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Rodríguez-Méndez BG, López-Callejas R, Mercado-Cabrera A, Peña-Eguiluz R, Valencia-Alvarado R, Betancourt-Ángeles M, Berrones-Stringel G, Jaramillo-Martínez C. Harnessing Non-Thermal Plasma to Supercharge Recovery in Abdominal Surgeries: A Pilot Study. J Clin Med 2024; 13:408. [PMID: 38256546 PMCID: PMC10816705 DOI: 10.3390/jcm13020408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: This study aims to evaluate the efficacy and safety of non-thermal plasma (NTP) therapy in accelerating wound healing in patients who have undergone laparoscopic and open surgeries. (2) Methods: NTP was applied using a needle-type reactor with an irradiance of 0.5 W/cm2 on the surgical wounds of fifty patients after obtaining informed consent. Three NTP treatments, each lasting three minutes, were administered hourly. (3) Results: The pilot study showed that NTP-treated surgical wounds healed completely without any signs of infection, dehiscence, pain, or itching. Notably, patients reported minimal pain after the NTP treatment. Visual assessments conducted twenty-four hours after surgery revealed no redness or fluid discharge. Comparisons with traditionally sutured wounds indicated that NTP-treated wounds healed at a rate equivalent to seven days. (4) Conclusions: The application of NTP in laparoscopic and open wounds proved safe and effective, expediting the wound healing process and eliminating clinical risks post-surgery. Significantly, NTP facilitated a healing rate within twenty-four hours, equivalent to seven days for suture-treated wounds, significantly reducing the hospitalization time to a single day. These findings highlight the potential of NTP to be a transformative approach for promoting postoperative recovery.
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Affiliation(s)
- Benjamín G. Rodríguez-Méndez
- Plasma Physics Laboratory, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac 52750, Mexico; (B.G.R.-M.); (R.L.-C.); (R.P.-E.); (R.V.-A.)
| | - Régulo López-Callejas
- Plasma Physics Laboratory, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac 52750, Mexico; (B.G.R.-M.); (R.L.-C.); (R.P.-E.); (R.V.-A.)
| | - Antonio Mercado-Cabrera
- Plasma Physics Laboratory, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac 52750, Mexico; (B.G.R.-M.); (R.L.-C.); (R.P.-E.); (R.V.-A.)
| | - Rosendo Peña-Eguiluz
- Plasma Physics Laboratory, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac 52750, Mexico; (B.G.R.-M.); (R.L.-C.); (R.P.-E.); (R.V.-A.)
| | - Raúl Valencia-Alvarado
- Plasma Physics Laboratory, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac 52750, Mexico; (B.G.R.-M.); (R.L.-C.); (R.P.-E.); (R.V.-A.)
| | - Mario Betancourt-Ángeles
- Medical Center ISSEMyM Toluca, Av. Baja velocidad 284 km. 57.5, San Jerónimo Chicahualco, Metepec 52170, Mexico
| | - Guillermo Berrones-Stringel
- Medical Center ISSEMyM Toluca, Av. Baja velocidad 284 km. 57.5, San Jerónimo Chicahualco, Metepec 52170, Mexico
| | - César Jaramillo-Martínez
- Medical Center ISSEMyM Toluca, Av. Baja velocidad 284 km. 57.5, San Jerónimo Chicahualco, Metepec 52170, Mexico
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Bashir M, Munir W, Davies H, Bailey DM, Williams IM. The retroperitoneal approach for contemporary open abdominal aortic aneurysm surgery: The anatomical reasoning. Asian Cardiovasc Thorac Ann 2021; 29:654-660. [PMID: 34409877 DOI: 10.1177/02184923211039799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In current practice, the place of open surgery in managing abdominal aortic aneurysm is a contentious issue. The principal reason being greater applications of endovascular techniques treating increasingly complicated aortic disease. Development of branched and fenestrated devices enabled this, with numbers increasing annually. This meant a good risk patient with a long infrarenal aortic neck and normal diameter non-tortuous iliac arteries may be suitable for both endovascular and open techniques. However, indications for open surgery are becoming increasingly unclear nowadays due to short-term gains in morbidity and mortality. Exact aortic anatomical morphologies optimum for open or endovascular techniques remains unclear. As graft technology evolves, possibilities for endovascular options are expanding. Currently, establishing optimum treatment plans for complicated abdominal aortic aneurysm (little or no infrarenal neck) is difficult without considering general fitness of the patient. Hence, two sets of possible postoperative complications and follow-up protocols must be explained to patients before either approach. Complicating matters is the optimum surgical approach used for any open repair. The standard approach for open abdominal aortic aneurysm surgery has been transperitoneal as this provides excellent access to the infrarenal aorta and iliac arteries. However, although less commonly used, the retroperitoneal approach has advantages particularly when location of proximal aortic disease indicates suprarenal clamp might be optimum. This paper scrutinises benefits of the retroperitoneal approach performed purely for anatomical reasons where stent graft may be considered complicated. Also, long-term outcomes are examined in terms of endo-leak and subsequent development of true and false aneurysm following both endovascular and open repair.
