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1.
Medicine (Baltimore) ; 99(7): e19177, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049850

RESUMO

RATIONALE: Tooth extraction is a common dental surgical procedure. There is a possibility that various complications often occur during third molar tooth extractions. PATIENT CONCERNS: The authors report herein 2 cases of migration of a high-speed dental hand-piece bur during mandibular third molar extraction-one case with the iatrogenic foreign body migrating into the mandibular body and another case with the iatrogenic foreign body migrating into the floor of mouth are reported. DIAGNOSIS: The patient was diagnosed with the iatrogenic foreign body associated with mandibular third molar extraction by imaging examinations. INTERVENTIONS: The authors performed elective surgery to remove the foreign body under general anesthesia in Case 1, and performed emergency surgery to remove the foreign body under local anesthesia in Case 2. OUTCOMES: The foreign bodies were removed, and complete removal of the foreign bodies was confirmed by postoperative x-ray examination. The patients' postoperative courses were uneventful. LESSONS: The selection of adequate surgical procedures and instruments will prevent the occurrence of iatrogenic foreign bodies. If migration accidents occur, their positions should first be confirmed by imaging examinations. Dentists and/or oral surgeons should perform removal operations considering the degree of emergency based on the results of imaging examinations.


Assuntos
Migração de Corpo Estranho/etiologia , Dente Serotino/cirurgia , Extração Dentária/efeitos adversos , Adulto , Feminino , Migração de Corpo Estranho/cirurgia , Humanos
2.
J Vasc Access ; 21(1): 33-38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31159638

RESUMO

The Infusional Services Team at a large cancer centre in Belfast, Northern Ireland, performed a cross-sectional analysis of two catheter securement technologies to address an area of frequent, but underestimated concern - peripherally inserted central catheter migration and dislodgement. Healthcare practitioner and patient feedback, along with economic impact, were assessed. The costs associated with catheter replacement during the adhesive device group study period were calculated using an average cost per insertion, based on material costs required for the procedure. Other factors were the replacement cost of the adhesive engineered securement device with each dressing change. In the subcutaneous securement group, the material costs were adjusted for use of the subcutaneous device as it remained in situ for the duration of the catheters' dwell time. This review found that subcutaneous securement offers both patient and facilities a safe, effective and economical alternative for device securement with patients who are unable to tolerate or have successful securement with adhesive securement devices. The use of subcutaneous devices provided for reduced risks for peripherally inserted central catheters in terms of dislodgement, migration or malposition, alleviating the potential risks to develop catheter-related thrombosis and device-related infection.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Migração de Corpo Estranho/prevenção & controle , Adesivos Teciduais/uso terapêutico , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/economia , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/economia , Cateteres de Demora/economia , Cateteres Venosos Centrais/economia , Pesquisa Comparativa da Efetividade , Análise Custo-Benefício , Estudos Transversais , Desenho de Equipamento , Migração de Corpo Estranho/economia , Migração de Corpo Estranho/etiologia , Custos de Cuidados de Saúde , Humanos , Irlanda do Norte , Fatores de Tempo , Adesivos Teciduais/efeitos adversos , Adesivos Teciduais/economia , Resultado do Tratamento
3.
Ann Vasc Surg ; 62: 30-34, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31201976

