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Toale C, Morris M, Konge L, Nayahangan LJ, Roche A, Heskin L, Kavanagh DO. Generating a Prioritized List of Operative Procedures for Simulation-based Assessment of General Surgery Trainees Through Consensus. Ann Surg 2024; 279:900-905. [PMID: 37811854 DOI: 10.1097/sla.0000000000006118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To develop appropriate content for high-stakes simulation-based assessments of operative competence in general surgery training through consensus. BACKGROUND Valid methods of summative operative competence assessment are required by competency-based training programs in surgery. METHOD An online Delphi consensus study was conducted. Procedures were derived from the competency expectations outlined by the Joint Committee on Surgical Training Curriculum 2021, and subsequent brainstorming. Procedures were rated according to their perceived importance, perceived procedural risk, how frequently they are performed, and simualtion feasibility by a purposive sample of 30 surgical trainers and a 5-person steering group. A modified Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula was applied to the generated data to produce ranked procedural lists, which were returned to participants for re-prioritization. RESULTS Prioritized lists were generated for simulation-based operative competence assessments at 2 key stages of training; the end of 'phase 2' prior to the development of a sub-specialty interest, and the end of 'phase 3', that is, end-of-training certification. A total of 21 and 16 procedures were deemed suitable for assessments at each of these stages, respectively. CONCLUSIONS This study describes a national needs assessment approach to content generation for simulation-based assessments of operative competence in general surgery using Delphi consensus methodology. The prioritized procedural lists generated by this study can be used to further develop operative skill assessments for use in high-stakes scenarios, such as trainee progression, entrustment, and end-of-training certification, before subsequent validity testing.
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Affiliation(s)
- Conor Toale
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Morris
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Adam Roche
- Department of Simulation, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leonie Heskin
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Simulation, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dara O Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
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Ramjit SE, Ashley E, Donlon NE, Weiss A, Doyle F, Heskin L. Safety, efficacy, and cost-effectiveness of minimally invasive esophagectomies versus open esophagectomies: an umbrella review. Dis Esophagus 2022; 35:6590375. [PMID: 35596955 DOI: 10.1093/dote/doac025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/03/2022] [Indexed: 12/16/2022]
Abstract
Traditionally, esophageal oncological resections have been performed via open approaches with well-documented levels of morbidity and mortality complicating the postoperative course. In contemporary terms, minimally invasive approaches have garnered sustained support in all areas of surgery, and there has been an exponential adaptation of this technology in upper GI surgery with the advent of laparoscopic and robotic techniques. The current literature, while growing, is inconsistent in reporting on the benefits of minimally invasive esophagectomies (MIEs) and this makes it difficult to ascertain best practice. The objective of this review was to critically appraise the current evidence addressing the safety, efficacy, and cost-effectiveness of MIEs versus open esophagectomies. A systematic review of the literature was performed by searching nine electronic databases to identify any systematic reviews published on this topic and recommended Joanna Briggs Institute approach to critical appraisal, study selection, data extraction and data synthesis was used to report the findings. A total of 13 systematic reviews of moderate to good quality encompassing 143 primary trials and 36,763 patients were included in the final synthesis. Eleven reviews examined safety parameters and found a generalized benefit of MIE. Efficacy was evaluated by eight systematic reviews and found each method to be equivalent. There were limited data to judiciously appraise cost-effectiveness as this was only evaluated in one review involving a single trial. There is improved safety and equivalent efficacy associated with MIE when compared with open esophagectomy. Cost-effectiveness of MIE cannot be sufficiently supported at this point in time. Further studies, especially those focused on cost-effectiveness are needed to strengthen the existing evidence to inform policy makers on feasibility of increased assimilation of this technology into clinical practice.
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Affiliation(s)
- Sinead E Ramjit
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Emmaline Ashley
- Department of Surgery, Royal College Surgeons Ireland, Dublin, Ireland
| | - Noel E Donlon
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Andreas Weiss
- Department of Surgery, University Hospital Regensburg, Bavaria, Germany
| | - Frank Doyle
- Department of Surgery, Royal College Surgeons Ireland, Dublin, Ireland
| | - Leonie Heskin
- Department of Surgery, Royal College Surgeons Ireland, Dublin, Ireland
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Heskin L, Galvin R, Traynor O, Simms C. Simulation in Upper and Lower Limb Trauma Skill Acquisition: A Review. Simul Healthc 2022; 17:54-65. [PMID: 34009908 DOI: 10.1097/sih.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT This review aimed to explore the published evidence with regard to the types and composition of both full- and part-task trainers to teach surgeons extremity exploration procedures in limb trauma management. Studies were included if they reported the development and/or validation of synthetic or virtual task trainers. Studies were evaluated to determine their derivation, usability, and clinical utility.A total of 638 citations were identified and 63 satisfied the inclusion criteria. Twenty-five articles addressed simulator validation and 36 addressed level of learning achieved with simulator engagement. Two studies described a dedicated limb simulator. Simulators were developed to repair limb structures including skin (n = 15), tendon (n = 7), nerve (n = 1), fascia (n = 1), muscle (n = 1), vascular (n = 24), and bone (n = 11). Considerations such as material fidelity, learning outcomes, cost or reusability, validity, and effectiveness are inconsistently reported. Future studies should address design standards for the effective production of synthetic or virtual simulators for limb trauma management.
