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1.
Vasc Endovascular Surg ; : 15385744241276689, 2024 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-39178294

RESUMO

Popliteal entrapment syndrome (PES) describes a cluster of symptoms related to the compression of the neurovascular bundle in the popliteal fossa, most commonly involving the popliteal artery. In approximately 10-15% of the cases of popliteal entrapment syndrome, the popliteal vein is compressed. Symptoms of popliteal vein entrapment can mimic venous insufficiency or deep venous thrombosis, causing the diagnosis to be missed or delayed. Diagnosis of popliteal vein entrapment can be done with duplex imaging with flexion and extension maneuvers; however, venography is the gold standard for diagnosis. While popliteal vein entrapment is commonly associated with younger individuals, it may also be an underdiagnosed condition in older patients. We describe two cases of successful diagnosis and treatment of late-onset presentation of popliteal vein entrapment.

2.
J Vasc Surg Cases Innov Tech ; 10(3): 101495, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38699665

RESUMO

May-Thurner syndrome or left iliac vein compression occurs when the left common iliac vein is compressed by the right common iliac artery, leading to venous outflow obstruction. This obstruction can cause venous hypertension, resulting in lower extremity swelling, discoloration, pelvic congestion, and venous ulcerations. The standard surgical treatment of May-Thurner syndrome is endovascular venous stent placement. In a small, single-center sample, surgical anteriorization of the left common iliac vein was used to treat symptomatic left common iliac vein compression in younger patients, alleviating their symptoms, and can be considered an alternative treatment.

3.
Ann Vasc Surg ; 105: 307-315, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38599481

RESUMO

BACKGROUND: Severe chronic kidney disease (CKD) predicts greater mortality after major lower-extremity amputation (LEA), but it remains poorly understood whether patients with earlier stages of CKD share similar risk. METHODS: We assessed long-term postoperative outcomes for patients with CKD in a retrospective chart review of 565 patients who underwent atraumatic major LEA at a large tertiary referral center from 2015 to 2021. We stratified patients by renal function and compared outcomes including survival. RESULTS: Preoperative CKD diagnosis was related to many patient characteristics, co-occurred with many comorbidities, and was associated with less follow-up and survival. Kaplan-Meier and Cox Regression analyses showed significantly worse 5-year survival for major LEA patients with mild, moderate, or severe CKD compared to major LEA patients with no history of CKD at the time of amputation (P < 0.001). Severe CKD independently predicted worse mortality at 1-year (odds ratio [OR] 2.91; P = 0.003) and 5-years (OR 3.08; P < 0.001). Moderate CKD independently predicted worse 5-year mortality (OR 2.66; P = 0.029). CONCLUSIONS: This study demonstrates that moderate and severe CKD predict greater long-term mortality following major LEA when controlling for numerous potential confounders. This finding raises questions about the underlying mechanism if causal and highlights an opportunity to improve outcomes with earlier recognition and optimization CKD preoperatively.


Assuntos
Amputação Cirúrgica , Extremidade Inferior , Doença Arterial Periférica , Insuficiência Renal Crônica , Índice de Gravidade de Doença , Humanos , Amputação Cirúrgica/mortalidade , Masculino , Feminino , Estudos Retrospectivos , Fatores de Tempo , Idoso , Fatores de Risco , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/diagnóstico , Pessoa de Meia-Idade , Resultado do Tratamento , Extremidade Inferior/irrigação sanguínea , Medição de Risco , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/cirurgia , Doença Arterial Periférica/diagnóstico , Rim/fisiopatologia , Rim/cirurgia , Idoso de 80 Anos ou mais , Taxa de Filtração Glomerular
4.
Am Surg ; 90(8): 2032-2041, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38561237