RESUMO

BACKGROUND: The Heli-FX EndoAnchor (EA) system is a transmural aortic fixation device with Federal Drug Administration (FDA) approval for treatment of endoleaks, endograft migration, or high-risk seal zones. Published data are primarily from industry-sponsored registries highlighting safety and efficacy. Our objective is to evaluate real-world outcomes of EA usage after FDA approval across a variety of stent grafts and indications at a single institution. METHODS: We retrospectively reviewed our prospectively maintained aneurysm database for patients undergoing endovascular aortic repair (EVAR) with Heli-FX EAs. Technical success was defined as successful EA deployment, while procedural success was defined as absence of endoleak on completion aortogram. Cohorts were divided by indication and outcomes assessed via review of clinical and radiographic data. RESULTS: From 2016 to 2018, 37 patients underwent EA fixation. We divided the cohort by indication: Group A (prior EVAR with endoleak), B (intraoperative type 1A endoleak), C (high-risk seal zone), and D (thoracic EVAR). In Group A (n = 11), all endoleaks were type 1A and a mean of 10 EAs were deployed with 100% technical and 45.4% procedural success. Two perioperative reinterventions were performed (translumbar coil embolization and proximal graft extension with bilateral renal artery stents). At a mean 10.6 months of follow-up, 45.4% of patients had persistent endoleaks, with 100% aortic-related survival. In Group B (n = 10), a mean of 8.7 EAs were used with 100% technical and procedural success. One immediate adverse event occurred (right iliac dissection from wire manipulation, treated with a covered stent). At 13.6-month mean follow-up, there was significant sac regression (mean 9.75 mm) with no type 1A endoleaks. In Group C (n = 10), a mean of 9.5 EAs were deployed with 100% technical and procedural success. At 11.2-month mean follow-up, there were no residual endoleaks and significant sac regression (mean 3.4 mm). Overall survival was 100%. In Group D (n = 6), a mean of 8.3 EAs were used with 83.3% technical and 66.6% procedural success. One immediate adverse event occurred, in which an EA embolized to the left renal artery. At 9.4-month mean follow-up, overall survival was 83.3% with a mean 2.2-mm increase in sac diameter. CONCLUSIONS: Early experience suggests that EAs effectively treat intraoperative type 1A endoleaks and high-risk seal zones, with significant sac regression and no proximal endoleaks on follow-up. In patients treated for prior EVAR with postoperative type 1A endoleaks, fewer than half resolved after EA attempted repair. Further experience and longer term follow-up will be necessary to determine which patients most benefit from postoperative EA fixation.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Implante de Prótese Vascular/efeitos adversos , California , Bases de Dados Factuais , Endoleak/etiologia , Endoleak/terapia , Procedimentos Endovasculares/efeitos adversos , Feminino , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/terapia , Humanos , Masculino , Desenho de Prótese , Retratamento , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
Khirurgiia (Mosk) ; (12): 13-17, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825338

RESUMO

OBJECTIVE: To analyze postoperative complications of totally implantable central venous port system (TIPCVP) deployment and develop methods of their prevention. MATERIAL AND METHODS: The study involved 43 patients who underwent TIPCVP implantation through right-sided jugular access and 3 patients with migration of the catheter transferred to the Domodedovo Central City Hospital. RESULTS: There were four perioperative and one early postoperative complication. None of the complications was the reason for removal of TIPCVP. Pinch-off syndrome occurred in two patients who were operated in other hospitals and a catheter was inserted through the right subclavian vein. CONCLUSION: Injury of the carotid artery and pneumothorax can be avoided by ultrasound navigation during internal jugular vein puncture. Catheterization of the internal jugular vein is useful to avoid pinch-off syndrome. Migration of the catheter is successfully cured by endovascular methods.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Pneumotórax/prevenção & controle , Cateterismo Venoso Central/métodos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Remoção de Dispositivo , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/terapia , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/lesões , Pneumotórax/etiologia , Veia Subclávia/diagnóstico por imagem , Ultrassonografia de Intervenção
5.
Ann R Coll Surg Engl ; 101(8): e172-e177, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31672034

RESUMO

Intragastric balloons have been used as an invasive non-surgical treatment for obesity for over 30 years. Within the last 37 years, we have found only 27 cases reported in the literature of intestinal obstruction caused by a migrated intragastric balloon. We report the laparoscopic management of such a case and make observations from similar case presentations published in the literature. A 26-year-old woman had an intragastric balloon placed endoscopically for weight control 13 months previously. She presented to the emergency department with a four-day history of intermittent abdominal cramps and vomiting. Contrast enhanced computed tomography confirmed the presence of the intragastric balloon within the small bowel. At laparoscopic retrieval, the deflated intragastric balloon was found impacted in the terminal ileum approximately 15 cm from the ileocaecal valve. The balloon was retrieved by enterotomy and primary closure of the ileum without event. The risk of balloon deflation and subsequent migration increases over time but several published cases demonstrate that this complication can occur within six months of insertion. The initial approach to the treatment of migrated intragastric balloons causing small bowel obstruction should be determined by the location of impaction, severity of obstruction and the available skill set of the attending radiologist, endoscopist and/or surgeon. Balloons causing obstruction in the duodenum are likely amenable to endoscopic retrieval whereas impaction within the jejunum or ileum could be managed by percutaneous needle aspiration (in selected cases), endoscopy (double-balloon enteroscopy), laparoscopy or open surgery.


