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1.
Medicine (Baltimore) ; 99(26): e20768, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590754

RESUMO

BACKGROUND: The operation of lung cancer may squeeze the tumor and further promote the spread of tumor cells to the circulation, which may be one of the reasons for the metastasis and recurrence of lung cancer. The potential risk of tumor cell dissemination can theoretically be minimized if the effluent veins were ligated first (via the vein-first [V-first] technique), instead of having the artery ligated first (via the artery-first [A-first] technique). However, this technical concept has not yet been widely accepted as a standard of surgical oncology in current guidelines owing to a lack of sufficient evidence. This systematic review and meta-analysis will be performed to determine which technique during lobectomy will achieve longer patient survival and be more beneficial for patients. METHODS: We will search PubMed, Web of Science, EMBASE, Cancerlit, the Cochrane Central Register of Controlled Trials, and Google Scholar databases for relevant clinical trials published in any language before October 1, 2020. Randomized controlled trials (RCTs), quasi-RCTs, propensity score-matched comparative studies, and prospective cohort studies of interest, published or unpublished, that meet the inclusion criteria will be included. Subgroup analysis of the type of operation, tumor pathological stage, and ethnicity will be performed. INPLASY registration number: INPLASY202050060. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: As far as we know, this study will be the first meta-analysis to compare the efficacy of the vein-first and artery-first surgical technique of lobectomy for patients diagnosed with resectable non-small cell lung cancer. Due to the nature of the disease and intervention methods, randomized controlled trials may be inadequate, and we will carefully consider inclusion in high-quality, non-randomized controlled trials, but this may result in high heterogeneity and affect the reliability of the results.


Assuntos
Artérias/cirurgia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Ligadura/métodos , Neoplasias Pulmonares/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Vasculares/métodos , Veias/cirurgia , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/patologia , Metanálise como Assunto , Inoculação de Neoplasia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
3.
Plast Reconstr Surg ; 145(5): 1302-1312, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332556

RESUMO

BACKGROUND: Limb salvage techniques using free tissue transfer in patients with chronic wounds caused by longstanding osteomyelitis, diabetes, and peripheral vascular disease are technically challenging. The longitudinal slit arteriotomy end-to-side anastomosis is the authors' preferred technique because it is the least invasive arteriotomy and is especially important for diseased recipient arteries. The authors reviewed highly comorbid patients who underwent free tissue transfer with this technique to understand the success rates, overall outcomes, and long-term limb salvage rates. METHODS: A retrospective review was performed to analyze outcomes of free tissue transfer using longitudinal slit arteriotomy end-to-side anastomosis between 2012 and 2018 performed by the senior surgeon (K.K.E.). RESULTS: One hundred fifteen free flaps were identified. Patients were, on average, 55.9 years old, with a body mass index of 29.2 kg/m. Comorbidities included osteomyelitis (83.5 percent), hypertension (60.9 percent), tobacco use (46.1 percent), diabetes (44.3 percent), peripheral vascular disease (44.3 percent), hypercoagulability (35.7 percent), and arterial calcifications (17.4 percent). Overall flap success was 93.0 percent; 27.8 percent required reoperation perioperatively because of complications. On univariate analysis, diabetes mellitus, hypertension, and hypercoagulability were significantly associated with eventual amputation (p < 0.05). Multivariate analysis showed that intraoperative thrombosis and take back was independently associated with flap failure. There was an overall limb salvage rate of 83.5 percent, and of those salvaged, 92.7 percent were ambulating without a prosthesis at a mean follow-up of 1.53 years. CONCLUSIONS: This is the largest series of longitudinal slit arteriotomy end-to-side anastomosis for patients undergoing free tissue transfer for limb-threatening defects in the compromised host. Overall flap success, limb salvage rates, and functional outcomes are high using this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Artérias/cirurgia , Retalhos de Tecido Biológico/transplante , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Salvamento de Membro/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/estatística & dados numéricos , Doença Crônica/terapia , Estado Terminal/terapia , Pé Diabético/complicações , Pé Diabético/epidemiologia , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Perna (Membro)/cirurgia , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/epidemiologia , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversos , Fumar/epidemiologia , Resultado do Tratamento , Adulto Jovem
5.
Angiology ; 71(7): 621-625, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32319306

