1,720,964 research outputs found
The use of virtual reality for carotid artery stenting (CAS) training in type I and type III aortic arches
No full textAIM: Simulation has been proposed to improve learning curves in carotid artery stenting (CAS), but previous studies have only evaluated CAS simulation in a single type of arch usually either type I or type II. The aim of our study is to define the use of virtual reality for CAS training in type I and type III aortic arches for novice operators.
MATERIALS AND METHODS: Fifty experienced interventionalists and fifty novice trainees with no prior experience with endovascular procedures performed a virtual CAS in a type I aortic arch case and one in a type III arch case. They trained on simulator for two hours and then repeated the procedures. Data of the procedures were collected and analysed.
RESULTS: Among novice operators, 38 out of 50 ended the first procedure on type I arch (76%) and 32% (16 out of
50) concluded the first procedure on type III arch (p < .05). After training, 100% of novice ended the easy case and 56% (28 out of 50) concluded the difficult case (p < .05). All experienced operators successfully carried out the simulations.
The simulator induced greater improvement among novice in type I arch rather than in type III arch. Performances of experienced didn’t improve significantly. Among novice, virtual performances of “difficult” cases were significantly worse
than those of “easy” cases, both before and after training.
CONCLUSIONS: Simulator is an effective tool for training of novice operators in type I aortic arch; on the contrary its role has yet to be established in type III aortic arch
Appropriateness of Duplex ultrasound assessment on venous system of the legs: a two-month preliminary analysis
No full textAIM: The goal of this study is to evaluate the appropriateness to prescribe venous ultrasound of lower limbs.
MATERIAL OF STUDY: Over a two months period, 1005 Duplex scans were performed by our Vascular Surgery Unit; out of the total, 225 exams were conducted on venous system of lower limbs. We retrospectively analyzed appropriateness of prescription (according to Lombardy District indications), urgency of prescription, time-lapse between application for the exams and its execution, positive or negative results, National Health System's sustained cost.
RESULTS: During the above mentioned period, 87,5% of the exams were conducted as normal screening with no urgency characteristics, 61 exams (27%) were combined with arterial duplex of the same district. General Practitioners' requests accounted for 76,8% while only 9,7% were from vascular surgeons. Following indications of appropriateness, 117 exams (52%) were judged as appropriate. Combining appropriateness and result (x(2) test) we found that if the indication was inappropriate the negative result rate was 90,75%; in the group of exams prescribed with an urgent request the rate of appropriateness raised to 60,7% of whose 94.1% were pathologically positive.
DISCUSSION: There is no evidence in Literature about appropriateness of prescription of Duplex ultrasound for vascular districts. While Lombardy District recently published guidelines for prescription, neither vascular surgeon societies nor National Health Service ever provided any indication.
CONCLUSION: Nowadays there is increasing demand for appropriateness in healthcare. This study delivered such significant data to make it a pivotal study for an extended analysis during 2016
A 16-year experience of carotid artery stenting for carotid artery stenosis
No full textAim: We report our experience of carotid artery stenting (CAS) for the endovascular treatment of significant carotid stenosis over 16 years.
MATERIALS AND METHODS: Data of all consecutive patients who came for a significant carotid artery stenosis from January 1st 1999 to August 31st 2015 were retrospectively collected and analyzed. Primary outcomes were the occurrence of death and major cerebrovascular events (MCE) both at 30-day and at long-term.
RESULTS: In. our experience CAS was a safe and effective technique, with acceptable mortality and neurological complication rates, both at 30 days and in the long term
Ultrasonic Debridement for the Treatment of Infected Vascular Graft
No full textIntroduction :
Vascular surgical site infection (SSI) is a feared complication of major vascular surgery procedures. Depending on the
virulence of the infectious pathogen and the site of surgery, its presentation is extremely variable, ranging from severe
sepsis to slow-evolving prosthetic colonisation by bacterial biofilm. Usually it is associated with poor patients’
prognosis and low rates of limb salvage. Medical treatment alone is not effective, given the very low penetration of
antibiotic into the bacterial biofilm. Radical surgical treatment is the current mainstay, consisting of complete graft
removal and reconstruction with autogenous or extra-anatomic conduits. Unfortunately it is burdened by high morbidity
and mortality rates, especially in those patients who are unfit for open major vascular procedures, furthermore recurrent
SSI is not to be ruled out. Less invasive surgical techniques, allowing partial or no graft excision, have therefore been
recently introduced. Aim of our study is to evaluate the results of a novel SSI treatment consisting of associated
ultrasonic debridement and antibiotic therapy in a subset of patients considered at extremely high risk for major surgery.
We used this technique to achieve the best tissue and or graft debridement while minimising the invasiveness of
surgery.