Assuntos
Migração de Corpo Estranho/cirurgia , Balão Gástrico/efeitos adversos , Doenças do Íleo/cirurgia , Obstrução Intestinal/cirurgia , Laparoscopia/métodos , Adulto , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/etiologia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obesidade/cirurgia , Tomografia Computadorizada por Raios X
6.
World Neurosurg ; 132: 292-294, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476459

RESUMO

BACKGROUND: Endovascular embolization is an important tool in the management of multiple pathologies as a preoperative adjunct in the care of arteriovenous malformations or vascular tumors. CASE DESCRIPTION: We report a case of delayed distal Onyx migration after surgical resection of a glomus vagale tumor, which had been preoperatively embolized. In this report, the patient underwent successful embolectomy of the migrated Onyx fragment using manual aspiration. CONCLUSIONS: This case represents the first in the literature to describe this potential delayed complication, as well as its management strategy.


Assuntos
Embolectomia/métodos , Migração de Corpo Estranho/cirurgia , Tumor Glômico/terapia , Neoplasias de Cabeça e Pescoço/terapia , Artéria Cerebral Média/cirurgia , Artéria Oftálmica/cirurgia , Polivinil , Tantálio , Adulto , Angiografia por Tomografia Computadorizada , Combinação de Medicamentos , Embolização Terapêutica , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Artéria Oftálmica/diagnóstico por imagem
7.
Rev Fac Cien Med Univ Nac Cordoba ; 76(3): 170-173, 2019 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-31465185

RESUMO

AIM: To compare the effect on epidural catheter migration of three different types of dressing used in labor. INTRODUCTION: Failure of labor epidural is due to multiple factors including catheter migration. Epidural catheter migration has been showed to be related to body mass index and patient position. The dressing technique also influences catheter migration and the risk of epidural failure. METHODS: Patients were randomly allocated to one of three groups based on type of dressing of labor epidural: TegadermTM (Group T), TegadermTM with sticky pad (Group P), and TegadermTM with Steri-StripTM (Group S). Measured variables included parity, gestational age, body mass index (BMI), level of puncture and distance of epidural catheter migration. RESULTS: There was an overall difference in epidural catheter migration (ECM) distance among different groups (p<0.05). Pairwise comparison revealed only a significant difference between groups P and T (0.76±1.35 vs. -0.14±1.03, p<0.01). CONCLUSION: Taping the lumbar epidural catheter used for labor analgesia with TegadermTM is inferior to TegadermTM with sticky pad or with Steri-StripTM in terms of catheter migration. There is no association of catheter migration and BMI.


Assuntos
Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Migração de Corpo Estranho/prevenção & controle , Complicações do Trabalho de Parto/prevenção & controle , Adulto , Analgesia Epidural/instrumentação , Analgesia Epidural/métodos , Analgesia Obstétrica/instrumentação , Analgesia Obstétrica/métodos , Bandagens , Índice de Massa Corporal , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Cateterismo Periférico/métodos , Feminino , Migração de Corpo Estranho/etiologia , Humanos , Complicações do Trabalho de Parto/etiologia , Gravidez , Fatores de Risco
8.
Vasc Endovascular Surg ; 53(7): 606-608, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31272303