RESUMO

BACKGROUND: Routine use of nil per os (NPO) prior to procedures has been associated with dehydration and malnutrition leading to patient discomfort. We aim to examine how duration of NPO status affects postoperative outcomes in patients undergoing elective below-knee amputation (BKA). METHODS: We performed a retrospective chart review of 92 patients who underwent elective BKA between 2014-2022 for noninfectious indications. We performed statistical analysis using Chi-square tests, t-tests, and linear/logistic regression with odds ratio using P < .05 as our significance level. RESULTS: The mean age was 48.0 ± 16.7 years, and there were 64 (70%) male patients and 41 (45%) Black patients. Mean NPO duration was 12.9 ± 4.7 hours. Patients with longer NPO duration were associated with increased rates of postoperative stroke (P = .03). Patients with shorter NPO duration had significantly lower mean BUN on postoperative day (POD) 1 (14.5, P < .001) and POD 3 (14.1, P < .001) compared to preoperative mean BUN (16.8), however this normalized by POD 7 (19.2, P = .26). There were no changes in postoperative renal function based on baseline kidney disease status or associated with longer NPO duration. Shorter NPO duration was a predictor of increased likelihood of 1-year follow-up (OR: 2.9 [1.24-6.79], P = .01), independent ambulation (OR: 2.7 [1.03-7.34], P = .04), and decreased mortality (OR: .11 [.013-.91], P = .04). CONCLUSION: While NPO duration does not appear to result in postoperative renal dysfunction, prolonged NPO duration predicts worse rates of follow-up, ambulation, and survival and is associated with increased stroke rates.


Assuntos
Amputação Cirúrgica , Complicações Pós-Operatórias , Caminhada , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Feminino , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo , Adulto , Cuidados Pré-Operatórios/métodos , Idoso , Perna (Membro)/irrigação sanguínea
5.
Am Surg ; 90(5): 1030-1036, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38063164

RESUMO

BACKGROUND: Major lower extremity amputation (LEA) is associated with significant morbidity and mortality. The modified frailty index (mFI-5) has been used to predict outcomes including ambulation and mortality after LEA. It remains unknown for which patient demographics the mFI-5 is a reliable predictor. METHODS: This was a retrospective review of all patients who underwent a first-time major LEA at our institution from 2015 to 2022. Patients were stratified into 2 risk groups based on their mFI-5 score: non-frail (mFI<3) and frail (mFI≥3) and assessed on outcomes. RESULTS: Our sample consisted of 687 patients of whom 134 (19.6%) were considered frail and 551 (80.4%) were considered non-frail. A higher mFI-5 is associated with decreased ambulation rates (OR: 0.565, P = .004), increased hospital readmission (OR: 1.657, P = .021), and increased mortality (OR: 2.101, P = .001) following major LEA. In African American patients, frail and non-frail patients differed on readmission at 90 days (P = .008), mortality at 1 year (P = .001), ambulatory status (P < .001), and prosthesis use (P = .023). In male patients, frail and non-frail patients differed on readmission at 90 days (P = .019), death at 1 year (P = .001), and ambulatory status (P = .002). In Caucasian patients and female patients, frail and non-frail patients did not differ significantly on outcomes. DISCUSSION: The mFI-5 is a valuable predictor of outcomes following major LEA, specifically in males and African American patients. Moreover, surgeons should consider using frailty status to risk stratify patients and inform treatment plans.


Assuntos
Fragilidade , Humanos , Masculino , Feminino , Idoso , Idoso Fragilizado , Fatores Raciais , Avaliação Geriátrica , Fatores de Risco , Amputação Cirúrgica , Estudos Retrospectivos , Caminhada , Extremidade Inferior/cirurgia , Complicações Pós-Operatórias , Medição de Risco
6.
Vasc Endovascular Surg ; 58(5): 523-529, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38148675

RESUMO

Aortoiliac occlusive disease (AIOD) can occur from either chronic, progressive atherosclerotic disease, acute on chronic thrombosis or acute arterial embolism, and can all result in limb ischemia. Bypass surgery had long been the gold standard for treatment for AIOD, however, with advances in endovascular techniques, minimally invasive treatment of aortoiliac lesions has become the first line choice of management in many cases. Herein, we describe a case of utilizing the Inari ClotTriever to perform aortoiliac mechanical thrombectomy and the ARTIX thrombectomy system to perform an embolectomy the superficial femoral artery, highlighting new therapies to treat AIOD.