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Affiliation(s)
- Mohamad Bashir
- Vascular and Endovascular, Health education and Improvement Wales, UK
| | - Wahaj Munir
- 105711Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Huw Davies
- Vascular Surgery, 97609University Hospital of Wales, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, 102493Faculty of Life Sciences and Education, University of South Wales, UK
| | - Ian M Williams
- Vascular Surgery, 97609University Hospital of Wales, UK.,Neurovascular Research Laboratory, 102493Faculty of Life Sciences and Education, University of South Wales, UK
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von Meijenfeldt GCI, Alberga AJ, Balm R, Vahl AC, Verhagen HJM, Blankensteijn JD, Zeebregts CJ, van der Laan MJ. Results from a nationwide prospective registry on open surgical or endovascular repair of juxtarenal abdominal aortic aneurysms. J Vasc Surg 2021; 75:81-89.e5. [PMID: 34197942 DOI: 10.1016/j.jvs.2021.06.031] [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: 11/27/2020] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Juxtarenal abdominal aortic aneurysms (JRAAA) can be treated either with open surgical repair (OSR) including suprarenal clamping or by complex endovascular aneurysm repair (cEVAR). In this study we present the comparison between the short-term mortality and complications of the elective JRAAA treatment modalities from a national database reflecting daily practice in the Netherlands. METHODS All patients undergoing elective JRAAA open repair or cEVAR (fenestrated EVAR or chimney EVAR) between January 2016 and December 2018 registered in the Dutch Surgical Aneurysm Audit (DSAA) were eligible for inclusion. Descriptive perioperative variables and outcomes were compared between patients treated with open surgery or endovascularly. Adjusted odds ratios for short-term outcomes were calculated by logistic regression analysis. RESULTS In all, 455 primary treated JRAAA patients could be included (258 OSR, 197 cEVAR). Younger patients and female patients were treated more often with OSR vs cEVAR (72±6.1 vs. 76±6.0, p<0.001, 22% vs 15%, p=0.047, respectively). Patients treated with OSR had significantly more major and minor complications as well as a higher chance of early mortality (OSR: cEVAR, 45% vs. 21%, p<0.001; 34% vs. 23%, p =0.011; 6.6% vs. 2.5%, p=0.046, respectively). After logistic regression with adjustment for confounders, patients who were treated with OSR showed an odds ratio of 3.64 (95%CI 2.25-5.89, p<0.001) for major complications compared to patients treated with cEVAR and for minor complications the odds ratios were 2.17 (95%CI 1.34-3.53, p=0.002) higher. For early mortality the odds ratios were 3.79 (95%CI 1.26-11.34, p=0.017) higher after OSR compared to cEVAR. CONCLUSION In this study, after primary elective OSR for JRAAA the odds for major complications, minor complications, and short-term mortality were significantly higher compared to cEVAR.
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Affiliation(s)
- Gerdine C I von Meijenfeldt
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anna J Alberga
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Scientific bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Ron Balm
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Anco C Vahl
- Department of Surgery, OLVG, Amsterdam, The Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan D Blankensteijn
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten J van der Laan
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Charchyan ER, Stepanenko AB, Gens AP, Galeev NA, Belov YV. Surgical approaches in juxtarenal and pararenal aortic aneurysms repair. Asian Cardiovasc Thorac Ann 2021; 29:928-934. [PMID: 33657828 DOI: 10.1177/0218492321997384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In this study, surgical tactic features and juxtarenal and pararenal treatment immediate results were analyzed depending on the use of various surgical approaches. METHODS Between 2015 and 2019, a total of 89 patients received surgical treatment, of which 52(58%) had juxtarenal aneurysms and 37 (42%) - pararenal aneurysms. During repairs, three types of surgical approaches were used: midline laparotomy, extended retroperitoneal approach and thoraco-phreno-retroperitoneal approach. The patients were divided into three groups accordingly. RESULTS At the immediate postoperative period, mortality rate equaled 2 (2.2%). The reasons were pulmonary embolism and sepsis. Statistically reliable data were obtained, confirming the advantages of midline laparotomic approach over the lateral retroperitoneal ones, which consisted in a shorter operative time, less pronounced pain syndrome, lesser blood loss, fewer postoperative days. The disadvantages were that enteroparesis occurred more often when the midline laparotomy was used in comparison to extended retroperitoneal or thoraco-phrenoretroperitoneal approaches. CONCLUSION Thus, open repairs of juxtarenal and pararenal aortic aneurysms have some specific technical and strategical features which are associated with intraoperative renal ischemia. During open surgical intervention, it is important to first consider the possibility of repair with midline laparotomy. However, lateral retroperitoneal approaches can also be used on a case-by-case basis noting their advantages and disadvantages.