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Affiliation(s)
- Leonie Heskin
- From the Department of Surgical Affairs, Royal College of Surgeons in Ireland (L.H., O.T.); University of Limerick (R.G.); and Trinity College Dublin (C.S.), Dublin, Ireland
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Heskin L, Simms C, Traynor O, Galvin R. 182 Surgical Simulator Design, What are Educators and Trainees Requirements? Simul Healthc 2021. [DOI: 10.54531/qsdb8946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Simulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to enable trainees to learn technical skills, practice skills and to be assessed in competency exams, need to be of the highest standard and to be of consistent design. Input into the design and makeup of task trainers used to teach surgical skills come from a multitude of sources. Enquiry into the perspectives of simulation has been described in the past but there is little description, in the literature, of the expectations of the desired features of the simulator itself.This study investigates the perceived requirements of simulation and simulators used to acquire skills in the surgical field, particularly in limb exploratory procedures in trauma.This study concentrated on the implementation and desired features of simulators for the acquisition of surgical technical skills.Semi-structured interviews were conducted until data saturation was achieved. An international group of 11 surgical educators and 11 surgical trainees, who had experience with surgical simulation, were interviewed via one-to-one video calls. The interviews focussed on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. This study concentrated on synthetic and virtual reality simulators for open surgical skills, as these types of simulators are open to design and redesign or adaptation. Interviews were recorded, transcribed and underwent thematic analysis. Ethical approval was obtained for this study.Analysis of the perspectives of surgical educators and surgical trainees on simulated training in open surgery yielded three main themes: (1) attitudes to simulation, (2) implementing simulation, (3) features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt that simulation could be improved with increased accessibility and a variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost-effectiveness, easy setup and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement.There is a clear positive appetite for the incorporation of simulation into general surgical and limb trauma training. The findings of this will inform the optimal requirements for high-quality implementation of simulation into a surgical trauma curriculum. The findings will inform the optimal features desired in a simulator or task trainer design. The aim is to inspire a more considered design approach to optimize surgical skills training and ultimately lead to increased patient safety.
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Heskin L, Simms C, Traynor O, Galvin R. Designing a synthetic simulator to teach open surgical skills for limb exploration in trauma: a qualitative study exploring the experiences and perspectives of educators and surgical trainees. BMC Surg 2021; 21:417. [PMID: 34911527 PMCID: PMC8672577 DOI: 10.1186/s12893-021-01417-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Simulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to adequately enable trainees to learn, practice and be assessed in surgical skills need to be of the highest standards. This study investigates the perceived requirements of simulation and simulators used to acquire skills in limb exploratory procedures in trauma. Methods Semi-structured interviews were conducted with an international group of 11 surgical educators and 11 surgical trainees who had experience with surgical simulation. The interviews focused on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. Interviews were recorded, transcribed and underwent thematic analysis. Results Analysis of the perspectives of surgical educators and surgical trainees on simulated training in limb trauma surgery yielded three main themes: (1) Attitudes to simulation. (2) Implementing simulation. (3) Features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt simulation could be improved with increased accessibility and variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost effectiveness, easy set up and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement. Conclusion There is a clear positive appetite for the incorporation of simulation into limb trauma training. The findings of this will inform the optimal requirements for high quality implementation of simulation into a surgical trauma curriculum and a reference to optimal features desired in simulator or task trainer design. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01417-7.