RESUMO

Thromboangiitis obliterans (TAO) is an inflammatory disease that usually affects small and medium-sized arteries in the upper and lower limbs of young smokers. Previous studies showed that the spectrum TAO has changed in the 80s: the male-to-female ratio decreased, older patients were diagnosed, and upper limb involvement was more common. The aim of our study was to assess the changing clinical spectrum of TAO in France during the past 40 years. All consecutive patients fulfilling TAO's criteria between January 1967 and January 2016 were retrospectively included in 3 departments of internal medicine. We compared TAO features in patients diagnosed before and after 2002; 141 (77.5%) men and 41 (22.5%) women were included. Patients diagnosed after 2002 were older (37 [31-39] vs 34 [29-35] years P = .03), had a more frequent isolated upper limb involvement (34.3% vs 7.8% P = .001), and less frequent isolated lower limb involvement (55.7% vs 74.5%, P < .001). The clinical spectrum of TAO has changed in France since the beginning of the 21st century.


Assuntos
Fatores Etários , Artérias/cirurgia , Fumar/efeitos adversos , Tromboangiite Obliterante/cirurgia , Adulto , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Tromboangiite Obliterante/diagnóstico
6.
World Neurosurg ; 138: 257-260, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32151772

RESUMO

BACKGROUND: Trigeminal neuralgia (TN) is one of the neuropathic pain syndromes, most commonly caused by vascular compression in the root entry zone of the trigeminal nerve in the cerebellopontine angle. It was rare as offending artery that primitive trigeminal artery and primitive trigeminal artery variant (PTAv) as an anomaly that occurs carotid-basilar anastomosis. We report a case of TN caused by the PTAv, and usefulness of fusion images of magnetic resonance imaging (MRI) and computed tomography angiography (CTA). CASE DESCRIPTION: A 65-year-old man presented with a 2-year history of left paroxysmal facial pain in the second division of the trigeminal nerve. We diagnosed left TN due to PTAv using constructive interference in steady state magnetic resonance imaging (CISS MRI) and CTA. Microvascular decompression surgery disclosed trigeminal nerve compressed by PTAv consisted with findings from preoperative neuroimaging. We report a case of TN caused by PTAv, and usefulness of fusion images of CISS MRI and CTA to understand the neurovascular and bony structure during the perioperative period. CONCLUSIONS: The fusion image created by CISS MRI and 3-dimensional CTA was useful to identify the offending vessel and to clearly understand the neurovascular structure preoperatively.


Assuntos
Variação Anatômica , Artérias/diagnóstico por imagem , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/etiologia , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/etiologia , Idoso , Artérias/cirurgia , Angiografia por Tomografia Computadorizada , Humanos , Imageamento Tridimensional , Imagem por Ressonância Magnética , Masculino , Imagem Multimodal , Síndromes de Compressão Nervosa/cirurgia , Neuralgia do Trigêmeo/cirurgia
8.
J Craniofac Surg ; 31(2): 534-537, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31977714

RESUMO

BACKGROUND AND OBJECTIVE: Craniofacial malignant tumors require not only extended resection but also appropriate reconstruction to restore appearance, which remains a major challenge. Here the authors introduced the application of superficial temporal artery (STA) flap in wound repairing after the resection of craniofacial malignant tumors. METHODS: From January 2015 to December 2018, 16 patients with craniofacial malignant tumors were enrolled into the study, including squamous cell carcinoma (n = 6), basal cell carcinoma (n = 3), melanoma (n = 4), neuroendocrine carcinoma (n = 2), and dermatofibrosarcoma protuberance (n = 1). All of the tumors underwent extended resection. The defects formed were repaired by flaps pedicled with superior or frontal branch of STA. Donor sites were repaired with skin grafts. Patients were followed up for 6 months to 3 years to monitor the recurrence of tumor. RESULTS: All the flaps survived well. Venous congestion occurred in two cases but resolved after blood-letting and application of drugs promoting venous draining. During the follow-up, no recurrence of tumors was observed and the appearance of flaps was satisfying. But flap donor sites suffered from relatively poor appearance or alopecia deformity. CONCLUSIONS: The STA flap is reliable for wound repairing after resection of craniofacial malignant tumors. The STA parietal branch flap is preferred for repairing scalp defects, while the STA frontal branch flap is preferred for repairing facial defects. However, the STA flap should be used prudently due to its disadvantage of the deformity in scalp donor sites.


