RESUMO
OBJECTIVE: To assess the efficacy, safety and acceptability of a new TLC-NOSF dressing with poly-absorbent fibres in the management of exuding leg ulcers, at the different stages of healing. METHOD: This work presents the results of two prospective, multicentric clinical studies: NEREIDES and CASSIOPEE. Patients with a non-infected, moderate-to-strongly exudating leg ulcer of venous or mixed origin, were treated with the dressing and an appropriate compression system for 12 weeks. The wounds included in NEREIDES had to be in debridement stage, and those in CASSIOPEE at granulation stage. In both studies, the primary outcome was the relative wound area reduction (RWAR) at week 12. Main secondary outcomes included healing rate, time-to-reach wound closure, adverse events and acceptability of the dressing by patients and health professionals. RESULTS: There were 37 patients included in NEREIDES and 51 in CASSIOPEE. The two cohorts presented similar patient and wound characteristics, except from the percentage of sloughy tissue on wound bed at baseline (median: 75% NEREIDES and 30% CASSIOPEE). At week 12, the RWAR (60% NEREIDES and 81% CASSIOPEE), wound closure rates (18% NEREIDES and 20% CASSIOPEE) and mean times-to-reach wound closure (58±27 days NEREIDES and 55±23 days CASSIOPEE) supported the beneficial outcomes of the treatment in both cohorts. In patients with a wound duration ≤6 months, the wound area reduction reached 85% in NEREIDES and 81% in CASSIOPEE, highlighting the importance to initiate adequate treatment as soon as possible. The nature and frequency of the local adverse events were similar in both studies and consistent with the good safety profiles of the poly-absorbent fibres and of the TLC-NOSF dressings. The acceptability of the dressing (easy to apply, conformable and non-adherent to the wound bed at removal, with no pain or bleeding at removal) has been judged 'very good' or 'good' at each stage of the healing process, by both nursing staff and patients. CONCLUSION: These clinical results establish the new TLC-NOSF dressing with poly-absorbent fibres (UrgoStart Plus, Laboratoires Urgo) as an effective, safe and simple treatment for the local management of leg ulcers, at the different stages of healing and until wound closure.
Assuntos
Curativos Hidrocoloides , Úlcera da Perna/terapia , Idoso , Feminino , França , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento , CicatrizaçãoRESUMO
Despite a recent flurry of publications on preferred techniques for femoral above-knee popliteal artery bypass, controversy persists over the use of autologous saphenous vein and expanded polytetrafluoroethylene (ePTFE) grafts. The purpose of this study was to compare our long-term results using these two bypass materials. In a series of 474 infrainguinal bypasses performed between January 1993 and December 1998, we performed a total of 75 femoral above-knee popliteal artery bypass using an autologous saphenous vein graft in 48 cases (64%) and an ePTFE graft in 27 cases (36%). Prosthetic grafts were used by choice in 17 cases and by necessity due to the absence of useable vein in 10 cases. There were 55 men and 18 women with a mean age of 70 years. The indication for bypass was lower extremity arterial occlusive disease at stage II in 17 cases (22.7%), stage III in 9 cases (12%), and stage IV in 36 cases (48%); subacute ischemia in 8 cases (10.7%); and femoropopliteal aneurysm in 5 cases (6.7%). Preoperative arteriography demonstrated three patent leg arteries in 15.5% of cases, two patent leg arteries in 43.5%, and one patent leg artery in 41%. There was no significance difference between the vein graft and ePTFE graft groups with regard to indications and arteriographic findings. No patient died during the immediate postoperative period. The mean duration of follow-up was 25.5 months (range, 3 to 108 months). The primary patency rate at 4 years was 82.2 +/- 8% for venous bypass vs. 80.6 +/- 11.8% for ePTFE bypass (p = 0.42). The secondary patency rate at 4 years was 84.7 +/- 7.4% for vein bypasses and 79.5 +/- 12% for ePTFE bypasses (p = 0.26). In our experience, there was no statistically significant difference in long-term outcome of femoral above-knee popliteal artery bypass using autologous vein grafts or prosthetic ePTFE grafts.
Assuntos
Arteriopatias Oclusivas/cirurgia , Prótese Vascular , Artéria Femoral/cirurgia , Politetrafluoretileno , Artéria Poplítea/cirurgia , Veia Safena/transplante , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Derivação Arteriovenosa Cirúrgica , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Perna (Membro)/irrigação sanguínea , Masculino , Radiografia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
The purpose of this study was to determine the impact of intraoperative quality control using arteriography on the conduct and immediate outcome of carotid artery surgery. This retrospective study included 623 carotid artery repair procedures performed between January 1993 and January 2000. There were 427 men and 159 women (37 bilateral procedures) with a mean age of 71.6 years. The repair technique consisted of conventional endarterectomy alone in 353 cases, conventional endarterectomy with patch closure in 95 cases, eversion in 44 cases, and vein (n = 105) or prosthetic (n = 26) grafting in 131 cases. Findings of intraoperative arteriography, which is used routinely in our department, were reviewed and analyzed in all cases. Our findings indicate that intraoperative quality control with arteriography is an important part of carotid artery surgery. In 11.7% of cases in this study, intraoperative arteriography revealed significant defects that are the main cause of postoperative neurological complications.
Assuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/cirurgia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Cuidados Intraoperatórios , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Artéria Carótida Primitiva/anormalidades , Estenose das Carótidas/mortalidade , Endarterectomia das Carótidas/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Controle de Qualidade , Reoperação , Instrumentos Cirúrgicos , Resultado do TratamentoRESUMO
PURPOSE: The purpose of this study was determination of the expansion rates relative to the size of the common iliac artery (CIA) after elective placement of a straight aortic tube graft for an infrarenal abdominal aortic aneurysm (AAA). METHODS: Between January 1993 and December 1997, 74 men (mean age, 69 years) with AAA underwent surgical repair with a straight tube graft. All patients underwent preoperative and postoperative computed tomography (CT) scans. The mean follow-up period was 68.3 months. The preoperative CT scan revealed a dilatation of at least one of the two CIAs in 32 patients (43.2%; group A). Within this group, the CIA was ectatic (12 mm < diameter < 18 mm) in 13 patients (subgroup A1) and aneurysmal (diameter >/=18 mm) in 19 patients (subgroup A2). The diameters of both CIAs were normal (diameter =12 mm) in the other 42 patients (56.8%; group B). RESULTS: Two patients (2.7%) in group A2 needed reoperation because of expansion of the diameter of the CIA; the preoperative diameter of the CIA in both patients was 30 mm. The diameters of the CIA aneurysms in the 17 other patients in subgroup A2 were smaller than 30 mm on the preoperative CT scan. After aortic surgery, the sizes of these aneurysms remained stable the first 5 years and reached a diameter of 30 mm on the CT scans obtained 7 to 8 years after surgery. Overall, 10 of the 74 patients (13.5%) had a CIA aneurysm develop that was smaller than 30 mm in diameter (mean diameter, 19.2 mm) 7 to 8 years after aortic surgery. The presence of a celiac aorta dilatation greater than or equal to 25 mm was the only statistically significant factor predictive of postoperative expansion of a CIA dilatation (P =.03). CONCLUSION: Straight aortoaortic tube grafts are indicated for CIAs with diameters smaller than 18 mm. Aorta biiliac bifurcated grafts are justified when the CIA diameter is between 18 and 30 mm, when the patient's life expectancy is longer than 8 years, or when the diameter of the celiac aorta is greater than or equal to 25 mm. A CIA aneurysm greater than or equal to 30 mm should be repaired during the same operative session as the AAA with placement of an aorta biiliac bifurcated graft.