Secondary outcomes were MI details and the corresponding treatment. RESULTS POEM was successfully performed in 1912 patients. A total of 338 patients experienced 387 MIs, for an overall frequency of 17.7% (338/1912). Type II MI was rare, with a frequency of 1.7% (39/1912). Major adverse events were more common in patients with MI than in those without MI (6.2% vs 2.5%, P < .001). On multivariable analysis, MI was independently associated with previous Heller myotomy (odds ratio [OR], 2.094; P = .026), previous POEM (OR, 2.441; P = .033), submucosal fibrosis (OR, 4.530; P < .001), mucosal edema (OR, 1.834; P = .001), and tunnel length ≥13 cm (OR, 2.699; P < .001). Previous POEM (OR, 5.005; P = .030) and submucosal fibrosis (OR, 12.074; P < .001) were significant predictors of type II MI. POEM experience >1 year was a protective factor for MI (OR, .614; P = .042) and type II MI (OR, .297; P = .042). CONCLUSIONS MI during POEM is common, but type II injury is rare. Previous POEM and submucosal fibrosis were significant predictors of type II mucosal injury. POEM experience after the learning curve reduces the risk of MI.
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Nation J, Schupper AJ, Deconde A, Levy M. CSF leak after endoscopic skull base surgery in children: A single institution experience. Int J Pediatr Otorhinolaryngol 2019; 119:22-26. [PMID: 30660855 DOI: 10.1016/j.ijporl.2019.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The endoscopic expanded endonasal approach (EEA) has been shown to be a safe and effective surgical technique in the resection of pediatric skull base lesions. Cerebrospinal fluid (CSF) leaks are among the most common complications of this approach. Here we review skull base resections using EEA in pediatric patients at our single institution, to identify potential risk factors for this surgical complication. METHODS A retrospective chart review was conducted on pediatric patients at our single institution for patients 19 years-old and under, who underwent an EEA for resection of a skull base tumor. RESULTS Thirty-nine pediatric patients (ages 1-19 years) with 8 different tumor pathologies underwent an EEA for resection of their skull base tumors. 21 patients experienced an intraoperative CSF leak, of which 10 (48%) were "high-flow" leaks and 11 (52%) were "low-flow" leaks. Nasoseptal flaps were only used to repair the intraoperative "high flow" leaks (n = 10), and "low flow" and "no leaks" were repaired with allograft and fat. No patients experienced a post-operative CSF leak. CONCLUSION In our pediatric series, the skull base repair algorithm of using an NSF only in cases of "high flow" intraoperative leaks was effective, and no post-operative CSF leaks occurred. Not using an NSF in cases of "low-flow" or "no leak" cases allows for decreased anatomical disruption in the growing patient.
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Ghobrial MSA, Egred M. Right Ventricular Wall Hematoma Following Angioplasty to Right Coronary Artery Occlusion. THE JOURNAL OF INVASIVE CARDIOLOGY 2019; 31:E66. [PMID: 30927538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Right ventricle intramural hematoma is a rare complication of right coronary artery PCI. With the increased uptake and prevalence of complex chronic total occlusion interventions, unusual complications will continue to occur; sharing and raising the awareness of these complications is of paramount importance.
