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1.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(2): 199-204, 2021 Apr 28.
Artículo en Chino | MEDLINE | ID: mdl-33966698

RESUMEN

Objective To investigate the risk factors for patients using intraoperative vasopressor infusions during carotid body tumor(CBT)excision.Patients' mean arterial pressure(MAP)and heart rate(HR)fluctuations as well as their requirements for vasoactive agents during surgery were assessed. Methods The patients receiving CBT excision in Peking Union Medical College Hospital from May 1,2013 to July 31,2017 were included for a retrospective cohort study.The potential factors of intraoperative requirement for vasopressor infusions were investigated using univariate analysis and Logistic multivariate analysis.Furthermore,the relationships of Shamblin types of CBT with intraoperative MAP/HR fluctuations and requirements for vasoactive agents were analyzed. Results A total of 108 patients with 116 CBTs were included.Univariate analysis revealed that maximum tumor diameter >4 cm,intraoperative internal carotid artery injury,internal carotid artery reconstruction,malignant pathology,advanced Shamblin types(type Ⅱ and Ⅲ),estimated blood loss ≥400 ml,and operation duration >4 hours were associated with intraoperative requirements for vasopressor infusions.Logistic analysis showed that Shamblin type Ⅲ(OR=2.286,95% CI=1.324-14.926,P=0.016)and operation duration >4 hours(OR=3.874,95% CI=1.020-14.623,P=0.046)were risk factors for intraoperative requirements for vasopressor infusions during CBT surgery.In addition,Shamblin type Ⅲ was associated with intraoperative abnormal HR elevation and requirements for vasopressors.Conclusions Shamblin type Ⅲ and operation duration>4 hours are risk factors for intraoperative requirements of patients for using vasopressor infusions during CBT surgery.Shamblin type Ⅲ is associated with intraoperative abnormal HR elevation and requirements for vasopressors.


Asunto(s)
Tumor del Cuerpo Carotídeo , Humanos , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares
2.
Rev Port Cir Cardiotorac Vasc ; 28(1): 39-44, 2021 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-33834653

RESUMEN

INTRODUCTION: Ruptured abdominal aortic aneurysm's treatment relies on the emergent surgery, considering preoperative prognosis. There are several scores that estimate perioperative mortality of ruptured abdominal aortic aneurysm, however, the accuracy of such algorithms in some populations remains unknown. OBJECTIVE: Compare the prognostic validity of the Weingarten score with the Glasgow Aneurysm Score and the Vancouver Scoring System. Validation of three prognostic ruptured abdominal aortic aneurysms tools for the Portuguese population. MATERIAL AND METHODS: A retrospective analysis of consecutive patients with ruptured abdominal aortic aneurysm surgically treated, in a peripheral and in a referral hospital between 2012 and 2016 was performed. The 30-day mortality discriminative power was analysed using each score. RESULTS: 120 patients were included. The mean Glasgow Aneurysm Score was 98.53 ± 19.57, the Vancouver Scoring System was 3.64 ± 1.43. The Weingarten score classified 51 (43.2%) patients as stable and 67 (56.8%) as unstable. The three scores demonstrated some predictive value concerning mortality, although Glasgow Aneurysm Score demonstrated the highest area under the ROC curve (0.74) and the best discriminatory capacity for cut-off points with higher specificity. Neither of the scores demonstrated clinically useful predictive value. CONCLUSIONS: The Weingarten score did not present as a superior prediction model of preoperative mortality in ruptured abdominal aortic aneurysm. None of the scores, even when optimized for a higher specificity, could select which patients will not benefit from surgical intervention. The Glasgow Aneurysm Score was validated for the Portuguese population.


Asunto(s)
Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Técnicas de Apoyo para la Decisión , Mortalidad Hospitalaria , Humanos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares
3.
Medicine (Baltimore) ; 100(17): e25700, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907150