Assuntos
Artérias/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos/cirurgia , Artérias Temporais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Transplante de Pele , Resultado do Tratamento , Cicatrização
9.
J Craniofac Surg ; 31(2): e133-e135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31934976

RESUMO

Recently, several adjunctive procedures have gained traction to aid cleft surgeons in repairing especially challenging palatal clefts. Buccal fat flaps and buccal myomucosal flaps have demonstrated particular utility in reinforcing thin palatal flaps or tissue deficits. Although their use has not been widely accepted, they may be particularly helpful in the setting of significant scarring or vascular compromise. Here the authors describe the case of an intraoperative salvage using bilateral buccal fat flaps and a right buccal myomucosal flap after transection of the right Greater Palatine artery (GPA) during palatoplasty on a 14-month old female with Pierre Robin Sequence and a wide Veau II cleft palate. For this operative salvage, bilateral buccal fat flaps were used to reinforce the hard-soft palate junction and a 4 cm × 2 cm flap of the right-sided buccal mucosa and buccinator muscle was inset along the majority of the right-sided soft and posterior hard palate. At 2 years follow-up, the patient had no significant complications and was doing well with healthy-appearing palatal tissue and age-appropriate speech.


Assuntos
Artérias/cirurgia , Fissura Palatina/cirurgia , Síndrome de Pierre Robin/cirurgia , Terapia de Salvação , Artérias/diagnóstico por imagem , Bochecha/cirurgia , Fissura Palatina/complicações , Fissura Palatina/diagnóstico por imagem , Músculos Faciais/cirurgia , Feminino , Humanos , Lactente , Cuidados Intraoperatórios , Mucosa Bucal/irrigação sanguínea , Mucosa Bucal/cirurgia , Palato Duro/irrigação sanguínea , Palato Duro/cirurgia , Síndrome de Pierre Robin/complicações , Síndrome de Pierre Robin/diagnóstico por imagem , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos/cirurgia
10.
Eur J Vasc Endovasc Surg ; 59(1): 137-147, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31699657

RESUMO

OBJECTIVES: Heparin has a non-predictable effect in the individual patient. The activated clotting time (ACT) is used to measure the level of anticoagulation after administration of heparin. To date, appropriate heparin dose protocols and corresponding therapeutic ACT values have not been established in non-cardiac arterial procedures (NCAP). The aim of this review was to study the use of ACT monitoring during NCAP, and whether an optimal ACT could be determined based on the fewest arterial thrombo-embolic complications (ATEC) and bleeding complications. METHODS: This systematic review was performed in accordance with the PRISMA Guidelines. A systematic search was conducted in MEDLINE, EMBASE, and the Cochrane database. Any associations were evaluated between peri-procedural ACT levels and ATEC and bleeding complications detected during the same admission as the primary procedure or during 30 day follow up. Also, heparin dose protocols, peri-procedural target ACTs, different ACT devices, protamine use and pre-, peri-, and post-procedural anticoagulation therapy were evaluated. RESULTS: In total, 21 studies with 3982 patients were included, on both open and endovascular NCAP. Four studies were primarily designed to correlate peak peri-procedural ACT with clinical outcomes; however, the definitions of the results and the clinical outcomes were too heterogeneous for analysis. There was major variability in all studied aspects of ACT measurement, heparin and protamine use, and in the type of procedures in the included studies. Overall methodological quality of the included studies was poor. No randomised controlled trials were found. Studies were at a high risk of bias. CONCLUSIONS: This systematic review demonstrates a lack of data and no consensus in the literature concerning the optimal ACT, and the possible association with haemorrhagic complications and ATEC during NCAP.