RESUMO

Hydrophilic polymer coatings are now widely applied to catheters and other intravascular devices used in neurovascular, cardiovascular, and peripheral vascular procedures. Emboli consisting of these materials have been previously identified in biopsies and autopsies following pulmonary infarction, stroke, gangrene, or death. We report a case involving a nonhealing foot ulcer that appeared following cardiac catheterization, stenting, and automatic implanted cardiac defibrillator (AICD) implantation in a patient without other evidence of significant peripheral artery disease. An 85-year-old woman with chronic atrial fibrillation, aortic valve stenosis, and coronary artery disease underwent coronary stenting and AICD implantation for ventricular tachycardia and syncope. She developed a toe ulcer shortly thereafter, which did not respond to standard treatment. A histological examination following amputation of the toe found amorphous basophilic material in capillaries adjacent to the edge of the ulcer, which was similar to material associated with hydrophilic polymer coatings. Ischemia and infarcts following endovascular procedures should not be presumed to result from thrombus or vascular disease, even if intravascular devices appear intact or properly placed after the procedure. To help establish the incidence of ischemia caused by hydrophilic polymer device coatings, if excision of ischemic or infarcted tissue after endovascular procedures using coated devices becomes necessary, the tissue should be evaluated microscopically. Surgeons should also consider the tolerance of distal organs to infarct or ischemia when selecting coated intravascular devices.


Assuntos
Materiais Revestidos Biocompatíveis/efeitos adversos , Embolia/etiologia , Úlcera do Pé/etiologia , Migração de Corpo Estranho/etiologia , Isquemia/etiologia , Polímeros/efeitos adversos , Dedos do Pé/irrigação sanguínea , Idoso de 80 Anos ou mais , Amputação , Angiografia , Biópsia , Embolia/diagnóstico por imagem , Embolia/cirurgia , Feminino , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/fisiopatologia , Úlcera do Pé/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Interações Hidrofóbicas e Hidrofílicas , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Fluxo Sanguíneo Regional , Dedos do Pé/cirurgia , Resultado do Tratamento
9.
World J Gastroenterol ; 25(25): 3207-3217, 2019 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-31333312

RESUMO

BACKGROUND: Stent insertion can effective alleviate the symptoms of benign esophageal strictures (BES). Magnesium alloy stents are a good candidate because of biological safety, but show a poor corrosion resistance and a quick loss of mechanical support in vivo. AIM: To test the therapeutic and adverse effects of a silicone-covered magnesium alloy biodegradable esophageal stent. METHODS: Fifteen rabbits underwent silicone-covered biodegradable magnesium stent insertion into the benign esophageal stricture under fluoroscopic guidance (stent group). The wall reconstruction and tissue reaction of stenotic esophagus in the stent group were compared with those of six esophageal stricture models (control group). Esophagography was performed at 1, 2, and 3 weeks. Four, six, and five rabbits in the stent group and two rabbits in the control groups were euthanized, respectively, at each time point for histological examination. RESULTS: All stent insertions were well tolerated. The esophageal diameters at immediately, 1, 2 and 3 wk were 9.8 ± 0.3 mm, 9.7 ± 0.7 mm, 9.4 ± 0.8 mm, and 9.2 ± 0.5 mm, respectively (vs 4.9 ± 0.3 mm before stent insertion; P < 0.05). Magnesium stents migrated in eight rabbits [one at 1 wk (1/15), three at 2 wk (3/11), and four at 3 wk (4/5)]. Esophageal wall remodeling (thinner epithelial and smooth muscle layers) was found significantly thinner in the stent group than in the control group (P < 0.05). Esophageal injury and collagen deposition following stent insertion were similar and did not differ compared to rabbits with esophageal stricture and normal rabbits (P > 0.05). CONCLUSION: Esophageal silicone-covered biodegradable magnesium stent insertion is feasible for BES without causing severe injury or tissue reaction. Our study suggests that insertion of silicone-covered magnesium esophageal stent is a promising approach for treating BES.