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Snapshot quiz. Br J Surg 2019; 106:383. [PMID: 30811051 DOI: 10.1002/bjs.11058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/30/2018] [Indexed: 11/08/2022]
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Jarrar MS, Fourati A, Fadhl H, Youssef S, Mahjoub M, Khouadja H, Hafsa A, Mraidha MH, Ghali A, Hamila F, Letaief R. Risk factors of conversion in laparoscopic cholecystectomies for lithiasic acute cholecystitis. Results of a monocentric study and review of the literature. LA TUNISIE MEDICALE 2019; 97:344-351. [PMID: 31539093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Nowadays, laparoscopic cholecystectomy has become the gold standard in the management of lithiasic acute cholecystitis. However, the rate of conversion to laparotomy remains considerable, greater than that of uncomplicated lithiasis. Some factors, related to the patient, the disease or the surgeon, are associated with a high risk of conversion. AIM To identify the factors associated with a significant risk of conversion in laparoscopic cholecystectomy for acute cholecystitis. METHODS Between January 2011 and December 2015, all patients operated on for acute cholecystitis at the Department of General and Digestive Surgery of Farhat Hached University Hospital of Sousse - Tunisia were divided into two groups: A for the laparoscopic approach and B for conversion. We compared the two groups. RESULTS The conversion rate was 21.9% (43 patients). At the end of this work, we found that the conversion rate was significantly increased for males (p = 0.044), ulcerative disease (p = 0.004), smokers (p = 0.007), ASA score = II (p = 0.005), abdominal guarding (p = 0.001), fever (p = 0.001), perivesicular effusion on ultrasound (p = 0.041), ultrasound Murphy's sign (p = 0.023), delayed cholecystectomy (p = 0.038), perivascular adhesions (p <10-3) and gangrenous cholecystitis (p = 0.009). CONCLUSION The conversion is sometimes badly perceived by the surgeon. However, it should in no way be considered a failure, but rather a change of strategy to ensure patient safety. Conversion should not be delayed, especially as risk factors have been identified.
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Velotti N, Manigrasso M, Di Lauro K, Vitiello A, Berardi G, Manzolillo D, Anoldo P, Bocchetti A, Milone F, Milone M, De Palma GD, Musella M. Comparison between LigaSure™ and Harmonic® in Laparoscopic Sleeve Gastrectomy: A Single-Center Experience on 422 Patients. J Obes 2019; 2019:3402137. [PMID: 30719344 PMCID: PMC6335858 DOI: 10.1155/2019/3402137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/26/2018] [Accepted: 12/09/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND New laparoscopic devices, such as electrothermal bipolar-activated devices (LigaSure™ (LS)) or ultrasonic systems (Harmonic® scalpel (HS)), have been applied recently to bariatric surgery allowing to reduce blood loss and surgical risks. The aim of this study was to retrospectively compare intraoperative performance of HS and LS, postoperative results, and clinical outcomes in a large cohort of patients undergoing LSG. METHODS Data from 422 morbidly obese patients undergoing LSG in our Bariatric Unit at the Advanced Biomedical Sciences Department of the "Federico II" University of Naples (Italy) between January 2009 and December 2017 were retrospectively analyzed. Subjects were divided into two groups (HS and LS), and operative time, intraoperative complications, and postoperative (within 30 days from surgery) complications were compared. Bleeding from the omentum or from the staple line, use of hemostatic clips, and absorbable hemostat were recorded as intraoperative complications; hemorrhages, abscess formation, gastric leaks, fever, and mortality were considered as postoperative complications. RESULTS Statistical analysis showed no difference in terms of baseline demographics between the two cohorts. Operative time (48 ± 9 vs 49 ± 6 min, p=0.646) and the rates of intraoperative and postoperative complications did not significantly differ between groups. CONCLUSION Harmonic® and LigaSure™ are both useful tools in bariatric surgery, and these two advanced power devices are user-friendly and can facilitate surgeon work; from this point of view, the choice of the energy device should be based on the preference of the surgeon and on the hospital costs policy and availability.