Assuntos
Anticoagulantes/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Monitoramento de Medicamentos/métodos , Heparina/efeitos adversos , Tromboembolia/prevenção & controle , Anticoagulantes/administração & dosagem , Artérias/cirurgia , Coagulação Sanguínea/efeitos dos fármacos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Consenso , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/normas , Procedimentos Endovasculares/efeitos adversos , Heparina/administração & dosagem , Humanos , Monitorização Intraoperatória/métodos , Monitorização Intraoperatória/normas , Tromboembolia/epidemiologia , Tromboembolia/etiologia
11.
Ann Vasc Surg ; 62: 342-348, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31449953

RESUMO

BACKGROUND: Arterial traumas of the extremities are quite rare in civilian records; nevertheless, patients with trauma of limbs are admitted daily in emergency departments worldwide. The up-to-date information about epidemiology and treatment (open vs. endovascular surgery) comes from war records and it is not always easy getting data on mortality and morbidity in these patients. The aim of this study is to analyze the approach (open or endovascular) and the outcome of patients with vascular trauma of upper limbs (from the subclavian artery) and/or lower limbs (distal to the inguinal ligament), in the greater Milan area. METHODS: A retrospective analysis was conducted on data recorded by the emergency departments of two hospitals of the greater Milan between 2009 and 2017. We collected all patients with arterial injuries of the limbs in terms of demography, injury patterns, clinical status at admission, therapy (open or endovascular approach), and outcomes in terms of limb salvage and survival. RESULTS: We studied 52 patients with vascular trauma of extremities. The main mechanism of trauma was road accident (48.1%), followed by criminal acts (32.7%), self-endangering behavior (13.5%), work (3.8%), and sport accidents (1.9%). Associated lesions (orthopedic, neurological, and/or venous lesions of the limbs) were present in 39 patients (75%). All patients underwent emergency surgery, forty-six patients (88.5%) by open repair (polytetrafluoroethylene or greater saphenous vein bypass grafts, arterial suture or ligation), whereas endovascular approach was used only in 6 patients (11.5%), all treated with embolization. The overall postoperative mortality rate was 5.7% (3 patients). Among survivors, we report 5 major amputations of the lower limbs, 3 of them after bypass graft infection, and 2 after graft failure. The rate of limb salvage was 90.4%. CONCLUSIONS: Isolated arterial trauma of the extremities are rare, usually they occur in the setting of multiple trauma patients. Despite progresses in surgical techniques, there are still controversies in diagnosis and treatment of these patients. We treated most cases with open surgery (n = 46), choosing endovascular approach (embolization performed mainly by interventional radiologists) in difficult anatomic districts. We believe that, during decision-making of the surgical strategy, it is important to consider the anatomical site of lesions and the general condition of the patients. Moreover, in case of multiple trauma, we suggest a multidisciplinary approach to provide the best medical care to the victims.


Assuntos
Artérias/cirurgia , Procedimentos Endovasculares , Extremidades/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/cirurgia , Adulto , Artérias/diagnóstico por imagem , Artérias/lesões , Tomada de Decisão Clínica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Lesões do Sistema Vascular/diagnóstico por imagem , Adulto Jovem
12.
BMC Surg ; 19(1): 188, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829162

RESUMO

BACKGROUND: When restoring the appearance and function of the fingers, hand surgeons face a challenge in choosing a suitable surgical method to repair finger skin defects. METHODS: In this study, we designed a long elliptical flap based on a propeller perforator flap and located slightly toward the dorsal lateral aspect of the finger. The flap with a pedicle consisting of the dorsal perforator of the distal digital artery and dorsal digital artery perforator chain is rotated to cover a large wound on the distal end. From December 2014 to December 2017, 10 patients with finger soft tissue defects were treated with the propeller perforator flap described in this study. RESULTS: All flaps survived after surgery, and 2 had a transient venous congestion. After a follow-up period of 3 to 12 months, the static two-point discrimination of the flap was 8.06 ± 1.75 mm, and the range of motion was 149.4 ± 12.9°. This designed flap can span several angiosomes supplied by the perforators. Due to the inclusion of a vessel chain between the dorsal digital artery perforators, the length-to-width ratio of the flap can be up to 3:1. CONCLUSIONS: This technique increases the size of flap that can be harvested safely while retaining a reliable blood supply. The present study describes a new method for repairing soft tissue defects of the finger by using the technique of propeller perforator flaps based on dorsal digital artery perforator chains. TRIAL REGISTRATION: The registration number of this study is ChiCTR1800014588; it has been retrospectively registered with Chinese Clinical Trial Registry (chictr.org.cn), 18/11/2019.