Assuntos
Implantes Absorvíveis/efeitos adversos , Estenose Esofágica/terapia , Stents Metálicos Autoexpansíveis/efeitos adversos , Animais , Modelos Animais de Doenças , Falha de Equipamento , Estenose Esofágica/etiologia , Estudos de Viabilidade , Migração de Corpo Estranho/epidemiologia , Migração de Corpo Estranho/etiologia , Humanos , Magnésio/efeitos adversos , Coelhos , Silicones/efeitos adversos , Resultado do Tratamento
11.
Acta Orthop ; 90(5): 460-466, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31210081

RESUMO

Background and purpose - Uncemented monoblock cruciate retaining (CR) trabecular metal (TM) tibial components in total knee arthroplasty (TKA) work well in the long-term perspective in patients ≤ 60 years. Younger persons expect nearly normal knee flexion after TKA, but CR implants generally achieve less knee flexion compared with posterior stabilized (PS) implants. Cemented PS implants have higher revision rate than CR implants. Can an uncemented monoblock PS TM implant be used safely in younger patients? Patients and methods - 40 patients (49 knees) age ≤ 60 years with primary (20 knees) or posttraumatic osteoarthritis (OA) were operated with a high-flex TKA using an uncemented monoblock PS TM tibial component. Knees were evaluated with radiostereometric analysis (RSA) a mean 3 days (1-5) postoperatively, and thereafter at 6 weeks, 3 months, 1, 2, 5, and 9 years. Clinical outcome was measured with patient-related outcome measures (PROMs). Results - The implants showed a pattern of migration with initial large migration followed by early stabilization lasting up to 9 years, a pattern known to be compatible with good long-term results. Clinical and radiological outcome was excellent with 38 of the 40 patients being satisfied or very satisfied with the procedure and bone apposition to the entire implant surface in 46 of 49 knees. Mean knee flexion was 130°. 1 knee was revised at 3 months due to medial tibial condyle collapse. Interpretation - The uncemented monoblock PS TM implant works well in younger persons operated with TKA due to primary or secondary OA.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Falha de Prótese/etiologia , Adulto , Fatores Etários , Artroplastia do Joelho/efeitos adversos , Cimentação , Feminino , Seguimentos , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Estudos Prospectivos , Desenho de Prótese , Radiografia , Análise Radioestereométrica , Amplitude de Movimento Articular , Resultado do Tratamento
12.
Ann Vasc Surg ; 60: 478.e7-478.e14, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200037

RESUMO

Endovascular aneurysm sealing (EVAS) using the Nellix™ System was introduced in clinical practice with the aim of reducing the incidence of complications such as migration, endoleaks, and reinterventions after conventional endovascular aneurysm repair (EVAR). Although, initial efficacy data on this device have been encouraging, EVAS has also demonstrated to undergo adverse events. Herein, we report a case of Nellix graft explant due to endobags shrinkage after air bubble reabsorption leading to proximal type I A endoleak and stent migration. The focus of this article is on the importance of a more assiduous surveillance of this new device, in particular in those cases with air into the endobags immediately after the procedure; this surveillance should be aimed to timely identify complications which can otherwise lead to consequences that require open conversion.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular , Remoção de Dispositivo , Endoleak/cirurgia , Procedimentos Endovasculares/instrumentação , Migração de Corpo Estranho/cirurgia , Stents , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Desenho de Prótese , Reoperação , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
Int Urol Nephrol ; 51(6): 1053-1058, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31089944

RESUMO

PURPOSE: Peritoneal dialysis (PD) catheter tip migration accounts for the majority of cases of PD catheter malfunction. In this case series, we described our experiences of using a modified PD catheter implantation approach through a site that is lower than the site that is conventionally used, to reduce catheter malfunction. METHODS: We retrospectively identified 76 patients who received PD catheter implantation at the Affiliated Wujin Hospital of Jiangsu University, among whom 39 received the traditional approach of low-site insertion and 37 received a modified approach of very-low-site insertion. All participants were followed up for at least 2 years after PD catheter implantation, and the development of catheter dysfunction or death during this period was monitored. RESULTS: We found that the survival rate of the initially inserted catheter was 75.68% among the very-low-site group. This survival rate was significantly better than that observed among the low-site group (48.72%; p = 0.029). Kaplan-Meier curves of the initial catheter survival also showed that the catheter survival was significantly higher in the patients in the very-low-site group than those in the low-site group (log rank p = 0.012). Complications, such as catheter tip migration, were not observed in the very-low-site group, while tip migration occurred in 15.38% of the patients in the low-site group (very-low-site group vs low-site group: p = 0.039). CONCLUSIONS: A safe and simple PD catheter implantation can be performed either through the low-site approach or the very-low-site approach.


