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La Marca MA, Dinoto E, Rodriquenz E, Pecoraro F, Turchino D, Mirabella D. Brachial artery aneurysm after hemodialysis fistula ligation: Case reports and review of literature. Int J Surg Case Rep 2024; 115:109306. [PMID: 38280341 PMCID: PMC10839962 DOI: 10.1016/j.ijscr.2024.109306] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION Brachial artery aneurysm (BAA) following long-standing arteriovenous fistula (AVF) ligation after renal transplantation is odd. CASE PRESENTATION Two cases of brachial artery aneurysm treated with bypass (a saphenous vein graft and a PTFE graft). In the first patient no complications were recorded whereas an infection was diagnosed after 6 months from the procedure in the second treatment. CLINICAL DISCUSSION Multiple factors activated by stress on the vessel wall followed by fistula ligation are the cause of vascular remodeling of the three layers making up the wall with possible evolution in aneurysmatic lesions. In literature the gold standard for this lesion is the surgical approach, only one endovascular procedure is reported. The traditional surgical approach uses the autologous vein or prosthetic PTFE grafts. CONCLUSION Brachial artery aneurysm is a complication that affects patients undergoing renal transplantation who have already undergone AVF ligation. In our experience autologous vein graft represented the best solution.
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Affiliation(s)
- M A La Marca
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - E Dinoto
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy.
| | - E Rodriquenz
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - F Pecoraro
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences - University of Palermo, Italy
| | - D Turchino
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Italy
| | - D Mirabella
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy
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Cloyd JM, Dalmacy D, Ejaz A, Pawlik TM. Rates and Outcomes of Aborted Cancer Surgery among Older Patients with Pancreatic Cancer: a SEER-Medicare Study. J Gastrointest Surg 2022; 26:1957-1959. [PMID: 35274193 DOI: 10.1007/s11605-022-05289-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/26/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Jordan M Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave, N-907 Doan Hall, Columbus, OH, 43210, USA.
| | - Djhenne Dalmacy
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Abstract
Chronic limb-threatening ischemia requires aggressive risk factor management and a thoughtful approach to the complex decision of best strategy for revascularization. Patients often have multilevel disease amenable to endovascular, open surgical, or hybrid approaches. Limited high-quality evidence is available to support a specific strategy; randomized trials are ongoing. Acute limb ischemia is associated with a high risk of limb loss and mortality. Catheter-directed thrombolysis is mainstay of therapy in patients with marginally threatened limbs, whereas those immediately threatened with motor deficits require more rapid restoration of flow with open or endovascular techniques that can establish flow in single setting.
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Affiliation(s)
- Jocelyn M Beach
- Section of Vascular Surgery, Heart and Vascular Institute, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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Olson KA, Teixeira PG. Mesenteric Ischemia: When and How to Revascularize. Adv Surg 2021; 55:75-87. [PMID: 34389101 DOI: 10.1016/j.yasu.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kristofor A Olson
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, 1500 Red River Street, Annex, Austin, TX 78701, USA
| | - Pedro G Teixeira
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, 1500 Red River Street, Annex, Austin, TX 78701, USA.
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Kumar A, Pulle MV, Asaf BB, Shivnani G, Maheshwari A, Kodaganur SG, Puri HV, Bishnoi S. Superior Vena Cava Resection in Locally Advanced Thymoma-Surgical and Survival Outcomes. Indian J Surg Oncol 2020; 11:711-719. [PMID: 33299285 DOI: 10.1007/s13193-020-01204-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/21/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
This study was aimed at reporting the surgical management of superior vena cava invasion in patients with locally advanced thymoma and to evaluate surgical and survival outcomes. This is a retrospective analysis of 12 patients operated for superior vena cava resection for locally advanced thymoma over 8 years in a thoracic surgery centre in India. An analysis of peri-operative variables including complications was carried out. The influence of various predictors on survival was assessed by log-rank test. Intra-operatively, superior vena cava (SVC) alone was involved in 3 (25%) cases, SVC with BCV involvement was there in 8 cases (66.7%) and in 1 patient, the SVC involvement extended into the right atrium also. In all cases, the tumour was resected en bloc with the involved part of SVC. Repair with primary closure was sufficient in 2 cases (16.6%) in view of < 1/3rd of circumferential involvement. However, in remaining 10 cases, SVC was replaced with PTFE graft (single graft in 6 cases, Y-graft in 2 cases and twin grafts in 2 cases). No peri-operative deaths. Overall survival (OS) at 1, 3 and 5 years was 100%, 91.6% and 83.3%, respectively. Myasthenia gravis and higher Masaoka stage (IV A) of the disease were poor predictors of survival. Superior vena cava resection and reconstruction is a feasible and oncologically superior option in invasive thymoma with SVC involvement. This challenging surgical procedure should only be attempted by an experienced team of thoracic and cardiac surgeons at high-volume centre to achieve best outcomes.