RESUMEN

RATIONALE: Postoperative atrial fibrillation following noncardiac surgery increases mortality, length of hospital stay, and medical expenses; moreover, compared to nonvalvular atrial fibrillation, it poses a similar risk of thromboembolic complications. In this report, we discuss our decision-making process for diagnosis and treatment in case with unexpected postoperative new-onset atrial fibrillation causing acute mesenteric ischemia. PATIENT CONCERNS: A 78-year-old male patient received varicose vein stripping and ligation in his right leg. The patient was previously healthy with no known comorbidities. The next day after surgery, he complained of sudden epigastric pain unresponsive to conservative treatment, and new-onset atrial fibrillation was observed on electrocardiography. DIAGNOSES: An abdominal computed tomography scan revealed acute embolic occlusion of the superior mesenteric artery. INTERVENTIONS: Emergent surgical embolectomy was performed successfully. The time to operation from the recognition of abdominal pain was 6 h. Surgical critical care was performed for life-threatening ischemic reperfusion injury. OUTCOMES: The patient was discharged from the hospital on the 40th postoperative day. LESSONS: Atypical postoperative abdominal pain unresponsive to conservative treatment should be considered a surgical emergency, and a high level of clinical suspicion for acute mesenteric ischemia is required. Preoperative electrocardiography and postoperative telemetry might be helpful in some asymptomatic patients.


Asunto(s)
Fibrilación Atrial , Embolectomía/métodos , Oclusión Vascular Mesentérica , Complicaciones Posoperatorias , Daño por Reperfusión , Procedimientos Quirúrgicos Vasculares/efectos adversos , Anciano , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/etiología , Fibrilación Atrial/terapia , Cuidados Críticos/métodos , Electrocardiografía/métodos , Humanos , Masculino , Arteria Mesentérica Superior/diagnóstico por imagen , Oclusión Vascular Mesentérica/diagnóstico , Oclusión Vascular Mesentérica/etiología , Oclusión Vascular Mesentérica/fisiopatología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Daño por Reperfusión/etiología , Daño por Reperfusión/prevención & control , Tromboembolia/diagnóstico , Tromboembolia/etiología , Tromboembolia/cirugía , Tiempo de Tratamiento/normas , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex/métodos , Várices/diagnóstico por imagen , Várices/cirugía , Procedimientos Quirúrgicos Vasculares/métodos
4.
Angiol Sosud Khir ; 27(1): 113-119, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33825737

RESUMEN

Our study was aimed at determining advantages of profundoplasty in patients with critical ischaemia of lower limbs in repeat arterial reconstructions. It included a total of 56 patients subjected to redo operations for thrombosis of a femoropopliteal bypass graft. Of these, 29 underwent profundoplasty (group I) and 27 repeat femoropopliteal bypass grafting (group II). Critical ischaemia was relieved in the early postoperative period in 28 (97%) and 24 (89%) patients of group I and II, respectively. The 3-year patency rate after profundoplasty amounted to 100% and after femoropopliteal bypass grafting to 47% (p<0.05). The lower-limb amputation rates over the 3-year period of follow up amounted to 3 (10%) and 11 (41%), p<0.05, respectively. Over the 3-year period of follow up, there was no statistically significant difference in the values of the ankle-brachial index (p>0.05).


Asunto(s)
Arteria Femoral , Isquemia , Arteria Femoral/cirugía , Humanos , Isquemia/diagnóstico , Isquemia/etiología , Isquemia/cirugía , Extremidad Inferior/cirugía , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/cirugía , Grado de Desobstrucción Vascular , Procedimientos Quirúrgicos Vasculares/efectos adversos
5.
Angiol Sosud Khir ; 27(1): 136-141, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33825740

RESUMEN

Occlusive and stenotic lesions of lower-limb arteries appear to be amongst the most common manifestations of the pathology of the cardiovascular system and are characterized by various degree of chronic arterial insufficiency. Revascularization is the main stage of treatment for chronic arterial insufficiency of the lower extremities. Performing a reconstructive operation aimed at restoring the arterial blood flow in the ischaemized extremity is accompanied and followed by the development of reperfusion syndrome. The purpose of this study was to assess efficacy of using regional lymphotropic therapy for treatment of reperfusion syndrome in patients with chronic ischaemia of lower limbs in the postoperative period. The study included two groups of patients: the comparison group with standard postoperative treatment and the study group where the standard therapy was supplemented with regional lymphotropic therapy. In the postoperative period, the patients in both groups developed reperfusion oedema of the operated lower limb on day 3 after arterial reconstruction, however, on POD 7 after revascularization, the severity of oedema was apparently less in the study group. Lymphorrhoea after operative treatment in the study group was encountered significantly less often as compared with the control group. According to the findings of ultrasonographic examination of soft tissues in the postoperative period, patients of both groups on POD 3 were found to have pronounced oedema of soft tissues. However, on POD 7 the study group patients demonstrated a dramatic decrease in the thickness of oedema of the subcutaneous fat versus the comparison group patients. Regional lymphotropic therapy after reconstructive operations on arteries of lower limbs promoted a decrease in the severity of reperfusion syndrome on the operated lower limb.