Assuntos
Cateterismo/métodos , Cateteres de Demora/efeitos adversos , Falha de Equipamento , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/prevenção & controle , Diálise Peritoneal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
15.
Ann Vasc Surg ; 60: 476.e7-476.e11, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075451

RESUMO

The Angio-Seal vascular closure device is used to reduce time to hemostasis after femoral artery puncture. Although rare, complications associated with Angio-Seal are significant, including infection, pseudoaneurysm formation, symptomatic femoral artery stenosis, and separation and embolization, leading to limb-threatening ischemia. This report describes Angio-Seal polymer anchor embolization to the tibioperoneal trunk successfully retrieved using the 8-French Indigo Aspiration System.


Assuntos
Malformações Arteriovenosas/terapia , Cateterismo Periférico , Remoção de Dispositivo/métodos , Artéria Femoral , Migração de Corpo Estranho/terapia , Mãos/irrigação sanguínea , Técnicas Hemostáticas/efeitos adversos , Claudicação Intermitente/terapia , Isquemia/terapia , Trombectomia/métodos , Dispositivos de Oclusão Vascular/efeitos adversos , Cateterismo Periférico/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Técnicas Hemostáticas/instrumentação , Humanos , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/etiologia , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Punções , Sucção , Resultado do Tratamento , Adulto Jovem
16.
Ann Vasc Surg ; 59: 307.e13-307.e16, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31075468

RESUMO

We report an unusual case of a 53-year-old male patient, previously undergone an extra-anatomic right-to-left iliofemoral bypass graft, who has developed gross hematuria after 4 months. The cystoscopic examination revealed a wall injury due to the presence of the graft crossing the bladder. Iatrogenic bladder injuries during vascular surgery are extremely rare. In the literature, only 11 cases of transvesical graft are reported. The complication has been resolved with the removal of the misplaced graft and the reconstruction of the bypass with silver-coated Dacron prosthesis. Despite the rarity of this complication, postoperative ultrasound of the bladder is recommended to timely detect any injury and adopt a correct surgical strategy.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Migração de Corpo Estranho/cirurgia , Doença Iatrogênica , Doença Arterial Periférica/cirurgia , Bexiga Urinária/cirurgia , Angiografia por Tomografia Computadorizada , Cistoscopia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Hematúria/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos , Desenho de Prótese , Resultado do Tratamento , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/lesões
17.
Ann Vasc Surg ; 60: 70-75, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075483

RESUMO

BACKGROUND: The aim of this study is to investigate the impact of proximal aortic diameter on outcome after endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms (AAAs). METHODS: This is a case-control (1:1) retrospective analysis of prospectively collected data on 732 AAA patients treated with EVAR in 2 university centers. Patients with an infrarenal neck diameter of 29-32 mm (wide neck, WN group) were compared with patients with a neck diameter of 26-28.9 mm (control group) matched for age, gender, and maximum aneurysmal sac diameter. Any patients treated outside the instructions for use of each endograft or with no adequate follow-up were excluded. The primary end point was any neck-related adverse event (a composite of type Ia endoleak, neck-related secondary intervention, and endograft migration) during follow-up. RESULTS: Sixty-four patients with a proximal neck diameter of 29-32 mm (WN group) were compared with a matched control group of 64 patients with a neck diameter of 26-28.9 mm (control group). Oversizing was significantly higher in the study group (17.9% vs. 15.5%, P = 0.001). Overall median available follow-up was 24 months (range 12-84) (WN group 24 months vs. control group 18.5 months, P = 0.943). Primary end point was recorded in 8 patients (12.5%) of the WN group and in 1 patient (1.6%) of the control group. Freedom from the primary end point at 36 months (standard error <10%) was 87.3% for the study versus 98.4% for the control group (log rank = 4.66, P = 0.03). On multiple regression analysis, the presence of a proximal aortic neck >29 mm was the only independent risk factor for neck-related adverse events (odds ratio 7.4, 95% confidence interval 1.2-47.1). CONCLUSIONS: EVAR in the presence of a wide proximal aortic neck is likely to be associated with higher adverse neck-related event rates and thus, in such cases closer follow-up may be required.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Migração de Corpo Estranho/etiologia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Endoleak/diagnóstico por imagem , Endoleak/terapia , Procedimentos Endovasculares/instrumentação , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/terapia , Grécia , Humanos , Masculino , Intervalo Livre de Progressão , Retratamento , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
18.
BMC Musculoskelet Disord ; 20(1): 260, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31142310