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Wu CF, de la Mercedes T, Fernandez R, Delgado M, Fieira E, Wu CY, Hsieh MJ, Paradela M, Liu YH, Chao YK, Gonzalez-Rivas D. Management of intra-operative major bleeding during single-port video-assisted thoracoscopic anatomic resection: two-center experience. Surg Endosc 2018; 33:1880-1889. [PMID: 30259160 DOI: 10.1007/s00464-018-6467-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 09/18/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Our objective is to report on two centers' experience of intra-operative management of major vascular injury during single-port video-assisted thoracoscopic (SPVATS) anatomic resections, including bleeding control techniques, incidence, results, and risk factor analysis. METHODS Consecutive patients (n = 442) who received SPVATS anatomic lung resections in two centers were enrolled. The different clinical parameters studied included age, previous thoracic surgery, obesity (BMI > 30), tumor location, neoadjuvant therapy, and pleural symphysis. In addition, peri-operative outcomes were compared between the groups, with or without vessel injury. RESULTS There were no intra-operative deaths in our study. Overall major bleeding incidence was 4.5%, whereby 70% of major bleeding episodes could be managed with SPVATS techniques. In order to determine risk factors possibly related to intra-operative bleeding, we used case control matching to homogenize our study population. After case control matching, pleural symphysis was significantly related in the univariate (p = 0.005, Odds ratio 4.415, 95% CI 1.424-13.685) and multivariate analysis (p = 0.006, Odds ratio 4.926, 95% CI 1.577-15.384). Operative time (p < 0.001), blood loss (p < 0.001), and post-operative hospital stay (p = 0.012) were longer in patients with major vascular injury. There were no differences in 30-day mortality and 90-day morbidity. CONCLUSIONS In summary, major intra-operative bleeding episodes during SPVATS anatomic lung resections are acceptable and most such bleeding episodes can be safely managed with SPVATS techniques.
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Kaestner L. Management of urological injury at the time of urogynaecology surgery. Best Pract Res Clin Obstet Gynaecol 2018; 54:2-11. [PMID: 30143389 DOI: 10.1016/j.bpobgyn.2018.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/10/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022]
Abstract
The presentation and management of bladder, ureteric and urethral injuries during and following urogynaecology surgery are discussed. Applied anatomy is reviewed, and the surgical management of injuries diagnosed intra- and post-operatively is discussed.
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Ko JKY, Seto MTY, Cheung VYT. Thermal bowel injury after ultrasound-guided high-intensity focused ultrasound treatment of uterine adenomyosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:282-283. [PMID: 29154472 DOI: 10.1002/uog.18965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/02/2017] [Accepted: 11/10/2017] [Indexed: 06/07/2023]
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Michowitz Y, Ben-Shoshan J, Tovia-Brodie O, Glick A, Belhassen B. Catheter Induced Mechanical Suppression of Outflow-tract Arrhythmias: Incidence, Characteristics, and Significance. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2018; 20:467-471. [PMID: 30084569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The incidence, characteristics, and clinical significance of catheter-induced mechanical suppression (trauma) of ventricular arrhythmias originating in the outflow tract (OT) area have not been thoroughly evaluated. OBJECTIVES To determine these variables among our patient cohort. METHODS All consecutive patients with right ventricular OT (RVOT) and left ventricular OT (LVOT) arrhythmias ablated at two medical centers from 1998 to 2014 were included. Patients were observed for catheter-induced trauma during ablation procedures. Procedural characteristics, as well as response to catheter-induced trauma and long term follow-up, were recorded. RESULTS During 288 ablations of OT arrhythmias in 273 patients (RVOT n=238, LVOT n=50), we identified 8 RVOT cases (3.3%) and 1 LVOT (2%) case with catheter-induced trauma. Four cases of trauma were managed by immediate radiofrequency ablation (RFA), three were ablated after arrhythmia recurrence within a few minutes, and two were ablated after > 30 minutes without arrhythmia recurrence. Patients with catheter-induced trauma had higher rates of repeat ablations compared to patients without: 3/9 (33%) vs. 12/264 (0.45%), P = 0.009. The three patients with arrhythmia recurrence were managed differently during the first ablation procedure (immediate RFA, RFA following early recurrence, and delayed RFA). During the repeat procedure of these three patients, no catheter trauma occurred in two, and in one no arrhythmia was observed. CONCLUSIONS Significant catheter-induced trauma occurred in 3.1% of OT arrhythmias ablations, both at the RVOT and LVOT. Arrhythmia suppression may last > 30 minutes and may interfere with procedural success. The optimal mode of management following trauma is undetermined.