Assuntos
Traumatismos dos Dedos/cirurgia , Retalho Perfurante , Lesões dos Tecidos Moles/cirurgia , Adulto , Artérias/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Pele , Transplante de Pele , Resultado do Tratamento
13.
Angiol Sosud Khir ; 25(4): 35-39, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855199

RESUMO

The authors analysed oral anticoagulant agents prescribed in the postoperative period to patients after endured reconstructive operative intervention on arteries of the femorotibial segment. The study included a total of 104 patients subjected to femoropopliteal or femorotibial bypass grafting using an autologous vein or a prosthesis. Depending on the prescribed anticoagulation agent, the patients were subdivided into two groups. Group One patients (n=43) in the postoperative period received rivaroxaban, and Group Two patients (n=61) took warfarin. Efficacy of therapy was evaluated by the frequency of haemorrhage and thromboses in the early and remote postoperative periods. The findings of the immediate postoperative period demonstrated comparable rates of haemorrhagic complications, early thromboses and redo interventions in both Groups (p=0.7). The duration of long-term postoperative period varied from 3 months to 5 years. No statistically significant differences in patency of the performed reconstructions were revealed between the groups. The 3-year primary assisted patency rate in the rivaroxaban group and warfarin group amounted to 89 and 80%, respectively. The incidence of haemorrhagic complications in the postoperative period was insignificant in the studied groups. Hence, rivaroxaban may be prescribed in the early and remote postoperative period to patients who underwent open reconstructive operative intervention on arteries of the infrainguinal zone.


Assuntos
Anticoagulantes/uso terapêutico , Rivaroxabana/uso terapêutico , Doenças Vasculares/tratamento farmacológico , Doenças Vasculares/cirurgia , Grau de Desobstrução Vascular/efeitos dos fármacos , Varfarina/uso terapêutico , Anticoagulantes/farmacologia , Artérias/efeitos dos fármacos , Artérias/cirurgia , Implante de Prótese Vascular , Artéria Femoral/efeitos dos fármacos , Artéria Femoral/cirurgia , Humanos , Extremidade Inferior/irrigação sanguínea , Artéria Poplítea/efeitos dos fármacos , Artéria Poplítea/cirurgia , Estudos Retrospectivos , Rivaroxabana/farmacologia , Artérias da Tíbia/efeitos dos fármacos , Artérias da Tíbia/cirurgia , Resultado do Tratamento , Varfarina/farmacologia
14.
J Med Vasc ; 44(6): 422-425, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31761308

RESUMO

Pseudoaneurysms of the gluteal arteries are rare, often secondary to blunt or penetrating pelvic trauma. These pseudoaneurysms are initially asymptomatic and manifest after a variable delay ranging from a few weeks to many years after the initial trauma. The spontaneous outcome can be fatal in case of rupture. Previously, treatment of gluteal pseudoaneurysms was exclusively surgical, but the advent of endovascular techniques revolutionized management practices by decreasing perioperative morbidity and offering results comparable to those of surgery. We report the case of a patient admitted for emergency management of a ruptured post-traumatic pseudoaneurysm of the superior gluteal artery that had occurred 20 days after penetrating buttock trauma. Selective embolization was successful.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Roto/cirurgia , Artérias/cirurgia , Nádegas/irrigação sanguínea , Procedimentos Endovasculares , Lesões do Sistema Vascular/cirurgia , Adulto , Falso Aneurisma/diagnóstico por imagem , Aneurisma Roto/diagnóstico por imagem , Artérias/diagnóstico por imagem , Artérias/lesões , Emergências , Humanos , Masculino , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem
15.
Eur J Vasc Endovasc Surg ; 58(6): 921-928, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31706740

