Editor's Choice - Early and Late Outcomes after Transcarotid Revascularisation for Internal Carotid Artery Stenosis: A Systematic Review and Meta-Analysis.

OBJECTIVE: Transcarotid/transcervical revascularisation (TCAR) is an alternative to carotid endarterectomy (CEA) and transfemoral carotid stenting (tfCAS). This review aimed to evaluate pooled data on patients undergoing TCAR. DATA SOURCES: Medline, Embase, Scopus, and Cochrane Library databases were used. REVIEW METHODS: This systematic review was conducted under Systematic Reviews and Meta-Analysis guidelines. Eligible studies (published online up to September 2020) reported 30 day mortality and stroke/transient ischaemic attack (TIA) rates in patients undergoing TCAR. Data were pooled in a random effects model and weight of effect for each study was also reported. Quality of studies was evaluated according to Newcastle - Ottawa scale. RESULTS: Eighteen studies (three low, seven medium, and eight high quality) included 4 852 patients (4 867 TCAR procedures). The pooled 30 day mortality rate was 0.7% (n = 32) (95% confidence interval [CI] 0.5 - 1.0), 30 day stroke rate 1.4% (n = 62) (95% CI 1.0 - 1.7), and 30 day stroke/TIA rate 2.0% (n = 92) (95% CI 1.4 - 2.7). Pooled technical success was 97.6% (95% CI 95.9 - 98.8). The cranial nerve injury rate was 1.2% (95% CI 0.7 - 1.9) (n = 14; data from 10 studies) while the early myocardial infarction (MI) rate was 0.4% (95% CI 0.2 - 0.6) (n = 16; data from 17 studies). The haematoma/bleeding rate was 3.4% (95% CI 1.7 - 5.8) (n = 135; data from 10 studies), with one third of these cases needing drainage or intervention. Within a follow up of 3 - 40 months the restenosis rate was 4% (95% CI 0.1 - 13.1) (data from nine studies; n = 64/530 patients) and death/stroke rate 4.5% (95% CI 1.8 - 8.4) (data from five studies; n = 184/3 742 patients). Symptomatic patients had a higher risk of early stroke/TIA than asymptomatic patients (2.5% vs. 1.2%; odds ratio 1.99; 95% CI 1.01 - 3.92); p = .046; data from eight studies). CONCLUSION: TCAR is associated with promising early and late outcomes, with symptomatic patients having a higher risk of early cerebrovascular events. More prospective comparative studies are needed in order to verify TCAR as an established alternative treatment technique.

A Case of Giant Aortoiliac Aneurysm Rupture when Open Repair Seems a One-Way Street.

Giant aortoiliac aneurysm is a rare nosological entity. Owing to the increased diameter, the risk of rupture is extremely high and, similarly, the repair is extremely challenging. In this article, open surgical repair of a ruptured giant aortoiliac aneurysm in a 72-year-old male is described. A bifurcated Dacron graft was used with left internal iliac artery revascularization, while the contralateral internal iliac artery was ligated. The patient had an uneventful recovery.

Chylous Ascites Following Open Abdominal Aortic Aneurysm Repair: An Unusual Complication.

Chylous ascites is a rare complication after abdominal aortic aneurysm repair. Accumulation of chyle within the close space of the peritoneal cavity may cause severe discomfort to the patient, complicating the postoperative course. Prompt diagnosis is needed to adopt measures for reducing lymph leakage and contributing to lymphatic fistula closure. Fortunately, conservative treatment is successful in the majority of cases. In the rare cases that do not respond to conservative treatment, surgery becomes mandatory. Accurate preoperative localization of lymph leakage is a prerequisite for a successful outcome. Postoperative chyloperitoneum has a benign course and an excellent prognosis.

Carotid endarterectomy in an asymptomatic patient with contralateral agenesis of the internal carotid artery.

A 64-year-old man was referred to the vascular surgery department with an incidental finding of right internal carotid artery stenosis during thyroid ultrasound imaging. Carotid artery color duplex revealed an ulcerated type III plaque producing stenosis of the right internal carotid artery of 70% and agenesis of the left internal carotid artery. Further imaging with computed tomography angiography confirmed the initial findings and excluded cerebral vascular malformations and ischemic cerebral infarcts. The patient was treated with endarterectomy of the right internal carotid artery with elective shunting and synthetic patch closure.