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Affiliation(s)
- L Heskin
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), 2nd Floor, 121 St Stephens Green, Dublin, Ireland.
| | - C Simms
- Trinity College Dublin, Dublin, Ireland
| | - O Traynor
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), 2nd Floor, 121 St Stephens Green, Dublin, Ireland
| | - R Galvin
- University of Limerick, Limerick, Ireland
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Gillanders SL, Anderson S, Mellon L, Heskin L. A systematic review and meta-analysis: Do absorbable or non-absorbable suture materials differ in cosmetic outcomes in patients requiring primary closure of facial wounds? J Plast Reconstr Aesthet Surg 2018; 71:1682-1692. [DOI: 10.1016/j.bjps.2018.08.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 06/26/2018] [Accepted: 08/20/2018] [Indexed: 11/30/2022]
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Heskin L, Cahill V, Filobbos G, Regan P, O'Sullivan ST, Bryan K. A new adaptation for a secure surgical drain placement and a comparison with four common drain fixation methods. Ann R Coll Surg Engl 2018; 101:60-68. [PMID: 30328703 DOI: 10.1308/rcsann.2018.0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/22/2022] Open
Abstract
INTRODUCTION The importance of postoperative drain fixation cannot be overemphasised. There are numerous described techniques for drain fixation. However, to our knowledge, there is no evidence-based comparison between the various techniques of drain fixation used in postoperative management. We describe a new method and compare its reliability with four other commonly used methods. MATERIALS AND METHODS Five methods were chosen for testing based on current trends in clinical practice: centurion sandal with plastic locking ties, centurion sandal or lattice method, centurion sandal with half-inch Steristrips®, double and multiple looped methods. We used an Instron 8872® tensiometer to apply a measured force to a secured drain. Each fixation method was tested ten times and all fixation methods were performed by the same experienced surgeon. We measured the average number of cycles before failure, the average displacement of the tube at failure and the time needed to apply each fixation method. RESULTS The number of cycles completed before failure showed that the centurion sandal method, the centurion sandal with plastic ties and the centurion sandal method with Steristrips had the lowest failure rate. The amount of displacement was the least in the centurion sandal with plastic ties followed by the double-loop method and centurion sandal with Steristrips. There was little difference in the time taken to complete the fixation methods (range 21-33 seconds). DISCUSSION We recommend the use of the centurion sandal with plastic locking ties, centurion sandal with Steristrips followed by the centurion sandal method alone as fixation techniques that are quick to perform, secure and reliable.
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Affiliation(s)
- L Heskin
- Cork University Hospital , Cork , Ireland
| | - V Cahill
- Cork University Hospital , Cork , Ireland
| | | | - P Regan
- University College Galway , Ireland
| | | | - K Bryan
- Cork Institute of Technology , Cork , Ireland
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Abstract
Complications after open aortic surgery pose a challenge both to the vascular surgeon and the patient because of aging population, widespread use of cardiac revascularization, and improved survival after aortic surgery. The perioperative mortality rate for redo elective aortic surgery ranges from 5% to 29% and increases to 70–100% in emergency situation. Endovascular treatment of the postaortic open surgery (PAOS) patient has fewer complications and a lower mortality rate in comparison with redo open surgical repair. Two cases of ruptured abdominal aortic aneurysm (AAA) were managed with the conventional open surgical repair. Subsequently, spiral contrast computer tomography scans showed reperfusion of the AAA sac remnant mimicking a type III endoleak. These graft-related complications presented as vascular emergencies, and in both cases endovascular aneurysm repair (EVAR) procedure was performed successfully by aortouniiliac (AUI) stent graft and femorofemoral crossover bypass. These 2 patients add further merit to the cases reported in the English literature. This highlights the crucial importance of endovascular grafts in the management of such complex vascular problems.
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Affiliation(s)
- Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University College Hospital, Galway, Ireland.
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Prakash D, Heskin L, Doherty S, Galvin R. Local anaesthesia versus spinal anaesthesia in inguinal hernia repair: A systematic review and meta-analysis. Surgeon 2016; 15:47-57. [PMID: 26895656 DOI: 10.1016/j.surge.2016.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 11/04/2015] [Revised: 01/12/2016] [Accepted: 01/16/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Inguinal hernias are a significant cause of morbidity. The purpose of this systematic review and meta-analysis is to determine the totality of evidence regarding the effectiveness of local anaesthesia when compared to spinal anaesthesia in individuals undergoing open inguinal hernia repair. METHODS A systematic literature search was conducted. Inclusion criteria were randomised controlled trials (RCTs) comparing spinal and local anaesthesia on clinical and self-reported outcomes, in patients undergoing open inguinal hernia repairs. The methodological quality was assessed using the Cochrane risk of bias tool. The mode of analysis used was the difference in outcomes between the groups post-surgery and at follow-up time points. Statistical heterogeneity was assessed using the I2 statistic. RESULTS Ten original RCTs were included, with a total of 1379 patients. There was no significant difference in operative time between the groups [Random Effects Model, MD -0.70 min (95% CI, -5.80 to 4.40 min), p = 0.79, I2 = 84%]. Patients in the local anaesthetic group experienced significantly less pain than those in the spinal group [Fixed Effects Model, SMD -0.63 (95% CI, -0.81 to -0.46), p < 0.01, I2 = 49%], lower rates of urinary retention [FEM, RR 0.03 (95% CI 0.01-0.08), p < 0.01, I2 = 0%], decreased rates of anaesthetic failure [FEM, OR 0.17 (95% CI 0.06-0.45), p < 0.01, I2 = 0%], and increased satisfaction with the anaesthetic [FEM, OR 3.40 (95% CI 2.09-5.52), p < 0.01, I2 = 0%]. The methodological quality of studies was variable. CONCLUSION Our findings support the use of local anaesthetic in adult patients undergoing open repair for a primary inguinal hernia.