Asunto(s)
Arteriopatías Oclusivas , Extremidad Inferior , Arterias , Humanos , Isquemia , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos
6.
Vasc Endovascular Surg ; 55(3): 286-289, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33663307

RESUMEN

Renal artery aneurysms are rare occurrences, representing less than 1% of all aneurysms in the general population. Little is known about the natural history and optimal management of these aneurysms. We report a 58-year-old female patient with bilateral renal artery aneurysms with significant rapid growth of the right aneurysm on 1-year follow-up. Due to her age and the anatomical complexity of the aneurysm, the patient was not a candidate for endovascular repair. She therefore underwent open repair of the right renal artery aneurysm with resection and primary anastomosis. This case offers an example of surgical management of this rare disease process.


Asunto(s)
Aneurisma/cirugía , Arteria Renal/cirugía , Procedimientos Quirúrgicos Vasculares , Anastomosis Quirúrgica , Aneurisma/diagnóstico por imagen , Progresión de la Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Arteria Renal/diagnóstico por imagen , Resultado del Tratamiento
7.
Ann R Coll Surg Engl ; 103(3): 145-150, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33645280

RESUMEN

INTRODUCTION: The relation between type of ventilation used in the operating theatre and surgical site infection has drawn considerable attention. It has been reported that there is a possible relationship between the type of ventilation used in the operation theatre and surgical site infection. This meta-analysis was performed to evaluate this relationship. METHODS: Through a systematic literature search up to May 2020, 14 studies describing 590,121 operations, 328,183 were performed under laminar airflow ventilation and 2,611,938 were performed under conventional ventilation. Studies were identified that reported relationships between type of ventilation with its different categories and surgical site infection (10 studies were related to surgical site infection in total hip replacement, 7 in total knee arthroplasties and 3 in different abdominal and open vascular surgery). Odds ratios with 95% confidence intervals were calculated comparing surgical site infection prevalence and type of theatre ventilation using the dichotomous method with a random or fixed-effect model. FINDINGS: No significant difference was found between surgery performed under laminar airflow ventilation and conventional ventilation in total hip replacement (OR 1.23; 95% CI 0.97-1.56, p = 0.09), total knee arthroplasties (OR 1.14; 95% CI 0.62-2.09, p = 0.67) or different abdominal and open vascular surgery (OR 0.75; 95% CI 0.43-1.33, p = 0.33). The impact of the type of theatre ventilation may have no influence on surgical site infection as a tool for decreasing its occurrence. CONCLUSIONS: Based on this meta-analysis, operating under laminar airflow or conventional ventilation may have no independent relationship with the risk of surgical site infection. This relationship forces us not to recommend the use of laminar airflow ventilation since it has a much higher cost compared with conventional ventilation.


Asunto(s)
Quirófanos , Procedimientos Quirúrgicos Operativos , Infección de la Herida Quirúrgica/epidemiología , Ventilación/estadística & datos numéricos , Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Ambiente Controlado , Humanos , Procedimientos Quirúrgicos Vasculares , Ventilación/métodos
8.
Khirurgiia (Mosk) ; (3): 73-77, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33710831

RESUMEN

We report the results of open surgical correction of a giant false aneurysm of the distal anastomosis in long-term period after iliofemoral bypass surgery. Preoperative diagnostic procedures made it possible to determine the most appropriate treatment strategy. Aneurysm resection was followed by distal anastomosis repair on the right with prosthesis 10 mm. Postoperative imaging is presented. The authors concluded the effectiveness of revascularization strategy.


Asunto(s)
Aneurisma Falso , Arteria Femoral/cirugía , Arteria Ilíaca/cirugía , Procedimientos Quirúrgicos Vasculares/efectos adversos , Anastomosis Quirúrgica/efectos adversos , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Implantación de Prótesis Vascular , Humanos , Arteria Ilíaca/diagnóstico por imagen , Reoperación , Resultado del Tratamiento
9.
Khirurgiia (Mosk) ; (4): 29-33, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33759465