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Avallone MA, Dietrich PN, Shepherd ST, Lalehzari M, O'Connor RC, Guralnick ML. Is mesenteric defect closure needed in urologic surgery using ileum? THE CANADIAN JOURNAL OF UROLOGY 2018; 25:9334-9339. [PMID: 29900822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Classic surgical teaching advocates for closure of the mesenteric defect (MD) after bowel anastomosis but the necessity is controversial. We sought to evaluate the necessity of MD closure at the time of harvest of ileum for genitourinary reconstructive surgery (GURS) by analyzing the incidence of early and late gastrointestinal adverse events (GIAE) in patients with and without MD closure. MATERIALS AND METHODS A retrospective review was conducted on patients undergoing urologic reconstruction with ileum to identify incidence of ileus, small bowel obstruction (SBO), gastrointestinal (GI) fistula and stoma complications. Patient and procedure variables were analyzed to identify risk factors for GIAE. RESULTS A total of 288 patients met inclusion criteria and 93% of GURS was for urinary diversion following cystectomy. MD was closed in 194 cases (67%). Median follow up was 19 months. Early (< 30 day) GIAE rates were 16.5% (n = 32) and 21.3% (n = 20) in the closure and non-closure groups, respectively (p = 0.22). The rate of early ileus/SBO requiring nasogastric tube decompression or laparotomy were similar after closure (15.0%) and non-closure (21.3%) (p = .18). The late GIAE rates were 5.7% (n = 11) and 6.4% (n = 6) in the closure and non-closure cohorts, respectively (p = 0.56). The rate of late SBO were similar and no cases of early or late SBO in either cohort were due to internal herniation. On multivariate analysis, increasing BMI was associated with both early and late GIAE. CONCLUSIONS After harvesting ileum for urologic reconstruction, the MD can safely be left open as we found no association between non-closure and early or late GIAE..
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Power JR, Nakazawa KR, Vouyouka AG, Faries PL, Egorova NN. Trends in vena cava filter insertions and "prophylactic" use. J Vasc Surg Venous Lymphat Disord 2018; 6:592-598.e6. [PMID: 29678686 DOI: 10.1016/j.jvsv.2018.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/27/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prophylactic vena cava filter (VCF) use in patients without venous thromboembolism is common practice despite ongoing controversy. Thorough analysis of the evolution of this practice is lacking. We describe trends in VCF use and identify events associated with changes in practice. METHODS Using the National Inpatient Sample, we conducted a retrospective observational study of U.S. adult hospitalizations from 2000 to 2014. Trends in prophylactic VCF insertion were analyzed both across the entire study population and within subgroups according to trauma status and type of concurrent surgery. Annual percentage change (APC) was calculated, and trends were analyzed using Poisson regression. RESULTS Among 461,904,314 adult inpatients (median [interquartile range] age, 58.1 [38.5-74.3] years; 39.6% male), the incidence of VCF insertion increased rapidly at first (from 0.19% to 0.35%; APC, 11.2%; 95% confidence interval [CI], 10.3%-12.2%; P < .001), then at a slower rate after the publication of the Prévention du Risque d'Embolie Pulmonaire par Interruption Cave 2 (PREPIC2) trial in 2005 (from 0.35% to 0.42%; APC, 4.4%; 95% CI, 2.8%-6.0%; P < .001), and it began decreasing after the 2010 Food and Drug Administration (FDA) safety alert (from 0.42% to 0.32%; APC, -5.5%; 95% CI, -6.5% to -4.6%; P < .001). The percentage of total VCFs that had a prophylactic indication increased quickly before publication of the PREPIC2 trial (APC, 19.5%; 95% CI, 17.9%-21.0%; P < .001), increased at a slower rate after publication in 2005 (APC, 4.4%; 95% CI, 2.6%-6.2%; P < .001), and dropped after the FDA safety alert, stabilizing at 18.5% for the last 3 years (APC, -0.3%; 95% CI, -2.2% to 1.7%; P = .8). Subgroups most associated with prophylactic VCF insertion were operative trauma (odds ratio [OR], 10.9; 95% CI, 10.2-11.7), orthopedic surgery (OR, 4.7; 95% CI, 4.3-5.2), and neurosurgical procedures (OR, 3.9; 95% CI, 3.6-4.2). All groups except orthopedic surgery experienced a deceleration in prophylactic VCF growth after the publication of PREPIC2. Meanwhile, the FDA safety alert was associated with a decrease in prophylactic VCF insertions for all groups except other major surgery. CONCLUSIONS Whereas publication of the PREPIC2 trial led to a deceleration in prophylactic VCF insertion growth, the FDA alert had a bigger impact, leading to declining rates of prophylactic VCF use. Further investigations of prophylactic insertion of VCF in trauma, orthopedic, and neurosurgical patients are needed to determine whether current levels of use are justified.