RESUMO

OBJECTIVE: There is currently uncertainty regarding the ideal treatment to salvage thrombosed or failing synthetic arteriovenous grafts (AVGs) in patients with end stage renal disease. Therefore, a systematic review up to December 2018 and network meta-analysis of randomised control trials (RCTs) that compared three month failure risk of available treatments was carried out. METHODS: Medline, Scopus, Embase, and the Cochrane Library were the data sources. Pairwise meta-analyses were based on random effects models. Network meta-analysis was conducted within a frequentist framework with a multivariable random effects approach to model treatment effects across studies. The metric of choice was the odds ratio (OR) along with the associated 95% confidence interval (CI). RESULTS: Sixteen two arm RCTs were included involving 2011 patients who were randomised to six different treatments (plain balloon angioplasty, open surgical repair, stents, stent grafts, drug eluting balloons (DEBs), and cutting balloons). The network of RCTs had a star like geometry with plain balloon angioplasty being the common comparator. There were no significant differences between treatments with regards to risk of failure at three months with the exception of stent graft use that significantly reduced the risk of failure compared with plain balloon angioplasty (OR 0.53, 95% CI 0.34-0.84). Based on surface under the cumulative ranking curve (SUCRA) values, the best interventions to salvage thrombosed or failing AVGs were DEB and stent grafts. CONCLUSIONS: Stent graft seems to perform better than plain balloon angioplasty in terms of saving thrombosed or failing AVGs. However, this network meta-analysis was limited by the lack of closed loops and thus unable to assess consistency between direct and indirect evidence. The efficacy of DEBs as a promising treatment deserves further investigation and new RCTs are required.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Oclusão de Enxerto Vascular/terapia , Falência Renal Crônica/complicações , Terapia de Salvação/métodos , Trombose/terapia , Angioplastia com Balão/instrumentação , Angioplastia com Balão/métodos , Artérias/cirurgia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Cateteres , Oclusão de Enxerto Vascular/etiologia , Humanos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia de Salvação/instrumentação , Stents , Trombose/etiologia , Fatores de Tempo , Falha de Tratamento , Grau de Desobstrução Vascular , Veias/cirurgia
16.
BMC Cancer ; 19(1): 1041, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690274

RESUMO

BACKGROUND: The ultimate goal of locoregional therapy (LRT) to the liver is to induce total tumor necrosis. Trans-arterial chemoembolization (TACE) is the mainstay bridging therapy for patients with hepatocellular carcinoma (HCC) waiting for liver transplantation (LT). However, tumor response rate is variable. The purpose of this study was to correlate HCC radiological appearance with level of tumor necrosis during explant analysis from patients undergoing LT who received pre-LT TACE. METHODS: From January 2000 to December 2018, a total of 66 patients with HCC who had been treated prior to LT by means of TACE were analyzed. Diagnosis of HCC was made based on AASLD guidelines and confirmed via histopathology explant analysis. Radiologic tumor response after TACE was based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). Degree of tumor necrosis was determined by histopathology analysis of liver explants. HCC radiological appearances on CT before TACE were assessed and correlated with histological findings after LT. RESULTS: Eighty nine TACE procedures (1.35 ± 0.67; 1-4) were performed, of which 18 were repeated TACE (27.3%) procedures. In 56.1% of the patients, ≥90% (near-complete) tumor necrosis was achieved. Concordance between mRECIST criteria and pathology was observed in 63% of the patients, with an underestimation of tumor response in 18 (27%) patients and an overestimation in 6 (9.1%). Near-complete tumor necrosis upon pathological analysis was associated with tumor hyper-enhancement in the arterial phase (P = 0.002), "typical tumor enhancement" (P = 0.010) and smooth tumor margins (p = 0.011). The multivariate analysis showed that well circumscribed HCCs with smooth margins and arterial hyper-enhancement independently correlated with post-TACE near-complete histological tumor necrosis. CONCLUSIONS: The well circumscribed HCC lesions with arterial hyper-enhancement are more susceptible to TACE than lesions with arterial phase iso or hypo-enhancement and lesions with infiltrative appearance. Pre-TACE CT imaging may ease the selection of an optimal treatment strategy for bridging patients with HCC to liver transplantation.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Neoplasias Hepáticas/diagnóstico , Fígado/diagnóstico por imagem , Adulto , Idoso , Artérias/cirurgia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Feminino , Humanos , Fígado/patologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Transplante de Fígado , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Necrose , Critérios de Avaliação de Resposta em Tumores Sólidos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
BMC Surg ; 19(1): 160, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690302

