87 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
In-vivo evaluation of silk fibroin small-diameter vascular grafts: state of art of preclinical studies and animal models
No full textAutologous vein and artery remains the first choice for vascular grafting procedures in small-diameter vessels such as coronary and lower limb districts. Unfortunately, these vessels are often found to be unsuitable in atherosclerotic patients due to the presence of calcifications or to insufficient size. Synthetic grafts composed of materials such as expanded polytetrafluoroethylene (ePTFE) are frequently employed as second choice, because of their widespread availability and success in the reconstruction of larger arteries. However, ePTFE grafts with small diameter are plagued by poor patency rates due to surface thrombogenicity and intimal hyperplasia, caused by the bioinertness of the synthetic material and aggravated by low flow conditions. Several bioresorbable and biodegradable polymers have been developed and tested to exploit such issues for their potential stimulation to endothelialization and cell infiltration. Among these, silk fibroin (SF) has shown promising pre-clinical results as material for small-diameter vascular grafts (SDVGs) because of its favorable mechanical and biological properties. A putative advantage in graft infection in comparison with synthetic materials is plausible, although it remains to be demonstrated. Our literature review will focus on the performance of SF-SDVGs in vivo, as evaluated by studies performing vascular anastomosis and interposition procedures, within small and large animal models and different arterial districts. Efficiency under conditions that more accurately mime the human body will provide encouraging evidence towards future clinical application
Are Endoleaks Type Ia Predictable?
No full textObjectives
Aortic proximal (type Ia) endoleak (EL) is one of the possible complications of endovascular aneurysm repair (EVAR) and usually needs a further reintervention. The aim of our study was to assess any preoperative factor which could predict the development of EL Ia and whether it is treatable through an endovascular approach.
Methods
Data of patients consecutively treated between January 2012 and December 2015 with EVAR for nonruptured abdominal aortic aneurysm (AAA) were retrospectively collected. For each patient, demographic and anatomical factors (sex, age, proximal aortic neck diameter, angulation and length, AAA diameter) and structural characteristics of different endograft (presence of barbs, free flow, and radial force) were analyzed and related to the development of EL Ia using JMP 5.1.2 software.
Results
We analyzed 190 patients (32 females [16.8%]; mean age, 75.7 years). The mean follow-up time was 19 months. Patients’ mean AAA diameter was 55.9 mm (range, 30-130 mm). A late EL Ia developed in 13 patients (7%), with a mean time of development of 30%, radial force, and the presence of suprarenal free flow and barbs were not significantly associated to the development of EL Ia. Female sex, age >77 years and a neck length <21 mm were statistically significant (P = .01, P = .02, and P = .02, respectively).
Conclusions
Among factors analyzed, female sex, age >77 years, and a proximal neck <21 mm were significantly associated with the occurrence of late EL Ia
Below the knee arteries - the why and how of surgical approaches
No full textBelow the knee lower limb revascularization is performed almost exclusively in critical limb threatening ischemia, whereas cases of functional ischemia (intermittent claudication) often require only conservative treatment
Manières d’être humain. Une autre philosophie morale
No full textPhilosophical ethics has been dominated for a long time by views (such as Utilitarianism and Kantianism) which aim at establishing normative criteria in isolation from concrete situations to which they are supposed to be applied. This book reverses the perspective and shifts the attention to the circumstances which make individual and social problems humanly and morally salient.
The task of ethics consists in deepening and reorganizing the ways of seeing, feeling, responding to the world which define the conceptual dimensions of our lives. The author elaborates on a tradition which begins with Wittgenstein and converses with Stanley Cavell, Elisabeth Anscombe, Iris Murdoch and Cora Diamond. It wishes to forge new philosophical instruments which allow to treat in a new way the issues of birth, death, sexuality and the conceptions of the human.Les conceptions philosophiques qui ont longtemps dominé l’éthique contemporaine (comme par exemple l’utilitarisme et le kantisme) visent à établir les critères normatifs en les isolant des situations concrètes auxquelles ils devaient être appliqués. Ce livre renverse une telle perspective et met au centre de sa réflexion les circonstances qui rendent humainement et moralement significatifs les problèmes dont se soucient les individus et les sociétés.
La tâche de l’éthique consiste alors en l’approfondissement et la réorganisation des manières de voir, de sentir, de réagir au monde qui définissent les dimensions conceptuelles de nos vies. Piergiorgio Donatelli réélabore une tradition qui part de Wittgenstein et dialogue avec des auteurs tels que Stanley Cavell, Elizabeth Anscombe, Iris Murdoch et Cora Diamond, en faisant émerger des nouveaux outils philosophiques qui permettent de traiter de façon nouvelle les questions concernant, par exemple, la naissance, la mort, la sexualité et les conceptions de l’humain
Double osteotomy of mandibula in the treatment of carotid body tumors with skull base extension
No full textWe report two patients with a carotid body paraganglioma that extended to the skull base, a position that is surgically inaccessible by means of a traditional lateral cervical approach. In both patients we were able to remove the lesion by performing a double mandibular osteotomy. Both patients underwent preoperative embolization to reduce the mass. In our experience, this approach has allowed a safe radical excision of exceptionally high lesions with only minor permanent nerve damage. In our opinion this advantage definitely outweighs the consequences of the increased invasiveness of this technique
Effect of chronic kidney disease on long-term survival in asymptomatic patients undergoing carotid endarterectomy
No full textObjectives: This study evaluated the effect of chronic kidney disease (CKD), assessed by preoperative estimated glomerular filtration rate (eGFR) and serum creatinine (Cr), on postoperative outcomes and long-term survival in asymptomatic patients undergoing carotid endarterectomy (CEA). Methods: Data of 678 asymptomatic patients who underwent CEA between 2002 and 2014 were collected. We identified four groups depending on different eGFR values, estimated by the Modification of Diet in Renal Disease (MDRD) formula: group A (90 mL/min/1.73 m2
), group B (89-60mL/min/1.73 m2 ), group C (59-30 mL/min/1.73 m2 ), and group D (#29 mL/min/1.73 m2 ), and in two groups based on preoperative Cr values: group 1 (<1.5 mg/dL) and group 2 (1.5 mg/dL). Primary outcomes were postoperative death, myocardial infarction (MI), and neurologic events (NE) within 30 days after surgery. The secondary outcome was long-term survival for each group. Odds ratios were calculated to evaluate multivariate hazards. Long-term survival of each group was assessed by Kaplan-Meier analysis. Results: One death (0.1%), 20 NEs (2.9%), and 4 MIs (0.6%) within 30 days after CEA were observed. Within this period, the Cr value was not a significant risk factor for morbility and mortality, to the contrary of eGFR value (OR, 1.02; confidence interval, 1.01-1.02; P < .0001). No significant differences in the 30-days outcomes were observed among eGFR and Cr groups. Median follow-up was 55 months (interquartile range, 27-84 months). The 5-year survival rates for groups A, B, C, and D were 98%6 0.02%, 91%6 0.02%, 80%6 0.03% and 58% 6 0.42%, respectively (P < .0001), and 88% 6 0.02%
for group 1 and 66% 6 0.08% for group 2 (P < .0001).Conclusions: eGFR and Cr classes are not a reliable method in evaluating postoperative risk of MI and NE after CEA in asymptomatic patients, although preoperative eGFR value influences 30-day morbility and mortality. Both eGFR and Cr groups are reliable predictors of long-term survival
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