Endovascular treatment of isolated iliac artery aneurysms with anaconda stent graft limb.

Isolated aneurysms of the iliac arteries are relatively rare conditions that traditionally have been treated by surgical reconstruction. We report our experience with endovascular treatment of iliac artery aneurysms (IAAs) with Anaconda stent graft limb. Two male patients were found to have 4.5 and 3.6 cm isolated common IAAs, respectively. The endograft was successfully advanced and deployed precisely to the intended position in both cases. In one case the internal iliac artery was embolized. No type I or II endoleak was observed immediately after the procedure. In one patient postimplantation fever (>38°C) and gluteal claudication occurred. After 2 years followup both iliac endovascular stent grafts are patent and without endoleak. Endovascular treatment with Anaconda limb stent graft seems to be a safe and feasible alternative to open surgery.

Late diagnosis of silent thoracic aortic rupture presented as a right pleural effusion.

Patients with ruptured thoracic aortic aneurysm rarely present in a stable clinical condition. A man was referred to our hospital with the diagnosis of ruptured saccular aneurysm of the descending thoracic aorta. He successfully underwent both endovascular graft repair and open thoracotomy.

Cowpox virus infection: an emerging health threat.

PURPOSE OF REVIEW: Human cowpox, a rare zoonotic infection, evokes a self-limited disease, except for immunocompromised and eczematous patients, particularly children, where it can become severe. The causative agent, cowpox virus, is distributed in Europe, west former USSR, and adjacent areas of Northern and Central Asia, with an increasing number of reports in Europe. The purpose of this paper is to review cowpox with an emphasis on its epidemiology and management. RECENT FINDINGS: Numerous reports of human cowpox affecting young people in Europe indicate that lack of smallpox vaccination, which has been abandoned since 1977, may render the population more vulnerable to cowpox virus. The ownership of wild and exotic animal pets is becoming more popular, and the range of recognized wild and domestic animal hosts is expanding, SUMMARY: Cowpox as a human emerging zoonotic hazard raises public health concerns as well as a question about the production of effective vaccine and antiviral agents.

A descriptive survey of the different management practices for peripheral IV catheters among Greek, Jordanian, and Australian teaching hospitals.

Peripheral IV catheters (PIVCs) are commonly placed in hospital patients. However, there is a lack of evidence on which to base this practice. The aim of this study was to assess current knowledge and practice for this procedure in 3 different cultures. The study collected information from a postal questionnaire sent to physicians and nurses in teaching hospitals in Greece, Jordan, and Australia. The results gathered from the questionnaire depict a number of misconceptions with regard to the management of PIVCs in the 3 healthcare organizations selected for the study.

Congenital duplication of the gallbladder.

Duplication of the gallbladder is a rare congenital anomaly of the biliary system. In this article, two cases of gallbladder duplication are presented. The first case is a patient with double gallbladder and concomitant choledocholithiasis. The probable diagnosis of double gallbladder was made preoperatively by computed tomography. The patient underwent a successful open cholecystectomy and common bile duct exploration. In the second case, two cystic formations in the place of gallbladder are demonstrated with ultrasound scan in a woman with acute cholecystitis. At surgery, two gallbladders were found. A brief review of epidemiology and anatomy of double gallbladder is included, along with a discussion of the difficulties in diagnosis and treatment of this condition.

Post-traumatic hepatic artery aneurysm--surgical treatment: report of a case.

Hepatic artery aneurysms (HAAs) are uncommon. We present the diagnosis and surgical treatment of a post-traumatic, extrahepatic artery aneurysm.

Early rupture of a partially treated abdominal aortic aneurysm: another endovascular lesson.

PURPOSE: To report early rupture of a partially treated abdominal aortic aneurysm. CASE REPORT: A 76-year-old man with a 6.4-cm abdominal aortic aneurysm had the main body of a bifurcated graft inserted into the aneurysm. However, it was not possible to cannulate the short cuff of the graft to deploy the contralateral limb, probably due to a proximal aortic stenosis compressing the stent-graft. The plan was for the patient to return on another date for a further attempt at recannulation; however, shortly after the patient was discharged, the aneurysm ruptured, necessitating conventional open repair, which the patient survived. CONCLUSIONS: Every effort should be made to complete endovascular treatment of abdominal aortic aneurysms at a single session.