RESUMEN

OBJECTIVE: To improve the treatment outcomes in patients with primary and metastatic liver tumors localized in segments VII-VIII involving the right hepatic vein and its branches. MATERIAL AND METHODS: There were 16 surgical interventions including resection of liver segment VII and/or VIII with resection of the right hepatic vein and its branches without reconstruction. All procedures were carried out at the Department of Liver and Pancreatic Tumors of the Blokhin National Medical Cancer Research Center for the period 2016-2020. The cause of surgery was colorectal cancer liver metastases in 8 patients, hepatocellular carcinoma in 2 cases, angiomyolipoma in 1 case and metastases of uterine cancer in 1 patient. Minor liver resection was additionally performed in 5 cases. RESULTS: Median surgery time was 150 (80-220) min, intraoperative blood loss - 400 (100-2000) ml. Afferent blood flow was blocked in 4 patients for 14 (12-25) min. None patient had intraoperative signs of impaired venous outflow. Biliary fistula in postoperative period occurred in 1 patient. No complications were noted in other cases. Median postoperative hospital-stay was 13 (9-19) days. There were no specific complications in long-term postoperative period that could be associated with venous outflow blockade through the right hepatic vein. CONCLUSION: Existing vessels and intrahepatic collaterals de novo can provide adequate venous outflow into the middle hepatic vein and short hepatic veins during resection of liver segments VII and/or VIII with resection of the right hepatic vein and its branches without reconstruction and the absence of inferior right hepatic vein.


Asunto(s)
Carcinoma Hepatocelular , Hepatectomía , Venas Hepáticas/cirugía , Neoplasias Hepáticas , Carcinoma Hepatocelular/cirugía , Hepatectomía/efectos adversos , Hepatectomía/métodos , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Procedimientos Quirúrgicos Vasculares , Insuficiencia Venosa/etiología , Insuficiencia Venosa/cirugía
10.
Khirurgiia (Mosk) ; (4): 85-91, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33759475

RESUMEN

Iatrogenic events made up 1-10% of in-hospital mortality. Currently, iatrogenic vascular injuries are described for almost all surgical areas. Incidence of iatrogenic vascular injuries is gradually increased that is primarily associated with high number of percutaneous endovascular interventions. Surgical treatment of patients with iatrogenic vessel injuries is extremely difficult. This is due to sudden development of this complication, severe clinical state of the patient associated with underlying disease, acute massive blood loss, as well as insufficient experience of surgeon in urgent vascular surgery. Simple lateral or circular suturing is not always possible to restore the vessel integrity. Vascular replacement including non-standard vascular reconstructions are often required. Prevention of iatrogenic vascular injuries is also insufficiently described in the literature. Most manuscripts devoted to iatrogenic vascular injuries are usually represented by case reports or small sample. Thus, it is impossible to identify the main measures for prevention of iatrogenic injury.


Asunto(s)
Enfermedad Iatrogénica , Lesiones del Sistema Vascular , Competencia Clínica , Procedimientos Endovasculares/efectos adversos , Hemorragia/etiología , Hemorragia/cirugía , Mortalidad Hospitalaria , Humanos , Enfermedad Iatrogénica/prevención & control , Procedimientos Quirúrgicos Vasculares/métodos , Procedimientos Quirúrgicos Vasculares/normas , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/mortalidad , Lesiones del Sistema Vascular/cirugía
13.
Ann R Coll Surg Engl ; 103(4): 278-281, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682450

RESUMEN

INTRODUCTION: Microvascular reconstruction is the gold standard for reconstruction in oral cavity cancers. Age and comorbidities determine the type of reconstruction. We aimed to analyse the impact of high-risk comorbidities on perioperative morbidity. METHODS: This is a retrospective study of 317 patients undergoing microvascular reconstruction from January 2014 to December 2017. High risk patients were based on age, American Society of Anaesthesiologists (ASA) grade (III/IV) and Charlson comorbidity index (CCI) score >4; overall, 73 out of 317 patients were evaluated. RESULTS: Median age was 59 years. Five patients (6.8%) had complete flap failures and seven (9.5%) had minor complications (wound breakdown, bleeding, wound dehiscence, partial flap loss). ASA score of IV was significantly associated with morbidity while age >65 years and CCI >4 was not associated. The overall flap success rate was 93.2%. CONCLUSIONS: A high-risk population has nearly similar outcomes for microvascular reconstruction as a younger age group. High ASA score adversely affects surgery-related outcomes.


Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Microcirugia/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Carcinoma de Células Escamosas de Cabeza y Cuello/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Colgajos Quirúrgicos , Resultado del Tratamiento
14.
Semin Vasc Surg ; 34(1): 47-53, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33757635

RESUMEN

Diabetic foot ulcers (DFUs) are a common but highly morbid complication of long-standing diabetes, carrying high rates of associated major amputation and mortality. As the global incidence of diabetes has increased, along with the lifespan of the diabetic patient, the worldwide burden of DFUs has grown steadily. Outcomes in diabetes and DFUs are known to depend strongly on social determinants of health, with worse outcomes noted in minority and socioeconomically disadvantaged populations. Effective treatment of DFUs is complex, requiring considerable expenditure of resources and significant cost to the health care system. Comprehensive care models with multidisciplinary teams have proven effective in the treatment of DFUs by decreasing barriers to care and increasing access to the multiple specialists required to provide timely and effective DFU procedural intervention, surveillance, and preventative care. Vascular surgeons are an integral part throughout the cycle of care for DFUs and should be involved early in the course of such patients to maximize their contributions to a multidisciplinary care model.


Asunto(s)
Pie Diabético/epidemiología , Pie Diabético/terapia , Grupo de Atención al Paciente , Factores de Edad , Terapia Combinada , Pie Diabético/diagnóstico , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Comunicación Interdisciplinaria , Masculino , Prevalencia , Factores Raciales , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares
15.
Semin Vasc Surg ; 34(1): 54-58, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33757636

RESUMEN

Dysvascular amputations, defined as those secondary to the complications of peripheral arterial disease or diabetes mellitus, are the most common cause of lower extremity amputations. Despite recent advancements in diabetes mellitus treatments and the many modern innovations in endovascular therapies, the incidence of dysvascular lower extremity amputations has not improved. In this article, we will review the most recent epidemiological data on lower extremity amputations, discuss the latest recommendations from different medical societies for the prevention of limb loss, and explore the role of the vascular surgeon as part of a multidisciplinary team in providing comprehensive care for patients at risk of undergoing amputations for ischemic or diabetic complications. We will also discuss the importance of considering patient perspectives and patient-reported outcomes to better understand the impact of amputations on the patient experience.


Asunto(s)
Amputación , Recuperación del Miembro , Extremidad Inferior/irrigación sanguínea , Atención Dirigida al Paciente , Enfermedad Arterial Periférica/terapia , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/epidemiología , Prevalencia , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Estados Unidos/epidemiología , Procedimientos Quirúrgicos Vasculares
16.
Semin Vasc Surg ; 34(1): 65-70, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33757638

RESUMEN

Thoracic outlet syndrome (TOS) describes a complex disease process with three anatomic variations each with their own individual characteristics. Understanding the prevalence, diagnosis, and treatment of TOS is challenging for many providers. For this reason, the establishment of comprehensive care models and expert leadership by dedicated vascular surgeons with TOS experience has been invaluable.


Asunto(s)
Síndrome del Desfiladero Torácico/epidemiología , Humanos , Grupo de Atención al Paciente , Prevalencia , Pronóstico , Factores de Riesgo , Síndrome del Desfiladero Torácico/diagnóstico , Síndrome del Desfiladero Torácico/terapia , Procedimientos Quirúrgicos Vasculares
18.
Medicine (Baltimore) ; 100(13): e25357, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33787638

RESUMEN

BACKGROUND: Total ear amputation is a relatively rare trauma with an absolute indication for surgical treatment. Numerous techniques for auricular reconstruction have been described. When local and general conditions allow microsurgical replantation, this must be the first choice. We propose the association of microsurgical techniques with some modification (modified Baudet technique) to obtain higher survival rate of the reimplanted stump. METHODS: This study included cases of 3 male patients with total ear amputation, the injuries and their mechanism (workplace accident) being identical. Chief complaints were pain, bleeding, important emotional impact due by an unaesthetic appearance. The established diagnosis was traumatic complete ear amputation (grade IV auricular injury according to Weerda classification). Microsurgical replantation was performed only with arteriorraphy, and no vein anastomosis. Cartilage incisions and skin excisions were made to enlarge the cartilage-recipient site contact area. Medicinal leeches were used to treat venous congestion, to which systemic anticoagulant therapy was added. RESULTS: The results showed the survival of the entire replanted segment in all cases, with good function and esthetical appearance. Patients were fully satisfied with the final outcome. CONCLUSION: Microsurgical replantation is the gold standard, for the surgical treatment of total ear amputation. We believe that cartilage incisions and the increased surface of contact between cartilage and recipient site has an adjuvant role in revascularization of the amputated stump (with only arterial anastomosis) and the use of hirudotherapy helps to relieve early venous congestion.


