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Vikatmaa P, Pilz M. Expanding Treatment Options in Hopeless Situations: The Value of Endovascular Therapy in Carotid Blowout Syndrome. Eur J Vasc Endovasc Surg 2024; 67:717. [PMID: 38295941 DOI: 10.1016/j.ejvs.2024.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Pirkka Vikatmaa
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Manuela Pilz
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
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Piazza C, Lancini D, Tomasoni M, Zafereo M, Poorten VV, Hanna E, Mäkitie AA, Fernandez-Alvarez V, Kowalski LP, Chiesa-Estomba C, Ferlito A. Malignant carotid body tumors: What we know, what we do, and what we need to achieve. A systematic review of the literature. Head Neck 2024; 46:672-687. [PMID: 38179805 DOI: 10.1002/hed.27624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
Malignant carotid body tumors (MCBT) are rare and diagnosed after detection of nodal or distant metastases. This systematic review (SR) focuses on MCBT initially approached by surgery. Preferred Reporting Items for SR and Meta-Analysis (MA) guided the articles search from 2000 to 2023 on PubMed, Scopus, and Web of Science. Among 3548 papers, 132 (337 patients) were considered for SR; of these, 20 (158 patients) for MA. Malignancy rate was 7.3%, succinate dehydrogenase (SDH) mutation 17%, age at diagnosis between 4th and 6th decades, with a higher prevalence of females. MCBTs were mostly Shamblin III, with nodal and distant metastasis in 79.7% and 44.7%, respectively. Malignancy should be suspected if CBT >4 cm, Shamblin III, painful or otherwise symptomatic, at the extremes of age, bilateral, with multifocal disease, and SDHx mutations. Levels II-III clearance should be performed to exclude nodal metastases and adjuvant treatments considered on a case-by-case basis.
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Affiliation(s)
- Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Vincent Vander Poorten
- Otorhinolaryngology - Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Ehab Hanna
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Veronica Fernandez-Alvarez
- Department of Vascular and Endovascular Surgery, Hospital Universitario de Torrecardenas, Almeria, Spain
| | - Luiz P Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School and Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology - Head and Neck Surgery, Donostia University Hospital, Deusto University - School of Medicine, BioGuipuzcoa Research Institute, San Sebastian, Spain
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Wang Y, Fu M, Xiao W, Zhao Y, Yuan P, Zhang X, Wu W. 3D Elastomeric Stent Functionalized with Antioxidative and Perivascular Tissue Regenerative Activities Ameliorated PVT Deprivation-Induced Vein Graft Failure. Adv Healthc Mater 2023; 12:e2301247. [PMID: 37440681 DOI: 10.1002/adhm.202301247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/15/2023]
Abstract
Clinically, arterial injuries are always accompanied with perivascular tissue damage, which may contribute to high failure rate of vein grafts due to intimal hyperplasia and acute thrombosis. In this study, a "perivascular tissue (PVT) deprivation" animal model is constructed to mimic clinical scenarios and identify the contribution of arterial PVT to the success of vein grafts. Proteomics analysis suggests that depriving PVT may exacerbate reactive oxygen species (ROS)-induced endothelial apoptosis by up-regulating inflammation response and oxidative stress. Locally administering metformin on vein grafts through 3D-printed external stent (PGS-PCL) shows antioxidative and anti-inflammatory properties to protect cells from ROS invasion, thereafter decreasing acute thrombosis. Moreover, metformin induce rapid regeneration of perivascular adipose tissue in recipient regions, which improves patency by inhibiting intimal hyperplasia. Proteomics, western blot, and in vitro blocking tests reveal that metformin resists endothelial apoptosis through AMPK/mTOR and NFκB signaling pathways. To conclude, PVT deprivation exacerbates inflammatory response and oxidative stress in vein grafts bridging arterial circulation. Metformin-loaded stent ameliorates "PVT damage" related vein graft failure, and enhances patency of through resisting endothelial apoptosis and regenerating arterial PVAT, offering a promising avenue to improve the success of vein grafts in clinic.
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Affiliation(s)
- Yinggang Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral&Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
| | - Mingdi Fu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral&Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
| | - Weiwei Xiao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral&Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
| | - Yajing Zhao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral&Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
| | - Pingping Yuan
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral&Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
| | - Xinchi Zhang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral&Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
| | - Wei Wu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral&Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
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Vikatmaa P. Emergencies during oncovascular surgery: Strategies and pitfalls. Semin Vasc Surg 2023; 36:157-162. [PMID: 37330230 DOI: 10.1053/j.semvascsurg.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
In a growing number of pathologies, vascular invasion is no longer considered a contraindication for surgery with a curative intention. This has led vascular surgeons to be more involved in the treatment of pathologies that they are not used to. These patients should be managed in a multidisciplinary manner. New types of emergencies and complications have emerged. Emergencies in oncovascular surgery are mostly avoidable with careful planning and good collaboration between oncological surgeons and a dedicated vascular surgery team. The operations often involve difficult vascular dissection and complex reconstructive techniques in a potentially contaminated and irradiated field, and the risk of postoperative complications and blow out is increased. However, after a successful operation and immediate postoperative course, the patients often recover faster than the typical fragile vascular surgical patient. This narrative review focuses on emergencies that are more or less specific to oncovascular procedures. A scientific approach and international collaboration are needed, so that we can better identify which patients should be operated, what problems to anticipate and could be avoided with better planning, and which solutions improve patient outcome.
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Affiliation(s)
- Pirkka Vikatmaa
- Vascular Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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