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Affiliation(s)
- Deepali Prakash
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Republic of Ireland.
| | - Leonie Heskin
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Republic of Ireland.
| | - Sally Doherty
- Department of Psychology, Royal College of Surgeons in Ireland, Republic of Ireland.
| | - Rose Galvin
- Department of Clinical Therapies, University of Limerick, Republic of Ireland.
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Heskin L, Mansour E, Lane B, Kavanagh D, Dicker P, Ryan D, Gildea-Byrne K, Pawlikowska T, Tierney S, Traynor O. The impact of a surgical boot camp on early acquisition of technical and nontechnical skills by novice surgical trainees. Am J Surg 2015; 210:570-7. [PMID: 26026339 DOI: 10.1016/j.amjsurg.2014.12.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/19/2014] [Accepted: 12/04/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acquisition of skills early in surgical training represents a significant challenge at present because of training time constraints. The aim of this study was to investigate if an intensive surgical boot camp was effective in transferring skills at the beginning of a surgical training program. METHODS New core surgical trainees (n = 58) took part in a 5-day boot camp. There were pretest and posttest assessments of knowledge, technical skills, and confidence levels. The boot camp used simulation and senior surgical faculty to teach a defined range of technical and nontechnical skills. RESULTS The scores for knowledge (53.8% vs 68.4%, P < .01), technical skills (35.9% to 60.6% vs 50.6% to 78.2%, P < .01), and confidence levels improved significantly during boot camp. Skills improvements were still present a year later. CONCLUSION The 5-day surgical boot camp proved to be an effective way to rapidly acquire surgical knowledge and skills while increasing the confidence levels of trainees.
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Affiliation(s)
- Leonie Heskin
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Ehab Mansour
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brian Lane
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dara Kavanagh
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Pat Dicker
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Donncha Ryan
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kate Gildea-Byrne
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Teresa Pawlikowska
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sean Tierney
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oscar Traynor
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Heskin L, Filobbos G, Cahill V, Bryan K, Ward J, O'Sullivan S, Regan P. An evidence based analysis of drain fixation methods in plastic surgery. Int J Surg 2012. [DOI: 10.1016/j.ijsu.2012.06.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sultan S, Heskin L, Hynes N, Akhtar Y, Cough V, Manning B, Aremu M, Courtney D. Salvage of critical limb ischemia with the "trellis reserve'' of subintimal superficial femoral-popliteal artery occlusion: a new modality in managing critical limb ischemia--a case report. Vasc Endovascular Surg 2005; 39:531-5. [PMID: 16382275 DOI: 10.1177/153857440503900611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Subintimal angioplasty is a safe, effective, but nondurable procedure in treating long superficial femoral artery occlusions in patients with severe lower limb ischemia. The authors report a case of acute thrombosis that presented 16 weeks after subintimal angioplasty. The ;;Trellis'' percutaneous thrombolytic infusion system permitted a controlled site-specific infusion of recombinant tissue-type plasminogen activator (rtPA). The unique design of the ;;Trellis'' allowed complete aspiration of thrombus and avoiding regional and systemic thrombolytic side effects. The ;;Trellis'' system is effective in percutaneous management of thrombotic lesions; however, intimal dissection may need to be addressed.
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Affiliation(s)
- Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University College Hospital Galway, Ireland.
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Sultan S, Heskin L, El Hediny Y, Oaikhinan K, Gough V, Akhta Y, Courtney D. Carotid stump syndrome. A case report and literature review. INT ANGIOL 2004; 23:284-7. [PMID: 15765045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Carotid stump syndrome occurs infrequently. Diagnosis and management requires flow studies with duplex ultrasound scan as well as anatomical delineation of the affected vessel by magnetic resonance angiography. Surgical exclusion of the internal carotid artery is safe and effective and is the gold standard of treatment with best medical therapy.
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Affiliation(s)
- S Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University College Hospital, Galway, Ireland.
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