1,721,110 research outputs found
Factors Affecting Patency of In Situ Saphenous Vein Bypass: 2-Year Results from LIMBSAVE (Treatment of Critical Limb Ischemia with Infragenicular Bypass Adopting In situ Saphenous Vein Technique) Registry
No full textObjective: Aim is to demonstrate contemporary outcomes of in situ saphenous vein bypass with the use of a new valvulotome in the framework of a national, multicenter registry based on the treatment of critical Limb IscheMia with infragenicular Bypass adopting in situ SAphenous VEin technique (LIMBSAVE).
Methods: Between January 2018 and December 2019 541 patients in 43 centers have been enrolled. In all patients a HYDRO LeMa LeMaître valvulotome (LeMa LeMaître Vascular, Burlington, MA) was used. Early outcomes were assessed. Two-year outcomes according to Kaplan-Meier curves in terms of patencies, and limb salvage were evaluated. Associations of patient and procedure variables were analyzed with univariate and multivariate analyses.
Results: In all cases valvulotome was able to lyse the valves. Vein injuries due to the in situ technique was 3.5%. Thirty-day mortality and major amputation rates were 3 and 0.9%, respectively. Mean follow-up was 12.1 months. Two-year estimated primary patency, primary assisted patency, secondary patency, and limb salvage were 69.1, 81.4, 86.5, and 94.5%, respectively ([Fig.]). Multivariate analysis showed association of preoperative vein diameter <3 mm with lower primary patency (HR 14.3, p <0.001), primary assisted patency (HR 9.4, p = 0.002), secondary patency (HR 7.2, p = 0.007), and limb salvage (HR 7.8, p = 0.005) rates. Distal anastomosis on a tibial/foot vessel also had association with lower primary patency (HR 4.8, p = 0.03), and primary assisted patency (HR 6, p = 0.01) rates. Use of a suprafascial tributary collateral as graft confirmed association with lower primary patency (HR 6.7, p = 0.01), and primary-assisted patency (HR 4.2, p = 0.04) rates.
Conclusion: Vein diameter <3 mm, distal anastomosis on a tibial/foot vessel, and use of a suprafascial tributary collateral as graft strongly affected 2-year patency and limb salvage of in situ saphenous vein bypass
RIvaroxaban and VAscular Surgery (RIVAS): insights from a multicenter, worldwide web-based survey
No full textEndoscopy Biopsy Forceps as Tool for Iliac Covered Stent Removal
No full textEndoscopy biopsy forceps is mostly used in the gastrointestinal tract but here it was used to remove a covered iliac self-expandable stent. A 57-year old male previously treated with bilateral iliac covered stenting and double barrel technique on the right iliac side was admitted for acute ischaemia of the right lower limb. Computed tomography showed thrombosis of covered stents on the right side [aorta/common iliac Viabahn 8 × 100 mm; external iliac artery (EIA) Viabahn 7 × 50 mm; internal iliac artery (IIA) 6 × 50 mm; W.L. Gore Medical, Flagstaff, AZ]. A left percutaneous femoral approach and surgical exposure of the right femoral arteries was performed. After distal clamping, an arteriotomy of the common femoral artery allowed the insertion of a large introducer sheath (Flexor 20F; Cook Medical, Bloomington, IN) via a stiff 0.035" guidewire after recanalization of the thrombosed iliac axis. Via this sheath a coaxial endoscopy biopsy forceps (reusable Fenestrated Rat Tooth Alligator Jaw, working length 230cm; Olympus, Center Valley, PA) was inserted to catch the distal edge of the covered self-expandable stent previously deployed in the EIA ([Fig.]), allowing removal of that covered stent. Next, a balloon was inserted and inflated on the left side, and an over-the-wire thrombectomy using a Fogarty 5F arterial embolectomy catheter (Edwards Lifesciences, Irvine, CA). was performed. A larger covered stent (Viabahn 8 × 100 mm) was used to reline the iliac axis. The ostium of IIA was occluded. In conclusion, endoscopy biopsy forceps could be used in “ultima ratio” as a vascular tool for removing covered self-expandable stents via a surgical femoral approach
Open Repair of Ruptured Abdominal Aortic Aneurysms in a High-Volume Tertiary Referral Center: Proposal of a Prediction Model for 30-Day Mortality
No full textObjective: About open surgical repair (OSR) in ruptured abdominal aortic aneurysms (rAAAs), several factors could affect the early outcomes. Some factors are modifiable, such as prompt diagnosis, time between symptoms and surgery, distance from the hospital, and surgical team's expertise. In Literature, a lot of studies identified predictive models to evaluate 30-day outcomes of rAAAs. All these models included preoperative clinical status and laboratory parameters. Aim of the study was to create a prediction model for 30-day mortality in patients underwent open surgical repair (OSR) for ruptured abdominal aortic aneurysm (rAAA) including pre- and intraoperative factors.
Methods: Between January 2007 and December 2020, 222 patients underwent OSR at our tertiary referral university hospital. Retrospective analysis of pre- and intraoperative factors was made by means of univariate analysis. Associations of patient and procedure variables with 30-day mortality rate were sought with multivariate Cox regression analysis. A mortality probability index was created by using a linear combination of all predictive factors multiplied by coefficients of the multiple logistic regression.
Results: Most of patients were male (189, 85.1%) with a mean age of 76.9 ± 8.7 years. Mean operation time was 221 ± 86 minutes. Overall, 30-day mortality rate was 28.8% (64 cases). Multivariate Cox regression analysis reported that age at intervention (>80 years), hypertension, congestive heart failure, chronic obstructive pulmonary disease, resuscitation maneuvers before surgery, loss of consciousness, and operation time >240 minutes were negative predictive factors for 30-day mortality risk (see [Table 1]). Patency of at least one hypogastric artery and infrarenal clamping had a protective role in reducing 30-day mortality rate. The analysis of the mortality index showed a cut-off point of 67.5 with a sensitivity of 81%, specificity of 78%, positive predictive value of 59%, and negative predictive value of 92%. Patients with values less than 67.5 had a 30-day mortality risk of 8.8%, while patient with values over 67.5 had a risk of 60.4%.
Conclusions: Elderly age, hypertension, congestive heart failure, chronic obstructive pulmonary disease, resuscitation maneuvers before surgery, loss of consciousness, and operation time >240 minutes affected 30-day mortality in patients undergoing OSR for rAAA. Patency of at least one hypogastric artery and infrarenal clamping had a protective role. In our mortality probability index a value over 67.5 increased the 30-day mortality risk up to 60%
RIvaroxaban and VAscular Surgery (RIVAS): insights from a multicenter, worldwide web-based survey
No full text
Endoscopy Biopsy Forceps as a Tool for Covered Iliac Stent Removal
No full textEndoscopic biopsy forceps are mostly used in the gastrointestinal tract but here they were used to remove a covered self expandable iliac stent
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