ABSTRACT
PURPOSE:: Outcomes of open iliac artery repair (OIR) and endovascular iliac artery repair (EVIR) were compared at a tertiary referral vascular center. METHODS:: From 2004 to 2015, all patients treated for isolated iliac artery aneurysms (IAAs) were retrospectively identified, and patient records and computed tomography (CT) scans were analyzed. The primary end point was overall survival; secondary end points were 30-day mortality and morbidity and freedom from reintervention. For follow-up, data from outpatient visits and CT scans following a standard surveillance protocol were used. RESULTS:: A total of 106 IAAs in 94 patients were treated (mean follow-up: 35.7 months; 66 OIR; 40 EVIR). Six (15%) aneurysms from the EVIR group and 4 (6.1%) from open-operated IAA presented in the state of rupture. There was no difference in overall survival between EVIR and OIR ( P = .14). In multivariable analysis, higher risk of death was associated with ruptured IAA (rIAA; hazard ratio [HR]: 40.44, 95% confidence interval [CI]: 2.05-796.18; P = .02) and coronary heart disease (HR: 11.07, 95% CI: 1.94-63.36; P < .01). The 30-day mortality was 1.9% overall (0% OIR, 5.0% EVIR, P = .27), but there were no differences between OIR and EVIR in 30-day morbidity ( P = .11). Freedom from reintervention was higher for OIR than for EVIR ( P < .01). In multivariable analysis, a higher reintervention rate was seen in EVIR (HR: 10.80, 95% CI: 2.20-53.01; P < .01) and in rIAA (HR: 12.02, 95% CI: 1.31-111.11; P = .03). CONCLUSION:: Iliac artery aneurysmss can be safely and effectively treated by EVIR or OIR regarding 30-day morbidity, mortality, and long-term survival, although freedom from reintervention is significantly lower after EVIR.
Subject(s)
Aneurysm, Ruptured/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Iliac Aneurysm/surgery , Aged , Aged, 80 and over , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/mortality , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/mortality , Computed Tomography Angiography , Endovascular Procedures/adverse effects , Endovascular Procedures/mortality , Female , Humans , Iliac Aneurysm/diagnostic imaging , Iliac Aneurysm/mortality , Ligation , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/therapy , Progression-Free Survival , Retreatment , Retrospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Traumatic rupture of the thyroid gland is rare. A common approach does not exist. Surgical and nonsurgical management have been advocated. METHOD: This work summarizes the publications in PubMed including an own case. This study will analyse the accident mechanism, the underlying thyroid pathologies, possible pathogenetic mechanisms of airway obstruction and the therapeutic options. A present classification is revised in order to develop it into a treatment proposal. RESULTS: A total of 34 case reports were analysed. The first half had to be performed a surgery on, the other half was observed without surgical treatment. None of the patients died of his injury. 59% of the patients, that had to be performed a surgery on had thyroid pathology before rupture. 50% of all patients had a road accident as a cause for the rupture. CONCLUSION: The revised classification and treatment proposal developed here presents a clinically-viable approach.
Subject(s)
Athletic Injuries/diagnosis , Soccer/injuries , Thyroid Gland/injuries , Accidents, Traffic , Airway Obstruction/diagnosis , Airway Obstruction/etiology , Airway Obstruction/surgery , Angiography , Arteries/injuries , Arteries/surgery , Athletic Injuries/surgery , Follow-Up Studies , Hematoma/diagnosis , Hematoma/surgery , Humans , Image Interpretation, Computer-Assisted , Imaging, Three-Dimensional , Lacerations/diagnosis , Lacerations/surgery , Male , Rupture , Thyroid Cartilage/injuries , Thyroid Cartilage/pathology , Thyroid Cartilage/surgery , Thyroid Gland/blood supply , Thyroid Gland/pathology , Tomography, X-Ray Computed , Ultrasonography , Young AdultABSTRACT
INTRODUCTION: Malfunction of microvascular anastomoses is the main reason for free-flap failures. The aim of this investigation was to prove the feasibility of endoscopic free-flap perfusion measurements in the upper aerodigestive tract (UADT) using indocyanine green (ICG). METHODS: Twenty-five patients undergoing free-flap reconstruction of the UADT were included. At least three ICG angiographies (0 h, 24 h and 72 h) were performed per participant. The sequences were subjectively judged online. The data were subsequently analysed, the results compared to clinical outcome and a survey with clinical staff (n = 21) performed. RESULTS: All 25 flaps survived. The ICG angiographies were tolerated well, showing a delayed fluorescence gain in transplanted tissue compared to surrounding but comparable final maximum fluorescence intensities. Four surgical revisions (two for a true and two for a false indication) could be additionally investigated. The two flaps with a real perfusion compromise showed fluorescence Indices (relative fluorescence maxima of transplant vs. surrounding) of 33% and 37%, whereas these values lay above 60% for all other examinations (including those two flaps that were revised for a false indication). The survey showed that ICG angiography leads to a better discrimination of well- and malperfused flaps compared with conventional inspection. CONCLUSION: In this small level IIb study, it was possible to prove the feasibility of endoscopic ICG angiography in patients with free-tissue transfer to the UADT. In difficult situations, it seems a welcome adjunct to conventional screening and might aid in the decision whether to revise a clinically suspect flap.