1,720,969 research outputs found
RR5. Surgical Treatment of Popliteal Aneurysms Using a Posterior Approach: Thirteen Years' Follow-up
No full textOBJECTIVES : Long-term results of posterior approach (PA) for the treatment of popliteal artery aneurysms are lacking in the literature. We compared our results with this access with those from a standard medial approach over a 13-years’ period.
METHODS: Clinical data of all patients treated for a popliteal aneurysm between 2/1998 and 10/2011 were retrospectively reviewed and outcomes analyzed: Kaplan-Meier method with log-rank, chi2 and Wilcoxon test were employed for analysis.
RESULTS : A total of 78 aneurysms were treated in 66 patients (65 men). Mean age was 68 years (range 48-96 years).
Thirty-six aneurysms were asymptomatic (46%). Mean sac diameter was 2.9±1 cm. A PA was used in 43 cases (55%) and a medial approach (MA) in 35. All PA consisted in aneurysmectomy with an interposition graft with end to end anastomoses; among MA 25 interposition grafts and 10 bypass were performed. A PTFE graft was used mostly (57 cases). The two groups differed for age only (median 65.4 for PA vs. 72.9 for MA p=0.01). Five patients had an early thrombosis and required a Fogarty thrombectomy (2 PA and 3 MA, all PTFE grafts). Mortality rate at 30 days was 0%.
One patient suffered a peroneal nerve lesion (permanent) and another one a major wound necrosis with tissue loss (both PA). There were no early amputations. Median follow-up was 58.8 months (range 5 days-166.7 months).
Nine patients died during follow-up for unrelated causes. The 5-year primary and secondary patency rates were 58.9%±8,7% and 96.4%±3.5% respectively for PA, and 67.4%±10,4% and 81.3%±8,9% respectively for MA (p=0.41 for primary patency rate and 0.28 for secondary patency rate). Limb salvage was 100% and 93.3%±6.4% at 5 and 10 years respectively for PA and 91.5%±5.6% at both time points for MA (p=0.3).
CONCLUSIONS : PA in our experience was burdened by a few more early complications compared to MA. However in the long term it provided results which compare favorably to MA.
AUTHOR DISCLOSURES: I. Barbetta, Nothing to disclose; M. Carmo, Nothing to disclose; R. Dallatana, Nothing to disclose; G. Grava, Nothing to disclose; D. Mazzaccaro, Nothing to disclose; A. M. Settembrini, Nothing to disclose; P. Settembrini, Nothing to disclose
Near-infrared spectroscopy for cerebral monitoring during carotid endarterectomy : symptomatic and asymptomatic patients might have different thresholds
No full textObjectives
This study evaluated the reliability of near-infrared spectroscopy (NIRS) monitoring during carotid endarterectomy (CEA) in patients affected by asymptomatic and symptomatic carotid stenosis. To identify the optimal cut-off value for regional oxygen saturation (rSO2) decrease in the two groups of patients.
Methods
We retrospectively reviewed NIRS data of 372 CEAs performed under general anesthesia from March 2007 to October 2014. Among them, 80 (21.5%) were treated for symptomatic disease. Ten (2.7%) postoperative neurologic events were registered (5 in asymptomatic and 5 in symptomatic group). Mean rSO2 preclamp values were collected and compared with the lowest rSO2 values during carotid cross-clamp. We considered different duration cutoffs, based on decrease lasting 1, 1.5, 2, 2.5, and 3 minutes. Receiver operating characteristic (ROC) curve analysis was performed to determine the best threshold value of rSO2 decrease in order to identify neurologic distress.
Results
No significant difference was found between the diverse duration of rSO2 decrease. ROC curve analysis was significant in asymptomatic patients, with an area under the curve (AUC) at 3 minutes of 0.75 (95% confidence interval [CI], 0.53-0.98). An optimal cutoff value of −17% was found in this group. Sensitivity was 80% (95% CI, 40%-100%) and specificity was 76.31% (95% CI, 70.9%-81.37%). Positive (PPV) and negative (NPV) predictive values were 5.48% and 99.54%, respectively. NIRS monitoring was not significant in symptomatic patients. In this group, we found an AUC of 0.39 (95% CI, 0.12-0.66) along with a threshold value of −9% (sensitivity, 100%; specificity, 24%; PPV, 8.1%; NPV, 100%).
Conclusions
Our results suggest that NIRS is a reliable method for cerebral monitoring during CEA in asymptomatic patients. A cutoff value of −17% might be safe, with a high NPV and acceptable sensitivity and specificity. For symptomatic patients, having in mind that our results did not reach statistical significance, we advise a −9% reduction as a threshold and therefore a wider use of shunt
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
Critical ischemia of the left arm caused by thoracic outlet syndrome (TOS) : case report and review of the literature
No full text
Unusual clinical presentation of primary aortoduodenal fistula
Full text linkPrimary aorto-enteric fistula (PAEF) develops between the native aorta and the gastro-intestinal tract, in the presence of an abdominal aortic aneurysm. It is a rare, life-threatening condition and appears to be less frequent than secondary aorto- enteric fistula, which is associated with previous aortic prosthetic reconstruction. When untreated, the overall mortality rate is almost 100%. Diagnosis may be challenging until the occurrence of a massive haemorrhage. In the presence of gross contamination, patients tend to a worse prognosis. Extra-anatomical bypass and repair of the enteric tract is the treatment of choice in case of gross contamination. In situ reconstruction is often reported in cases of mild bacterial contamination. Endovascular treatment has recently become a valid option in haemodynamically unstable patients, but a staged approach, with delayed surgical treatment, seems advisable
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
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