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Zhang C, Sun Z, Song M, Liu Y, Xu K, Han X, Jiao D. Effectiveness and safety of a ventricular septal occluder device for the treatment of Gastro-tracheal fistula. Clin Radiol 2024; 79:697-703. [PMID: 38866677 DOI: 10.1016/j.crad.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/07/2024] [Accepted: 05/16/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Gastro-tracheal fistula (GTF) is one of the most serious complications after esophagogastrostomy and radiotherapy, with very high disability and mortality rates. To evaluate the effectiveness and safety of ventricular septal occluder devices (VSOD) for the treatment of Gastro-tracheal fistula (GTF). METHODS From January 2020 to May 2022, 14 patients with GTF underwent VSOD under real-time fluoroscopy. The technical success, complications, quality of life (QoL), Eastern Cooperative Oncology Group (ECOG) score, Karnofsky score, and median overall survival (mOS) were recorded and analyzed. RESULTS Technical success, and major complication rates were 71.4%, and 14.3%, respectively. Both the ECOG and the Karnofsky score showed significant improvement at the 2-month evaluation compared with the pretreatment value (p<0.05). For QoL, general health, physical function, vitality, role physical, and social function all improved at the 2-month evaluation (p<0.05), but bodily pain, role emotion, and mental health showed no significant difference (P>0.05). During the mean follow-up of 9.6 months, eight patients were alive, and the mOS was 11.4 months (95% CI, 8.5-14.3). CONCLUSIONS VSOD is a simple and safe technique for GTF treatment, but long-term observation is needed at multiple centers to confirm our findings.
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Affiliation(s)
- C Zhang
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China
| | - Z Sun
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China
| | - M Song
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China
| | - Y Liu
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China
| | - K Xu
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China
| | - X Han
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China
| | - D Jiao
- One is the Department of Interventional Radiology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Therapy Institute of Zhengzhou University, Zhengzhou, China.
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Mady LJ, Poonia SK, Baddour K, Snyder V, Kurukulasuriya C, Frost AS, Cannady SB, Chinn SB, Fancy T, Futran N, Hanasono MM, Lewis CM, Miles BA, Patel U, Richmon JD, Wax MK, Yu P, Solari MG, Sridharan S. Consensus of free flap complications: Using a nomenclature paradigm in microvascular head and neck reconstruction. Head Neck 2021; 43:3032-3041. [PMID: 34145676 DOI: 10.1002/hed.26789] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/10/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We aim to define a set of terms for common free flap complications with evidence-based descriptions. METHODS Clinical consensus surveys were conducted among a panel of head and neck/reconstructive surgeons (N = 11). A content validity index for relevancy and clarity for each item was computed and adjusted for chance agreement (modified kappa, K). Items with K < 0.74 for relevancy (i.e., ratings of "good" or "fair") were eliminated. RESULTS Five out of nineteen terms scored K < 0.74. Eliminated terms included "vascular compromise"; "cellulitis"; "surgical site abscess"; "malocclusion"; and "non- or mal-union." Terms that achieved consensus were "total/partial free flap failure"; "free flap takeback"; "arterial thrombosis"; "venous thrombosis"; "revision of microvascular anastomosis"; "fistula"; "wound dehiscence"; "hematoma"; "seroma"; "partial skin graft failure"; "total skin graft failure"; "exposed hardware or bone"; and "hardware failure." CONCLUSION Standardized reporting would encourage multi-institutional research collaboration, larger scale quality improvement initiatives, the ability to set risk-adjusted benchmarks, and enhance education and communication.
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Affiliation(s)
- Leila J Mady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Seerat K Poonia
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Khalil Baddour
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vusala Snyder
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Ariel S Frost
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven B Cannady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Tanya Fancy
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Neal Futran
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Matthew M Hanasono
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carol M Lewis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brett A Miles
- Department of Otolaryngology, Northwell Health, New York, New York, USA
| | - Urjeet Patel
- Department of Otolaryngology-Head and Neck Surgery, Northwestern Medicine, Chicago, Illinois, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Mark K Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Peirong Yu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mario G Solari
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shaum Sridharan
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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