RESUMO

BACKGROUND: Electrosurgical vessel sealers are gradually replacing conventional techniques such as ligation and clipping. Algorithms that control electrosurgical units (ESU), known as modes, are important for applications in different surgical disciplines. This chronic porcine animal study aimed to evaluate the safety and effectiveness of the novel thermoSEAL electrosurgical vessel sealing mode (TSM). The BiClamp® mode (BCM) of the renowned VIO® 300 D ESU served as control. BCM has been widely available since 2002 and has since been successfully used in many surgical disciplines. The TSM, for the novel VIO® 3 ESU, was developed to reduce sealing time and/or thermal lateral spread adjacent to the seal while maintaining clinical success rates. The primary aim of this study was to investigate the long-term and intraoperative seal quality of TSM. METHODS: The BiCision® device was used for vessel sealing with TSM and BCM in ten German Landrace pigs which underwent splenectomy and unilateral nephrectomy during the first intervention of the study. The seals were cut with the BiCision® knife. Ninety-nine arteries, veins and vascular bundles were chronically sealed for 5 or 21 days. Thereafter, during the second and terminal intervention of the study, 97 additional arteries and veins were sealed. The carotid arteries were used for histological evaluation of thermal spread. RESULTS: After each survival period, no long-term complications occurred with either mode. The intraoperative seal failure rates, i.e. vessel leaking or residual blood flow after the first sealing activation, were 2% with TSM versus 6% with BCM (p = 0.28). The sealing time was significantly shorter with TSM (3.5 ± 0.69 s vs. 7.3 ± 1.3 s, p < 0.0001). The thermal spread and burst pressure of arteries sealed with both modes were similar (p = 0.18 and p = 0.61) and corresponded to the histological evaluation. The measured tissue sticking parameter was rare with both modes (p = 0.33). Tissue charring did not occur. Regarding the cut quality, 97% of the seals were severed in the first and 3% in the second attempt (both with TSM and BCM). CONCLUSIONS: The novel TSM seals blood vessels twice as fast as the BCM while maintaining excellent tissue effect and clinical success rates. TRIAL REGISTRATION: Not applicable.


Assuntos
Algoritmos , Eletrocirurgia/métodos , Nefrectomia/métodos , Esplenectomia/métodos , Animais , Artérias/cirurgia , Eletrocoagulação , Feminino , Ligadura , Suínos , Veias
18.
Analyst ; 144(24): 7310-7317, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31686084

RESUMO

Due to ageing populations the number of tumors is increasing worldwide. Successful surgical treatment requires complete resection of tumors to reduce recurrence rates. To reach this goal, novel methods combining in vivo tumor and tumor margin detection with low invasive precision surgical tools are needed. Coherent anti-Stokes Raman scattering (CARS) imaging is a highly promising optical tool for visualizing tumors based on characteristic changes in tissue morphology and molecular composition, while fs-laser ablation is to date the most precise surgical tool established in ophthalmology. In this contribution, CARS imaging has been combined with fs-laser ablation as a new approach for image-guided precision surgery for the first time. CARS guided fs-ablation has been applied to ablate brain, liver, skin, muscular and vascular tissues with µm-precision using sub-100 fs pulses of µJ level. We demonstrate superior imaging performance and contrast as well as detection of tissue margins by coherent Raman microscopy in comparison to laser reflectance imaging. The combination of CARS-image-guided tissue ablation is a promising tool for minimally invasive surgeries particularly in the vicinity of functional structures in the future.


Assuntos
Terapia a Laser/métodos , Microscopia/métodos , Análise Espectral Raman/métodos , Animais , Artérias/cirurgia , Encéfalo/cirurgia , Bovinos , Procedimentos Cirúrgicos Dermatológicos/métodos , Cabeça/cirurgia , Humanos , Fígado/cirurgia , Camundongos , Músculos/cirurgia , Pescoço/cirurgia , Coelhos , Suínos
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