Assuntos
Doenças da Aorta , Arteriopatias Oclusivas , Embolectomia , Endarterectomia , Artéria Ilíaca , Isquemia , Trombectomia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Isquemia/fisiopatologia , Isquemia/terapia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Artéria Ilíaca/fisiopatologia , Resultado do Tratamento , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Doença Aguda , Arteriopatias Oclusivas/cirurgia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Masculino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Artéria Femoral/fisiopatologia , Grau de Desobstrução Vascular , Idoso
7.
J Vasc Nurs ; 41(4): 235-239, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-38072578

RESUMO

BACKGROUND: Left renal vein (LRV) compression, or nutcracker phenomenon, describes the compression of the LRV, most commonly between the aorta and the superior mesenteric artery. The outflow obstruction that occurs from the compression causes venous hypertension leading to the development of pelvic collaterals, lumbar vein engorgement and gonadal vein reflux. The symptoms associated with LRV compression include abdominal pain, left flank pain, back pain, headache, pelvic pain/pressure, and hematuria. Symptomatic LRV compression can cause chronic pain and disability that impedes activities of daily living. Left renal auto transplantation (LR-AT) is one mode of treatment, leading to decreased pain with no significant vascular or urological complications. Herein we present a five patient case series with symptomatic LRV compression who underwent LR-AT with improved pain and quality of life after surgery. METHODS: Five patients underwent LR-AT between June 2020-December 2020 to resolve their symptomatic LRV compression. These patients were given three validated surveys pre- and post- intervention, then again at their three month follow up visit to assess their pain and health-related quality of life. RESULTS: The five patients were all female with the average age of 36.8 years old (36-41) and underwent LR-AT to treat their symptomatic LRV compression. The average Numeric Rating Scale (NRS) pain score pre intervention was 8.3 (range 6.7 to 10) which improved to pain rating 5.22 (range 2.7 to 6) post intervention, p-value = 0.013. The average pain NRS score at 3 month follow up was 3.86 (range 1.3-6), p-value = 0.006 when compared to pre-intervention pain scores. The average pain intensity pre intervention was 4.5 (4 to 5) and 2.7 (1 to 4.3) post intervention, p-value = 0.024. The average pain intensity score at 3 month follow up was 2.24 (range 1.3-3.3), p-value = 0.002 when compared to pre-intervention. The VascuQoL-6 survey score pre intervention averaged score of 9.6 (range 7-12) which improved to an average score of 20.6 (range 18-24), p-value = 0.001. The average VascuQoL score at 3 month follow up was 22.6 (range 22-24), p-value = < 0.001 when compared to pre intervention QoL scores all showing a statistically significant improvement of health-related quality of life. CONCLUSION: The diagnosis of LRV compression can be challenging due to the non-descript symptoms and overall lack of awareness. Understanding venous tributary pathways and drainage can help clarify why patients present with unusual symptoms. Surgical treatment of LRV compression through LR-AT can improve patients' pain and improve vascular quality of life.


Assuntos
Atividades Cotidianas , Qualidade de Vida , Humanos , Feminino , Adulto , Síndrome , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Veias Renais/cirurgia
8.
Am Surg ; 89(9): 3950-3952, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37259508

RESUMO

Median arcuate ligament syndrome (MALS) can be a debilitating condition resulting in epigastric pain, nausea, difficulty eating due to postprandial pain, weight loss, and malnutrition in otherwise healthy individuals. The pain is caused by the compression of the celiac artery and neural ganglia by the median arcuate ligament as it attaches from the spine to the diaphragm. Diagnostic imaging, either duplex or angiography, can show the abnormality however, vague symptoms can lead to a missed diagnosis. While MALS is a known anatomical variation in the population, to our knowledge, has not been identified to be caused by trauma. Here, we present 4 patients who developed MALS following abdominal or spinal trauma whom all required surgery to alleviate lifestyle-limiting pain.


