The use of intravenous indocyanine green in minimally invasive segmental lung resections: a systematic review.

Background: To identify intersegmental planes (ISPs) in video/robot-assisted thoracoscopic segmentectomies, indocyanine green (ICG) is commonly used. The aim of this systematic review is to evaluate the efficacy of intravenous ICG in the identification of ISP. Methods: A systematic search was performed. Studies evaluating patients who underwent a video/robot-assisted thoracoscopic segmentectomy using intravenous ICG were included. The primary outcome measure was the frequency and percentage of patients in whom the ISP was adequately visualized. Secondary outcomes encompassed the ICG dose, time to visualization, time to maximum ICG visualization, time to disappearance of ICG effect and adverse reactions to ICG. Results: Eighteen studies were included for systematic review, enrolling a total of 1,090 patients. Irrespective of the injected dose, intravenous ICG identified the ISP in 94% of the cases (range, 30-100%). Overall, there was a considerable amount of heterogeneity regarding the injected dose of ICG (range, 5-25 mg or 0.05-0.5 mg/kg). The mean time before first effect of ICG was visible ranged from 10 to 40 seconds. The mean total time of ICG visibility ranged from 90 to 140 seconds after a bolus injection and was 170 seconds after continuous infusion. No adverse reactions were reported. Conclusions: After administration of intravenous ICG, visualization of the ISP is successful in up to 94% of cases, even after administration of a low dose (0.05 mg/kg) of ICG. The use of intravenous ICG is safe with no reported adverse effects in the immediate peri-operative period.

Clinical outcomes of MANTA closure device in percutaneous endovascular aortic aneurysm repair.

OBJECTIVE: The MANTA device is a plug-based vascular closure device (VCD) designed for large bore femoral arterial access site closure. It showed promising results in transcatheter aortic valve replacement cases. In this study, we report our results and evaluate the MANTA VCD in percutaneous endovascular aortic aneurysm repair (pEVAR). METHODS: All data of consecutive patients who underwent an elective pEVAR between October 2018 and December 2022 were retrospectively reviewed. In all patients at least one common femoral artery was intended to close with the MANTA VCD. Depending on the sheath size, the 14Fr or 18Fr MANTA VCD was used. On the preoperative computed tomography scan, the diameter of the common femoral artery (CFA) was measured and the amount of calcification based on the Peripheral Arterial Calcium Scoring System (PACSS) was scored. Primary outcome was procedural technical success. Procedural technical success was defined as placement of the MANTA closure device resulting in vascular closure with patent CFA, without requiring immediate open or endovascular surgery. The secondary outcomes were access site complications requiring reintervention and all-cause mortality at 30-day follow-up. RESULTS: In total, 152 consecutive patients underwent pEVAR with 291 common femoral artery closure procedures with the Manta VCD. Mean age was 74.1 ± 6.4 years, with a mean body mass index of 27.7 ± 4.4 kg/m2. The mean diameter of the CFA was 10.5 ± 1.9 mm. In 52.6% of the cases, there were no calcification on the preoperative computed tomography scan. The 18Fr and 14Fr Manta VCD were used 169 and 122 times, respectively. The technical success rate was 96.6%. Major vascular complications were reported in 4.5% of the cases, without any death-related events. CONCLUSIONS: This single-center retrospective cohort study analyzed the procedural technical success, major vascular complications and all-cause mortality at 30-day follow-up of the MANTA vascular closure device in 152 pEVAR patients with 291 common femoral artery closure procedures. The technical success rate was 96,6%. Major vascular complications were reported in 4.5% of the cases, without any death related events. We concluded that the MANTA device is a safe and feasible option with a high rate of technical success in patients undergoing pEVAR.

Fatal sepsis with peripheral necrosis due to Capnocytophagus canimorsus infection after dog bite: a case report.

Capnocytophaga canimorsus is a commensal bacterium in dogs and cats' saliva that can be transmitted to humans by licking, biting, or scratching. Although rare, an infection with C. canimorsus can have lethal consequences. Based on this case, the authors want to emphasize the importance of adequate wound care, close monitoring, and the use of prophylactic antibiotics after a dog bite or cat bite. Case Presentation: The authors present the case of a healthy 52-year-old patient with severe sepsis, disseminated intravascular coagulation, multiorgan failure, and peripheral necrosis of the lower arms, lower legs, nose, and genitals due to an infection with C. canimorsus after a dog bite. The patient eventually died on the ICU. Clinical Discussion: Due to the severeness of the sepsis, the patient was admitted to the ICU for maximum supportive care. As a last resort to save his life, an amputation of his nose, genitals, lower arms, and a transtibial amputation was proposed. In good consultation with the family, the decision was made not to perform this very mutilating surgery. The therapy was stopped because the loss in quality of life was too severe to justify continuation. The patient died soon after stopping supportive therapy. Conclusion: Based on this case, the authors would like to point out that, although rare, an infection with C. canimorsus can have devastating consequences with a high mortality and morbidity rate. It is important to know about this complication and to be aware of the importance of adequate wound care, close monitoring, and the use of prophylactic antibiotics after a dog bite or cat bite.

Pyogenic liver abscess after open hemorrhoidectomy.

BACKGROUND: Surgical excision of hemorrhoids remains the gold standard for patients who have grade III or IV hemorrhoids. The complication rate is low and success rate is high. In this case, we describe a 44-year-old male with septic shock and small liver abscesses as a rare complication after Milligan-Morgan hemorrhoidectomy. METHODS: In this case report, we describe the case of a patient with septic shock and small liver abscesses as a rare complication after Milligan-Morgan hemorrhoidectomy. A search in the PubMed database showed only three publications describing patients with liver abscesses after hemorrhoidectomy and some more cases after rubber band ligation. RESULTS: The patient was admitted at the intensive care unit and received intravenous antibiotics. He could leave the hospital in good condition after 17 days. He received antibiotics for six weeks in total. CONCLUSION: Pyogenic liver abscess after open hemorrhoidectomy is a rare complication after Milligan-Morgan hemorrhoidectomy and rubber band ligation. Pyogenic liver abscesses can be treated with antibiotics, sometimes associated with percutaneous drainage or surgeryIn patients with predisposing factors prophylactic use of antibiotics could be considered on a case-by-case basis.

Protamine Induced Anaphylactic Shock after Peripheral Vascular Surgery.

Anaphylactic reactions to protamine are quite rare and almost exclusively reported during cardiac surgery. In this report, we illustrate a rare case of protamine reaction after peripheral vascular surgery a couple of months after cardiac surgery and how the patient survived this critical complication.