Asunto(s)
Amputación Traumática/cirugía , Arterias/cirugía , Oído Externo/cirugía , Microcirugia/métodos , Reimplantación/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Anastomosis Quirúrgica/métodos , Animales , Oído Externo/irrigación sanguínea , Oído Externo/lesiones , Estética , Hirudo medicinalis , Humanos , Hiperemia/etiología , Hiperemia/prevención & control , Aplicación de Sanguijuelas/métodos , Masculino , Microcirugia/efectos adversos , Persona de Mediana Edad , Satisfacción del Paciente , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Reimplantación/efectos adversos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos
19.
Georgian Med News ; (310): 11-18, 2021 Jan.
Artículo en Ruso | MEDLINE | ID: mdl-33658402

RESUMEN

Objective - to improve the results of treatment of patients with chronic ischemia of the lower extremities based on optimization of the technique of operations on the deep femoral artery. During 6 years (from 2014 to the end of 2019), 150 patients were initially operated on for obliterating atherosclerosis of the femoropopliteal-tibial segment of the lower extremities in the department of vascular surgery of the Andrey Novak Regional Clinical Hospital, the clinical base of the Uzhgorod National University. In the presence of "short" stenoses, preference should be given to open endarterectomy with an autovenous and / or autoarterial patch. With extended stenoses, the essence of profundoplasty is again reduced to the restoration and expansion of the lumen by endarterectomy with an autovenous patch and/or by bypassing or prosthetics of the DFA segment. The choice of reconstruction is also influenced by the presence of enveloping and piercing branches at the site of the required level of disinfection. If the length of the DFA stenosis is up to 4 cm, regardless of the plaque density, it is recommended to open the EAE with autovenous, autoarterial and/or aloinsertion. With a stenosis length of 4 to 10 sm with a soft or medium density atherosclerotic plaque, an open EAE with an autovenous patch is shown. If the lesion is more than 10 cm long, regardless of the density of the atherosclerotic plaque, femoral-deep femoral shunting and/or prosthetics are recommended. When prosthetics of the DFA and the diameter of the perforating and/or circumflex arteries is ≥2 mm and the preserved retrograde blood flow, their reimplantation on the site into the prosthesis is indicated.


Asunto(s)
Arteria Femoral , Arteria Poplítea , Endarterectomía , Arteria Femoral/cirugía , Humanos , Extremidad Inferior/cirugía , Arteria Poplítea/cirugía , Procedimientos Quirúrgicos Vasculares
20.
Sultan Qaboos Univ Med J ; 21(1): e116-e119, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33777432

RESUMEN

Objectives: This study aimed to discuss the different challenges faced while managing emergency vascular surgery cases during the COVID-19 pandemic and how these challenges were overcome. Methods: This study details 14 emergency cases that were managed during a period of one month from mid-March to mid-April at Sultan Qaboos University Hospital, Muscat, Oman. The cases included acute limb ischaemia, critical limb ischaemia, type B dissection of the thoracic aorta, thoraco-abdominal aneurysm, critical internal carotid artery stenosis, trauma, infected arteriovenous forearm loop graft and thrombosed arteriovenous fistulas. Results: Only one patient was confirmed to have COVID-19. Five were negative for COVID-19 while the remaining eight were not tested. Various strategies on how the vascular surgical team accommodated changes in hospital protocols and nationwide lockdown are discussed in detail. Conclusions: With the judicious use of personal protective equipment and consumable surgical and endovascular devices, communication with support services and other hospitals and implementation of triage protocols, it was possible to manage vascular surgery emergencies effectively.


Asunto(s)
/diagnóstico , Urgencias Médicas , Derivación y Consulta , Enfermedades Vasculares/terapia , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Anciano de 80 o más Años , Amputación/métodos , Aneurisma Disecante/terapia , Angioplastia/métodos , Aneurisma de la Aorta/terapia , Derivación Arteriovenosa Quirúrgica , Estenosis Carotídea/terapia , Manejo de la Enfermedad , Embolectomía/métodos , Femenino , Oclusión de Injerto Vascular/complicaciones , Oclusión de Injerto Vascular/terapia , Humanos , Isquemia/terapia , Extremidad Inferior , Masculino , Persona de Mediana Edad , Omán , Centros de Atención Terciaria , Extremidad Superior
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