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Affiliation(s)
- Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | | | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Ganesh Shivnani
- Department of Cardiac Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Arun Maheshwari
- Department of Cardiac Anaesthesia, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | | | - Harsh Vardhan Puri
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
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Mintziras I, Miligkos M, Wächter S, Manoharan J, Bartsch DK. Palliative surgical bypass is superior to palliative endoscopic stenting in patients with malignant gastric outlet obstruction: systematic review and meta-analysis. Surg Endosc 2019; 33:3153-3164. [PMID: 31332564 DOI: 10.1007/s00464-019-06955-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 05/03/2019] [Accepted: 07/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastrojejunostomy (GJ) and self-expanding metal stents (SEMS) are the two most common palliative treatment options for patients with malignant gastric outlet obstruction (GOO). Randomised trials and retrospective studies have shown discrepant results, so that there is still a controversy regarding the optimal treatment of GOO. METHODS Medline, Web of Science and Cochrane Library were systematically searched for studies comparing GJ to SEMS in patients with malignant GOO. Primary outcomes were survival and postoperative mortality. Secondary outcomes were frequency of re-interventions, major complications, time to oral intake and length of hospital stay. RESULTS Twenty-seven studies, with a total of 2.354 patients, 1.306 (55.5%) patients in the SEMS and 1.048 (44.5%) patients in the GJ group, were considered suitable for inclusion. GJ was associated with significantly longer survival than SEMS (mean difference 43 days, CI 12.00, 73.70, p = 0.006). Postoperative mortality (OR 0.55, CI 0.27, 1.16, p = 0.12) and major complications (OR 0.73, CI 0.5, 1.06, p = 0.10) were similar in both groups. The frequency of re-interventions, however, was almost three times higher in the SEMS group (OR 2.95, CI: 1.70, 5.14, p < 0.001), whereas the mean time to oral intake and length of hospital stay were shorter in the SEMS group (mean differences - 5 days, CI - 6.75, - 3.05 days, p < 0.001 and - 10 days, CI - 11.6, - 7.9 days, p < 0.001, respectively). CONCLUSIONS Patients with malignant GOO and acceptable performance status should be primarily considered for a palliative GJ rather than SEMS.
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Affiliation(s)
- Ioannis Mintziras
- Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Michael Miligkos
- Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece
| | - Sabine Wächter
- Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Jerena Manoharan
- Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Detlef Klaus Bartsch
- Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
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Abstract
The accurate assessment of peripheral perfusion is a critical step in caring for a diabetic patient with active ulceration. This article guides the provider through diagnostic and therapeutic options. The perfusion assessment begins with a physical examination and augmented using noninvasive tests. Although some of these tests can be performed at the bedside, often a dedicated vascular laboratory is required. Additional cross-sectional imaging studies or formal angiography should be performed as well. These tools aid in the creation of the best therapeutic plan, which aims to restore perfusion and allow for rapid wound healing via open or endovascular means.
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Affiliation(s)
- Michael Cyrus Siah
- Department of Vascular Surgery, MedStar Washington Hospital Center, 106 Iriving Street Northwest POB North 3150, Washington, DC 20010, USA
| | - Steven Abramowitz
- Department of Vascular Surgery, MedStar Washington Hospital Center, 106 Iriving Street Northwest POB North 3150, Washington, DC 20010, USA.
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Miyake K, Kikuchi S, Okuda H, Koya A, Abe S, Sawa Y, Ota T, Azuma N. Successful limb salvage through staged bypass combined with free gracilis muscle transfer for critical limb ischemia with osteomyelitis after failed endovascular therapy. Surg Case Rep 2018; 4:40. [PMID: 29717398 PMCID: PMC5930295 DOI: 10.1186/s40792-018-0449-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/19/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Critical limb ischemia with osteomyelitis is so difficult to treat that even appropriate revascularization and wound therapy cannot achieve limb salvage because of uncontrollable infection. It is still difficult to judge the possibility of limb salvage before revascularization. CASE PRESENTATION A 73-year-old male complained of a small ulcer on his left toe, which was treated with multiple endovascular therapy. After failed endovascular therapy, he suffered extensive tissue loss with tibial osteomyelitis. We carried out staged surgery that was composed of dual bypass to the sural artery and posterior tibial artery. After intensive debridement and wound care, insertion of a subsequent free gracilis muscle flap to cover the exposed tibial bone was performed, achieving functional limb salvage. CONCLUSION Even in the threatened limb with extensive tissue loss and osteomyelitis, intensive and multidisciplinary treatment with staged revascularization, muscle transfer, and appropriate wound care achieved functional limb salvage.