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Muir KB, Smoot CP, Viera JL, Sirkin MR, Yoon B, Bader J, Smiley R, Holt D, Hofmann LJ. Determination of Proper Timing for the Placement of Intra-Abdominal Mesh after Incidental Enterotomy in a Rodent Model ( Rattus norvegicus). Am Surg 2018; 84:593-598. [PMID: 29712612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Controversy exists regarding the appropriate timing for placement of permanent intra-abdominal mesh after inadvertent enterotomy during elective hernia repair. The aim of this study was to examine mesh placement at variable postoperative periods and the subsequent risk of infection. Fifty rodents were divided into five groups. Groups one to four underwent laparotomy, enterotomy, and repair. Physiomesh® was placed at the index operation one, three, or seven days postoperatively in Groups 1, 2, 3, and 4. Group 5 underwent mesh placement only. Necropsy with mesh harvest was performed seven days after placement. Cultures of mesh were obtained and Fisher's exact test was used to compare groups. Bacterial growth postsonication was identified in 30, 30, 50, and 90 per cent versus 20 per cent in controls. Compared with controls, there was significantly increased risk of mesh infection when it was placed seven days after enterotomy (P = 0.006). There was no significant difference in bacterial growth when mesh was placed at the time of enterotomy, one or three days later. The risk of bacterial contamination of permanent mesh placed immediately after inadvertent enterotomy during elective hernia repair is as safe as placing mesh at one or three days. Placing mesh at seven days significantly increased the risk of mesh contamination.
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Kimura T, Ibayashi K, Kawai K. Intraoperative Resuturing of Occluded Superficial Temporal Artery-Middle Cerebral Artery Anastomoses: Single-Center Retrospective Study. World Neurosurg 2018; 113:e650-e653. [PMID: 29499427 DOI: 10.1016/j.wneu.2018.02.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND In superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis, there is a certain risk of intraoperative acute occlusion of the bypass that can cause operative complications. OBJECTIVE We sought to assess the efficacy of resuturing at the same site after intraoperative acute occlusion of the bypass. METHODS In total, 129 STA-MCA anastomosis operations were performed on 125 patients at our institution. The electronic medical records of each patient were reviewed to gather information regarding intraoperative occlusion events, and the operative videos and postoperative radiologic images were also reviewed. RESULTS Twelve intraoperative acute occlusions were identified. In each case, resuturing was performed after cutting all knots, flushing the thrombus, and trimming the edges of the STAs. In 11 cases, indocyanine green videoangiography and/or Doppler sonography revealed patency during the operation, which was confirmed by postoperative magnetic resonance angiography. None of the 12 cases exhibited high-signal intensities in the MCA area on diffusion-weighted images. CONCLUSION If intraoperative acute occlusion of STA-MCA anastomosis occurs, reanastomosis at the site should be the first option.
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Kazui T, Lin TM, Lick SD. Coronary Sinus Rupture Repair: Patency Is Important. Ann Thorac Surg 2018; 106:e25-e26. [PMID: 29496435 DOI: 10.1016/j.athoracsur.2018.01.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/08/2018] [Accepted: 01/18/2018] [Indexed: 11/18/2022]
Abstract
We report a case of coronary sinus (CS) injury with a retrograde cardioplegia catheter and repair that compromised CS patency. This resulted in acute global cardiac dysfunction shortly after weaning from bypass, which reversed after patch repair with confirmed CS patency. The case report shows that acute CS occlusion may not be tolerated in some humans.