Materials/Methods
Ultrasound (US) technology and its interaction with living tissues has been already studied: the largest experience
comes from dentistry for cleansing purpose and lately ultrasonic debridement has gained a role in the treatment of nonhealing chronic leg ulcers. When applied to infected wounds, US generate mechanical and cavitational energy that
preferentially disrupts necrotic tissues, due to their lower tensile strength, and stimulate formation of granulation tissue.
Besides, US enhancement of antibiotic action against bacterial biofilms associated with implant infection has been well
documented by several in-vivo experimental studies. We used an ultrasonic generator operating through a piezoelectric
probe vibrating at 26 KHz with a vibratory amplitude of 15-30 μm and irrigating normal saline. Patients with a
prosthetic vascular graft infection and poor medical condition or unavailable autogenous graft underwent an extensive
US debridement on the graft and wound tissues to allow a less invasive reconstruction. Non incorporated vascular
prostheses and surrounding tissues were treated with this device by moving the probe over their surfaces until all
necrotic parts and fibrin were removed and the colour of the graft and tissue returned to appear normal. Ultrasonic
debridement was followed by local antibiotic irrigation and was associated to antibiogram-oriented systemic
antimicrobial treatment. Graft removal and Sartorius muscle flap to cover the inguinal region were selectively employed
Patients’ charts were reviewed to extract their history, lab data, operative details, cultures and follow up.
Results
Our study involved 12 patients with a mean age of 73 years (range 57-92) composed of 7 males and 5 females. SSI
onset was early in 8 cases and late in 4. Possible clinical presentations were draining sinus tract (5 patients), wound
dehiscence (5 patients) and acute hemorrhage due to prosthesis’ detachment (2 patients). Prosthetic materials were
Dacron (8 patients), PTFE (1 patient), composite Dacron-PTFE (2 patients) and bovine pericardium (1 patient). US
debridement was performed after partial graft excision in order to allow an in situ reconstruction with a Silver prosthetic
graft in 5 patients, while 7 patients underwent US debridement without graft removal. A Sartorius flap to cover the
groin was carried out in 5 cases. Cultures revealed a single infectious pathogen (4 patients) or ≥2 pathogens (6 patients);
in the two remaining patients no microorganism was found. We noticed no harm on Dacron grafts even when an
intensive and prolonged debridement was done; PTFE grafts needed a special attention, because of a slight loss of
impermeability after long ultrasound exposure. However no major damage occurred to any of our grafts.
Estimated freedom from recurrent infection was 91.6% at 6 months (1 early recurrence) and 83.3% at 1 and 2 years (1
late recurrence). Limb survival was 81.8% at 6 months, 72.7% at 1 year and 63.6% at 2 years. Early post-operative
mortality was 8.3% (1 patient died because of cardiac complications).
Conclusions
In our experience ultrasonic debridement of infected grafts obtained promising results. We believe that it can be
considered as another viable option for the treatment of this dramatic complication. An extensive debridement of the
graft and of surrounding tissues allowed us to treat patients more conservatively without compromising the chance of
eradication of the infectious pathogen
Assessment of risk factors for mortality, endoleak and late reintervention after EVAR
No full textIntroduction. Endoleak (EL) and late reintervention represent the Achilles heel of endovascular repair of abdominal aortic diseases (EVAR) if compared to open surgical repair (OSR), as they countermand the early advantage of the former over the latter in terms of postoperative mortality and morbidity. Moreover, differently from OSR, they mandate a long-term postoperative surveillance, which increases the overall costs of EVAR. Aim of our study was to review our experience with EVAR, analyzing any preoperative and intraoperative factor which could predict a late reintervention or occurrence of EL and help in a proper selection of patients before the procedure. Materials and methods. Data of all consecutive patients who underwent EVAR from January 2003 and May 2012 at our Institution were retrospectively collected. Outcomes were analyzed to evaluate any factor which could affect survival, the occurrence of EL or the need for reintervention. The following items were specifically assessed: history of smoke, assumption of antiplatelet/anticoagulant drugs, sac diameter, proximal neck (diameter, length and angle), percentage of circumference of the sac covered by thrombus, number of patent lumbar arteries arising from the sac, patency of inferior mesenteric artery (IMA), graft oversizing > 25%, hypogastric arteries coverage, IMA or lumbar preoperative embolization. P value < .05 was considered statistically significant. Results. One-hundred and sixty patients (143 men, 89.4%; median age 77 years, range 45-92) underwent EVAR, most of them for degenerative infrarenal AAA (139 patients, 86.8%). Seven procedures were performed in an emergent setting for acute contained rupture; 8 patients were symptomatic for lumbar pain (5), anemia and melena (2) and blue toe syndrome (1). An aorto-bisiliac endograft was deployed in most cases (124, 77.6%), a chimney technique was used in 2 cases. Median duration of the procedure was 190 minutes (IQR 155-210 min) and median in-hospital stay was 5 days (IQR 4-9 days). Perioperative mortality was 4.4% and 12 patients (7.5%) were discharged having a type II EL under close surveillance. Long-term follow-up was available for 146 patients (median 16.6 months, IQR 6.2-37.6 months). Survival was 69.7%+4.3% at 3 years and 53.8%+5.5% at 5 years. There were 2 fatal ruptures. Survival was significantly affected by age (P=.03), preoperative rupture and symptoms (P<.001, RR 0.3, 95%CI 0.2-0.5 and P=.01, RR 0.45, 95%CI 0.28-0.82 respectively). Freedom from EL at 3 and 5 years was 67.8%+4.3% and 60.1%+5.8% respectively. We observed 13 type Ia EL (all of them treated with placement of a proximal aortic cuff) and 31 type II EL (2 required selective embolization of the guilty vessel, 12 spontaneously regressed, the remaining are still under surveillance). Furthermore there were 3 graft thromboses which contributed to an overall reintervention rate of 12.3%.