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Affiliation(s)
- Keisuke Miyake
- Department of Vascular Surgery, Asahikawa Medical University, 1-1-1, Midorigaoka-higashi-2jyo, Asahikawa, 078-8510, Japan.,Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shinsuke Kikuchi
- Department of Vascular Surgery, Asahikawa Medical University, 1-1-1, Midorigaoka-higashi-2jyo, Asahikawa, 078-8510, Japan
| | - Hiroko Okuda
- Department of Vascular Surgery, Asahikawa Medical University, 1-1-1, Midorigaoka-higashi-2jyo, Asahikawa, 078-8510, Japan
| | - Atsuhiro Koya
- Department of Vascular Surgery, Asahikawa Medical University, 1-1-1, Midorigaoka-higashi-2jyo, Asahikawa, 078-8510, Japan
| | - Satomi Abe
- Department of Orthopedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tetsuo Ota
- Department of Physical Medicine and Rehabilitation, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, 1-1-1, Midorigaoka-higashi-2jyo, Asahikawa, 078-8510, Japan.
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Ali JM, Dunning J. Stented CorMatrix® conduit to bypass benign superior vena caval obstruction. Eur J Cardiothorac Surg 2018; 53:472-474. [PMID: 28958011 DOI: 10.1093/ejcts/ezx303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/18/2017] [Revised: 07/24/2017] [Accepted: 07/30/2017] [Indexed: 11/13/2022] Open
Abstract
Surgical venous bypass is an effective treatment option in the management of benign superior vena caval obstruction. Here, we present CorMatrix® as a novel conduit choice, supported internally by an endovascular stent in an attempt to prevent stenosis and reduce reintervention rate following surgical bypass.
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Affiliation(s)
- Jason M Ali
- Department of Cardiothoracic Surgery, Papworth Hospital Foundation NHS Trust, Papworth Everard, Cambridge, UK
| | - John Dunning
- Department of Cardiothoracic Surgery, Papworth Hospital Foundation NHS Trust, Papworth Everard, Cambridge, UK
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Roque J, Ho SH, Goh KL. Preoperative drainage for malignant biliary strictures: is it time for self-expanding metallic stents? Clin Endosc 2015; 48:8-14. [PMID: 25674520 PMCID: PMC4323440 DOI: 10.5946/ce.2015.48.1.8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 11/30/2014] [Accepted: 12/01/2014] [Indexed: 12/16/2022] Open
Abstract
Palliation of jaundice improves the general health of the patient and, therefore, surgical outcomes. Because of the complexity and location of strictures, especially proximally, drainage has been accompanied by increased morbidity due to sepsis. Another concern is the provocation of an inflammatory and fibrotic reaction around the area of stent placement. Preoperative biliary drainage with self-expanding metallic stent (SEMS) insertion can be achieved via a percutaneous method or through endoscopic retrograde cholangiopancreatography. A recently published multicenter randomized Dutch study has shown increased morbidity with preoperative biliary drainage. A Cochrane meta-analysis has also shown a significantly increased complication rate with preoperative drainage. However, few of these studies have used a SEMS, which allows better biliary drainage. No randomized controlled trials have compared preoperative deployment of SEMS versus conventional plastic stents. The outcomes of biliary drainage also depend on the location of the obstruction, namely the difficulty with proximal compared to distal strictures. Pathophysiologically, palliation of jaundice will benefit all patients awaiting surgery. However, preoperative drainage often results in increased morbidity because of procedure-related sepsis. The use of SEMS may change the outcome of preoperative biliary drainage dramatically.
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Affiliation(s)
- Jason Roque
- Division of Gastroenterology and Hepatology and Combined GI Endoscopy Unit, Department of Medicine, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Shiaw-Hooi Ho
- Division of Gastroenterology and Hepatology and Combined GI Endoscopy Unit, Department of Medicine, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Khean-Lee Goh
- Division of Gastroenterology and Hepatology and Combined GI Endoscopy Unit, Department of Medicine, University of Malaya Medical Center, Kuala Lumpur, Malaysia
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