Assuntos
Síndrome do Ligamento Arqueado Mediano , Humanos , Síndrome do Ligamento Arqueado Mediano/complicações , Síndrome do Ligamento Arqueado Mediano/cirurgia , Síndrome do Ligamento Arqueado Mediano/diagnóstico , Constrição Patológica/cirurgia , Constrição Patológica/complicações , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/cirurgia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Náusea
9.
J Vasc Nurs ; 41(1): 19-21, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36898800

RESUMO

COVID-19 pandemic brought new challenges in healthcare including the need to create tiered class recommendations about which types patients to treat urgently and which surgical cases to defer. This is a report of a single center's Office Based Laboratory (OBL) system to prioritize vascular patients and preserve acute care resources and personnel. In reviewing three months of data, it appears that by continuing to provide the urgent care needed for this chronically ill population, the insurmountable backup of surgical procedures is prevented in the operating room once elective surgeries resumed. The OBL was able to continue providing care at the same pre-pandemic rate to a large intercity population.


Assuntos
COVID-19 , Humanos , Pandemias/prevenção & controle , Procedimentos Cirúrgicos Vasculares , Assistência Ambulatorial
10.
Am Surg ; 89(6): 2476-2480, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35561271

RESUMO

INTRODUCTION/OBJECTIVE: Below the knee amputations (BKAs) are preferred to above the knee amputations (AKAs) due to better rehabilitation and functional outcomes. Assessment of literature for best practice identified that utilization of a removable rigid dressing (RRD) improves post-operative BKA care by expediting wound healing and reduces the hospital length of stay compared to a soft dressing. We hypothesized that there would be a decrease of conversions from BKA to AKA following utilizing of RRD device. METHODS: Retrospective chart review of all BKA performed by the vascular surgery service at a tertiary care hospital between January 2017 and December 2021. Demographic data obtained including age, body mass index (BMI), comorbid conditions, infection at time of BKA, anesthesia type, and operative blood loss. Data analyzed using Wilcoxon rank sum, Fisher's exact, and Student's t-tests. This study was approved by the institutional review board. RESULTS: From 2017 to 2019, conversion to AKA occurred in 18 out of the 42 patients who underwent BKA (42.86%) within the first 4-week post-operative period. After the standard used of a RRD, 53 patients underwent BKA surgery, with only 4 (7.55%) requiring conversion to AKA within the 4-week post-operative period. CONCLUSION: Utilizing a RRD after BKA can improve wound healing, protect the residual limb, and help prevent conversions to AKA. In this retrospective review at a single institution there was a decrease of conversion from BKA to AKA in a 2-year period. Ridged removal dressings should be considered first-line therapy in the post-operative care of BKA patients.


Assuntos
Amputação Cirúrgica , Desarticulação , Humanos , Estudos Retrospectivos , Bandagens , Resultado do Tratamento
11.
Ann Vasc Surg ; 91: 242-248, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36481669

RESUMO

BACKGROUND: Lower extremity amputations are often associated with limited postoperative functionality and postoperative complications. Removable rigid dressings (RRDs) have been used following below-knee amputation (BKA) to improve limb maturation, decrease postoperative complications, reduce time to prosthesis casting, and limit conversion rates to above-knee amputation (AKA). We hypothesized that usage of RRD following BKA will correlate with decreased prescription narcotics required at discharge and improved ambulatory status at follow-up. METHODS: A retrospective chart review was conducted to identify all patients who underwent BKA performed by the vascular surgery service at a large, acute care hospital between July 2016 and July 2021. Data collected included age, sex, body mass index, conversion to AKA, narcotic prescriptions at discharge, and ambulatory status at follow-up. RESULTS: Between July 2016 and 2021, rate of conversion to AKA was significantly lower in patients who received an RRD (9.3%), as opposed to those who did not (41.5%) (P = 0.0002). Narcotic prescriptions at discharge, compared following conversion to morphine equivalents, were also significantly lower in the rigid dressing group compared to patients who did not receive the dressing (50.5 vs. 108.9 morphine eq/24 h, P = 0.0019). Furthermore, use of rigid dressing significantly improved ambulatory status at follow-up to 75.9% in RRD patients compared to 29.3% in patients with conventional dressing (P < 0.0001). This statistical significance persisted after all patients who were converted to AKA were removed from analysis (79.6% vs. 39.3% ambulatory, P = 0.000363). Multivariate analysis revealed that ambulatory status at follow-up was only associated with age more than 80 years (P = 0.042) and use of postoperative RRD (P = 0.001). CONCLUSIONS: These findings support the utility of an RRD following BKA to reduce conversion to AKA, reduce narcotic dosages required at discharge, and improve ambulatory status at follow-up.