None of the assessed factors affected significantly the occurrence of EL or the need for reintervention.
Conclusions. In our study, survival after EVAR was significantly affected by age, preoperative rupture and symptoms. None of the analyzed factors has been shown to be predictive of the occurrence of EL or complications that required reintervention. These results further justify the need for close follow-up after EVAR
Long term results of carotid artery stenting in patients 80 years and older
No full textIntroduction. We report our experience about carotid artery stenting (CAS) in patients 80 years and older. Materials and Methods. Out of 582 patients who underwent CAS at our institution from January 1999 to June 2010, 102 patients (group A) were 80 years or older. The clinical data of these patients were retrospectively reviewed, outcomes analyzed, and compared with those of younger patients who underwent CAS during the same period (group B). Results. Outcomes of group B were similar to those of group A, both at 30 days and at long term. Male gender, symptoms, and not using an embolic protection device were related to long-term complications in both groups. Occurrence of bradycardia/asystole during CAS was a risk factor for long-term myocardial infarction for group A only. Conclusions. CAS can be safely performed in patients 80 years or older, with results that compare favorably to those of younger patients
Varicose veins: new trends in treatment in a vascular surgery unit
No full textAIM: Less invasive techniques such as foam sclerotherapy, endovenous laser or radiofrequency ablation have recently been introduced as a valid alternative to surgery for the treatment of varicose veins (VVs). We retrospectively reviewed our experience in the treatment of VVs with particular attention to how our therapeutic approach has changed over the last years. MATERIAL OF STUDY: Data of all patients consecutively treated from September 1st 2013 to July 31st 2015 for both primitive and recurrent VVs were retrospectively collected and analyzed. Statistical analysis was performed using the software JMP 5.1.2 (SAS Institute). RESULTS: A total of 409 legs in 378 patients were treated. The percentage of stripping of the great saphenous veins (GSV) for primary VVs has decreased over the years (67% in 2013 vs 15.2% in 2015), differently from what happened to the percentage of RFA of the GSV (14.3% vs. 31.5% respectively in 2013 and in 2015) and to the percentage of legs treated with the A.S.V.A.L. technique (8.7% vs. 31.5% respectively in 2013 and in 2015). Likewise, in 2013 most procedures were performed using spinal anesthesia (77.5%), while in 2015 the most used anesthetic techniques were both the local anesthesia and the local anesthesia with conscious sedation (35.9% and 29.3% respectively). Postoperative course was uneventful in all cases but seven (1.7%). At follow-up (median 16.9 months, IQR 7.5-22.6 months), neither major adverse events nor deaths were recorded. CONCLUSIONS: During the years of our experience, we observed a trend towards a less invasive approach for the treatment of VVs, with safe and effective results
Seat belt injuries of the abdominal aorta in adults-case report and literature review
No full textBlunt abdominal trauma with major vascular involvement is found to be rare. Although few series have been reported in the literature, the true incidence of blunt abdominal aortic injury is unknown. Different modalities of blunt trauma may occur among civilians with steering wheel and seat belt injury secondary to motor vehicle accident the most frequent. Mechanical forces produce variable patterns of injury; therefore, the onset of signs and symptoms can be different. Dissection and thrombosis of the abdominal aorta have been frequently described among seat-belted adult patients with major vascular involvement. The associated abdominal viscus and/or vertebral lesions must always be taken into account. Prompt diagnosis allows adequate surgical treatment. We present the case of a 66-year-old woman, restrained front passenger involved in a motor vehicle collision, who had small bowel transection, vertebral fractures, and aortic partial occlusion below inferior mesenteric artery with bilateral iliac artery involvement. Along with the case reported, the purpose of this study is to highlight and compare features and management of the previous cases described in the English literature
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
- …