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Affiliation(s)
| | | | - Andrey P Gens
- Petrovsky National Research Centre of Surgery Abrikosovsky, Russia
| | - Nail A Galeev
- Petrovsky National Research Centre of Surgery Abrikosovsky, Russia
| | - Yuri V Belov
- Petrovsky National Research Centre of Surgery Abrikosovsky, Russia
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Rosenfeld ES, Macsata RA, Nguyen BN, Lala S, Ricotta JJ, Pomy BJ, Lee KB, Sparks AD, Amdur RL, Sidawy AN. Thirty-day outcomes of open abdominal aortic aneurysm repair by proximal clamp level in patients with normal and impaired renal function. J Vasc Surg 2020; 73:1234-1244.e1. [PMID: 32890718 DOI: 10.1016/j.jvs.2020.08.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/04/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) has often been reserved in contemporary practice for complex aneurysms requiring a suprarenal or supraceliac proximal clamp level. The present study investigated the associated 30-day outcomes of different proximal clamp levels in OSR of complex infrarenal/juxtarenal AAA in patients with normal renal function and those with chronic renal insufficiency (CRI). METHODS All patients undergoing elective OSR of infrarenal and juxtarenal AAA were identified in the American College of Surgeons National Surgical Quality Improvement Program-targeted AAA database from 2012 to 2018. The patients were stratified into two cohorts (normal renal function [estimated glomerular filtration rate, ≥60 mL/min] and CRI [estimated glomerular filtration rate, <60 mL/min and no dialysis]) before further substratification into groups by the proximal clamp level (infrarenal, inter-renal, suprarenal, and supraceliac). The 30-day outcomes, including mortality, renal and pulmonary complications, and major adverse cardiovascular event rates, were compared within each renal function cohort between proximal clamp level groups using the infrarenal clamp group as the reference. Supraceliac clamping was also compared with suprarenal clamping. RESULTS A total of 1284 patients with normal renal function and 524 with CRI were included in the present study. The proximal clamp levels for the 1808 patients were infrarenal for 1080 (59.7%), inter-renal for 337 (18.6%), suprarenal for 279 (15.4%), and supraceliac for 112 (6.2%). In the normal renal function cohort, no difference was found in 30-day mortality with any clamp level. Increased 30-day acute renal failure was only observed in the supraceliac vs infrarenal clamp level comparison (5.9% vs 1.5%; adjusted odds ratio [aOR], 3.97; 95% confidence interval [CI], 1.04-5.18; P = .044). In the CRI cohort, supraceliac clamping was associated with an increased rate of renal composite complications (22.7% vs 5.6%; aOR, 8.81; 95% CI, 3.17-24.46; P < .001) and ischemic colitis (13.6% vs 3.0%; aOR, 4.78; 95% CI, 1.38-16.62; P = .014) compared with infrarenal clamping and greater 30-day mortality (13.6% vs 2.4%; aOR, 6.00; 95% CI, 1.14-31.55; P = .034) and renal composite complications (22.7% vs 10.8%; aOR, 2.87; 95% CI, 1.02-8.13; P = .047) compared with suprarenal clamping. Suprarenal clamping was associated with greater renal dysfunction (10.8% vs 5.6%; aOR, 2.77; 95% CI, 1.08-7.13; P = .035) compared with infrarenal clamping, with no differences in mortality. No differences were found in 30-day mortality or morbidity for inter-renal clamping compared with infrarenal clamping in either cohort. No differences were found in major adverse cardiovascular events with higher clamp levels in either cohort. CONCLUSIONS In elective OSR of infrarenal and juxtarenal AAAs for patients with CRI, this study found a heightened mortality risk with supraceliac clamping and increased renal morbidity with suprarenal clamping, though these effects were not present for patients with normal renal function. Every effort should be made to keep the proximal clamp level as low as possible, especially in patients with CRI.
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Affiliation(s)
- Ethan S Rosenfeld
- Department of Surgery, The George Washington University, Washington, D.C..
| | - Robyn A Macsata
- Department of Surgery, The George Washington University, Washington, D.C
| | - Bao-Ngoc Nguyen
- Department of Surgery, The George Washington University, Washington, D.C
| | - Salim Lala
- Department of Surgery, The George Washington University, Washington, D.C
| | - John J Ricotta
- Department of Surgery, The George Washington University, Washington, D.C
| | - Benjamin J Pomy
- Department of Surgery, The George Washington University, Washington, D.C
| | - K Benjamin Lee
- Department of Surgery, The George Washington University, Washington, D.C
| | - Andrew D Sparks
- Department of Surgery, The George Washington University, Washington, D.C
| | - Richard L Amdur
- Department of Surgery, The George Washington University, Washington, D.C
| | - Anton N Sidawy
- Department of Surgery, The George Washington University, Washington, D.C
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Mohamed N, Galyfos G, Anastasiadou C, Sachmpatzidis I, Kikiras K, Papapetrou A, Giannakakis S, Kastrisios G, Papacharalampous G, Geroulakos G, Maltezos C. Fenestrated Endovascular Repair for Pararenal or Juxtarenal Abdominal Aortic Aneurysms: a Systematic Review. Ann Vasc Surg 2020; 63:399-408. [DOI: 10.1016/j.avsg.2019.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022]
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