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Zhai J, Panchal RR, Tian Y, Wang S, Zhao L. The Management of Cerebrospinal Fluid Leak After Anterior Cervical Decompression Surgery. Orthopedics 2018; 41:e283-e288. [PMID: 29451938 DOI: 10.3928/01477447-20180213-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/15/2017] [Indexed: 02/03/2023]
Abstract
Cerebrospinal fluid (CSF) leak is a rare but potentially troublesome and occasionally catastrophic complication after anterior cervical decompression surgery. There is limited literature describing this complication, and the management of CSF leak varies. The aim of this study was to retrospectively review the treatment of cases with CSF leak and develop a management algorithm. A series of 14 patients with CSF leak from January 2011 to May 2016 were included in this study. Their characteristics, management of CSF leak, and outcomes were documented. There were 5 male and 9 female patients. Mean age at surgery was 57.1±9.9 years (range, 37-76 years). All instances of CSF leak, except 1 noted postoperatively, were indirectly repaired intraoperatively. A closed straight wound drain was placed for all patients. A lumbar subarachnoid drain was placed immediately after surgery in 4 patients and postoperatively in 7 patients. In 1 patient, lumbar drain placement was unsuccessful. In 2 additional patients, the surgeon decided not to place a lumbar drain. One patient developed meningitis and recovered after antibiotic therapy with meropenem and vancomycin. Another patient had a deep wound infection and required a revision surgery. Wound drains and lumbar drains should be immediately considered when CSF leak is identified. Antibiotics also should be considered to prevent intradural infection. [Orthopedics. 2018; 41(2):e283-e288.].
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Grodecki K, Huczek Z, Scisło P, Kochman J, Filipiak KJ, Opolski G. Thromboembolic Occlusion of the Left Coronary Artery During Transcatheter Aortic Valve Implantation. THE JOURNAL OF INVASIVE CARDIOLOGY 2018; 30:E21-E22. [PMID: 29378976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Non-cerebral thromboembolic complications of transcatheter aortic valve implantation are rare, but life threatening. We report a 62-year-old woman with aortic stenosis who qualified for TAVI due to obesity and developed hypotension and bradycardia as a result of thromboembolic occlusion of the LCA.
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Ogrodnik J. Superficial Peroneal Nerve Injured During Fasciotomy: A Successful Repair with Cadaveric Nerve Allograft. Am Surg 2018; 84:e59-e60. [PMID: 30454479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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72
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Fokin AA, Kireev KA. [Algorithm of treatment policy for a femoral artery false aneurysm]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2018; 24:195-200. [PMID: 29924791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of the study was to elaborate an algorithm of treatment policy for post-puncture false aneurysms of the femoral artery (FAFA). The study was performed on the basis of the clinical material over 2014-2017 at the Regional Vascular Centre whose specialists have since 2017 been using the femoral arterial approach (FAA) only if the radial arteries are inaccessible for puncture or for inserting the endovascular tools and appliances. The obtained findings demonstrated that the number of coronary interventions performed with the use of the femoral arterial approach in patients presenting with acute coronary syndrome decreased from a total of 758 (100.0%) in 2014 to 166 (13.8%) in 2017. The frequency of FAFAs not subjected to surgical management and those subjected to surgical suturing by 2017 increased to 3.0 and 1.2%, respectively, with the same values for 2014 amounting to 1.8 and 0.4%, respectively. Taking into account the still existing necessity of using the femoral arterial approach in the patients, as a rule, belonging to the cohort of the so-called 'problem patients', the authors worked out an algorithm of therapeutic policy for FAFAs, which would make it possible to increase both efficiency and safety of the carried out endovascular interventions, as well as to determine the risks with their minimization in the postoperative period.
