ABSTRACT
OBJECTIVE: Endovascular abdominal aortic aneurysm repair (EVAR) sometimes requires internal iliac artery (IIA) coverage to achieve a landing zone in the external iliac artery. The aim of this study was to determine complication rates following IIA exclusion. MATERIALS AND METHODS: A systematic review of key journals was undertaken from January 1980 to April 2016. Studies detailing occlusion (using coils or plugs) or coverage of the IIA with outcome data were included. Weighted means were calculated for continuous variables. Meta-analysis was performed when comparative data were available. Quality was assessed using the GRADE system. RESULTS: Sixty-one non-randomised studies (2671 patients; 2748 IIAs) were analysed. Fifteen per cent of EVARs require IIA sacrifice. Buttock claudication (BC) occurred in 27.9% of patients, although 48.0% resolved after 21.8 months. BC rates were 32.6% with coils, 23.8% with plugs, and 12.9% with coverage alone, and less with unilateral (vs. bilateral) IIA treatment (OR 0.57, 95% CI 0.36-0.91). More proximal coil placement resulted in lower rates of BC (OR 0.12, 95% CI 0.03-0.48). Erectile dysfunction occurred in 10.2% of males, with higher rates after coiling. Type II endoleaks were more frequent after covering alone; however re-interventions were rare. Significant ischaemic events (bowel/gluteal/spinal ischaemia) were very rare. Plugs were quicker to place and required less radiation (p < .001) than coils. GRADE scoring was very low for all outcomes. CONCLUSION: Overall the quality of reported data on IIA sacrifice is poor. Buttock claudication and erectile dysfunction occurred frequently after IIA sacrifice. Where both options are technically possible, plugs could be considered preferential to coils, and placed as proximally in the IIA as possible.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation , Embolization, Therapeutic , Endovascular Procedures , Iliac Artery/surgery , Aortic Aneurysm, Abdominal/mortality , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/mortality , Chi-Square Distribution , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/instrumentation , Embolization, Therapeutic/mortality , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Endovascular Procedures/mortality , Humans , Odds Ratio , Postoperative Complications/etiology , Prosthesis Design , Risk Factors , Treatment OutcomeABSTRACT
From its inception in 1911, the topic of spinal fusion has seemingly been shrouded in controversy. In that year, Dr. Russell Hibbs performed the first human spinal fusion on a patient with spinal tuberculosis. This spawned a debate over the procedure that led to the denial of Hibbs' membership to the American Orthopedic Association. The procedure (and Hibbs' appointment to the AOA) was validated by the Association after ten years of debate. The debate over spinal fusions is manifold to this date. The literature is replete with differing opinions regarding the indications, techniques and outcomes of spinal fusions. The topic is further compounded by the fact that the specifics of a spinal fusion are often distinct to the area of the spine fused.
ABSTRACT
Family physicians need to have an increased awareness of the medical needs of pilots. A close, trusting relationship is essential. Special consideration must be given when prescribing medications. Hypoxia is a special problem for pilots with cardiovascular and/or respiratory diseases. Several medical problems may occur because of rapid changes in barometric pressure, including barotitis media, which is best treated in flight. Minor ailments, use of alcohol and smoking may become serious problems for aviators; therefore, patient education is important.
Subject(s)
Aerospace Medicine , Alcohol Drinking , Atmospheric Pressure , Common Cold , Coronary Disease/diagnosis , Drug Therapy , Humans , Hypoxia/etiology , Otitis Media with Effusion/diagnosis , Otitis Media with Effusion/etiology , Rhinitis, Allergic, SeasonalABSTRACT
A number of factors that influence the success of microvascular anastomosis have been studied, including adventitial stripping, choice of suture material and needles, suturing technique, and perfusion of the distal lumen. It is apparent that only minimal stripping of the adventitia is indicated in order to prevent increased necrosis of the vessel ends at the anastomosis site. The use of 10-0 monofilament nylon suture material with needles 75 microns or less in diameter achieves the best results in small vessel anastomoses. Optimal anastomosis of 1 mm. vessels requires interrupted full thickness sutures with minimal adventitial stripping and the use of the smallest number of sutures possible. We do not advocate routine perfusion of small arteries unless there are specific indications. An experienced team of microsurgeons utilizing these principles along with proper patient selection and a sound postoperative regimen should be able to achieve more than a 70 per cent success rate in replantation of completely amputated digits and hands.