Assuntos
Amputação Cirúrgica , Alta do Paciente , Humanos , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Resultado do Tratamento , Fatores de Risco , Amputação Cirúrgica/efeitos adversos , Caminhada , Complicações Pós-Operatórias/etiologia , Bandagens/efeitos adversos , Entorpecentes , Derivados da Morfina , Extremidade Inferior/irrigação sanguínea
12.
J Vasc Nurs ; 40(2): 100-104, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35750372

RESUMO

There is a growing need for new and innovative ways to care for patients in the ambulatory setting, including providing wound care for patients. A vascular surgery department in a large urban academic medical center noted there was an increasing number of patients with chronic wounds that needed weekly care. The number of patients, the time needed to provide wound care, and limited clinic space was creating a strain on traditional clinic hours. Collaboration between one of the vascular surgery advanced practice registered nurses (APRN) and vascular registered nurse (RN) led to the creation of a vascular wound clinic. Patients with chronic wounds were identified by vascular surgeons at one institution and referred to the wound clinic. A retrospective chart review was used to look at number of patients, number of visits per patient, surgical interventions, number of wounds closed, size of wounds, and complications. The ability to provide a single point of contact for the patient's vascular surgery and wound care needs allowed the clinic to provide comprehensive care for 29 patients and close more than 75% of wounds. The retrospective chart review found that patients receiving weekly wound care with clear communication from the multidisciplinary team, the nursing and nurse practitioner interventions kept most patients out of the hospital, with only two unplanned readmissions to the hospital, neither due to chronic wounds. This nursing led wound clinic was able to accommodate complex vascular surgery patients, heal chronic wounds, and decrease unplanned readmissions. Expanding the clinic to assist with limb salvage and more podiatric patients is providing a new patient base and improving the care for the community that it serves.


Assuntos
Pacientes Ambulatoriais , Readmissão do Paciente , Humanos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
13.
Adv Skin Wound Care ; 34(5): 268-272, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33852463

RESUMO

BACKGROUND: Fasciotomy with resection of nonviable muscle is often necessary when there is a delay in compartment syndrome (CS) diagnosis after revascularization. The reported rate of major amputation following missed CS or delayed fasciotomy ranges from 12% to 35%. Herein, the authors present a series of critically ill patients who experienced delayed CS diagnosis and required complete resection of the anterior and/or lateral compartments but still achieved limb salvage and function. METHODS: A retrospective chart review identified five patients from April 2018 to April 2019 within a single institution who met the inclusion criteria. Patient charts were reviewed for demographic data, risk factors, time to diagnosis following revascularization, muscle compartments resected, operative and wound care details, and functional outcome at follow-up. RESULTS: All of the patients developed CS of the lower extremity following revascularization secondary to acute limb ischemia and required two-incision, four-compartment fasciotomies. Further, they all required serial operative debridements to achieve limb salvage; however, there were no major amputations, and all of the patients were walking at follow-up. CONCLUSIONS: Delay in CS diagnosis can have devastating consequences, resulting in major amputation. In cases where myonecrosis is isolated to two or fewer compartments, complete compartment muscle resection can be safely performed, and limb preservation and function can be maintained with aggressive wound management and physical therapy.


Assuntos
Compartimentos de Líquidos Corporais , Salvamento de Membro/métodos , Adulto , Idoso , Síndromes Compartimentais/prevenção & controle , Síndromes Compartimentais/cirurgia , Feminino , Humanos , Salvamento de Membro/normas , Salvamento de Membro/estatística & dados numéricos , Extremidade Inferior/fisiopatologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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