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Tsuei YS, Liao CH, Lee CH, Liang YJ, Chen WH, Yang SF. Intraprocedural arterial perforation during neuroendovascular therapy: Preliminary result of a dual-trained endovascular neurosurgeon in the neurosurgical hybrid operating room. J Chin Med Assoc 2018; 81:31-36. [PMID: 29033375 DOI: 10.1016/j.jcma.2017.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/19/2017] [Accepted: 04/24/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Intraprocedural arterial perforation (IPAP) is a potentially dismal complication of neuroendovascular therapy with high mortality and morbidity rates. The management of IPAP with the techniques described has been well established, but rescue results from the dual-trained endovascular neurosurgeon in the neurosurgical hybrid operating room (OR) are rarely reported. Here, we report five cases of successful rescue of IPAP in the neurosurgical hybrid OR and compare them with other series. METHODS Between December 2009 and December 2013, 146 intracranial neuroendovascular procedures were performed in the hybrid operating room of Taichung Veterans General Hospital. A total of five patients with IPAP were identified. Postoperative clinical outcome was evaluated by Glasgow Coma Scale scores and postoperative 3-month modified Rankin Scale. RESULTS The causes of the IPAP were coil protrusion (n = 3), microcatheter perforation (n = 1), and microwire penetration (n = 1). Two cases involved emergent ruptured aneurysms, while three cases occurred during elective procedures. Salvage treatment with emergent external ventricular drainage (EVD) was applied in all five cases. The average time-to-first-EVD was 16.25 min, and the average time-to-patent-EVD was 32.5 min. Postoperative 3-month outcome was good recovery (mRS ≤ 2) in all five cases. The zero mortality rate in our series is the most encouraging result in the published literature. CONCLUSION IPAP can be rescued successfully with an aggressive approach and quick conversion to backup surgery by a dual-trained endovascular neurosurgeon in the hybrid OR. The value of the hybrid OR in neuroendovascular therapy should be further investigated in the future.
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Abdelaziz HK, Eichhofer J, Patel B. A Novel, Simple, and Safe Technique for Retrieving a Crushed Stent From the Coronary Artery: Balloon-Assisted Stent Retraction. THE JOURNAL OF INVASIVE CARDIOLOGY 2017; 29:E203-E204. [PMID: 29207373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Various percutaneous methods have been described for the retrieval of damaged stents; however, these methods can be complex and carry a risk of stent embolization or vascular damage. We present a simple and safe technique using a compliant balloon for stent retrieval.
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Feng B, Xiao K, Shao J, Fan Y, Weng X. Open repair of intraoperative popliteal artery injury during total knee arthroplasty in a patient with severe hemophilia A: A case report and literature review. Medicine (Baltimore) 2017; 96:e8791. [PMID: 29145340 PMCID: PMC5704885 DOI: 10.1097/md.0000000000008791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Arterial injuries during total knee arthroplasty (TKA) though rare may occur. Hemophilia may further challenge the management of such injury. PATIENT CONCERNS A 48-year-old male patient with severe hemophilia type A and stiff knee arthropathy underwent bilateral TKAs. Left popliteal artery injury was detected at the end of the left TKA. DIAGNOSES Urgent angiography confirmed the diagnosis of the left popliteal artery transection. INTERVENTIONS With clotting factor VIII replacement treatment, open repair was performed by end-to-end vascular bypass with the autograft of the large saphenous vein. No anticoagulant and antiplatelet treatment was administered postoperatively. Doses of the factor VIII were decreased step by step postoperatively. OUTCOMES Left lower limb was reperfused 4 hours after the onset of the ischemia. The patient recovered uneventfully. Postoperative Doppler examination showed the left popliteal artery remained patent. LESSONS The hemophilia may endanger the patients to higher risk of arterial injury during TKA because of the severe deformity and fibrosis around knee joint. For the hemophilia patients, with rational coagulation factor replacement therapy, open repair with autograft was an effective revascularization procedure for artery injury.
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