RESUMO

BACKGROUND: The risk of posterior cage migration (PCM) exists when a fusion cage is used for transforaminal lumbar interbody fusion (TLIF). This complication is influenced by contact pressure between the endplate and the cage. Previous reports demonstrated that anteriorly located cages bore more load and had greater strain than posteriorly located cages. However, there have been no detailed reports on the correlation between cage positioning and PCM. METHODS: From March 2014 to October 2015, we reviewed 953 patients receiving open transforaminal lumbar interbody fusion (TLIF) and bilateral pedicle screw instrumentation. One hundred patients without PCM were randomly sampled as the control group. Postoperative sagittal and coronal cage positions in the disc space were evaluated with the 'depth ratio' and the 'coronal ratio'. The demographic data of patients with and without PCM were compared to detect patient-related factors. Radiographic and cage related parameters, including cage position, preoperative disc height, preoperative spine stability, cage geometry, cage size, and height variance (= cage height - preoperative disc height) were compared between the PCM group and the control group. Univariate analyses and a multivariate logistic model were used to identify risk factors of PCM. RESULTS: Posterior cage migration occurred in 24 (2.52%) of 953 patients. The univariate and multivariate analyses revealed that those with a decreased depth ratio (OR, 9.78E-4; 95% CI, 9.69E-4 - 9.87E-4; p < 0.001) and height variance (OR, 0.757, 95% CI, 0.575-0997, p = 0.048) had a significantly higher risk of developing PCM. CONCLUSIONS: Our results verified that posteriorly located cages and undersized cages are more prone to developing PCM, which may aid surgeons in making optimal decisions during TLIF procedures.


Assuntos
Migração de Corpo Estranho/epidemiologia , Fixadores Internos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Idoso , Estudos de Casos e Controles , Tomada de Decisão Clínica , Feminino , Seguimentos , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Disco Intervertebral/anatomia & histologia , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Vértebras Lombares/anatomia & histologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/patologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos
20.
BMC Ophthalmol ; 19(1): 120, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138164

RESUMO

BACKGROUND: This study aimed to investigate the incidence of and risk factors for the anterior chamber migration of an intravitreal dexamethasone implant (Ozurdex®). METHODS: A retrospective review of 640 consecutive intravitreal dexamethasone implant injections was conducted from February 2011 through February 2018 at the University Eye Hospital in Tübingen, Germany. Those patients who experienced anterior chamber dexamethasone implant migrations were identified, as well as the reasons for the anterior chamber migration. The surgical histories were obtained and comprehensive ophthalmic examinations were conducted for all of the eyes. Cross-tabulations, chi-squared tests, and Fisher's exact tests were used to assess the influences of different factors on the anterior chamber implant migrations. RESULTS: Overall, 4 eyes of four patients (0.63%) showed anterior chamber implant migrations. All four of the eyes were pseudophakic, and they had undergone prior vitrectomies. Three eyes had sclerally-fixated intraocular lenses, and one eye had a posterior chamber intraocular lens in the capsular bag, with a capsular tension ring due to partial zonular dehiscence. When comparing the vitrectomized eyes with reduced zonular/capsular bag complex integrity to the vitrectomized pseudophakic eyes with intact zonular/capsular bags, the former were significantly associated with an increased risk of anterior chamber implant migration (P = 0.008). The vitrectomized pseudophakic eyes, in contrast to the nonvitrectomized pseudophakic eyes, were significantly associated with an increased risk of anterior chamber implant migration (P = 0.009). CONCLUSIONS: The anterior chamber migration of an intravitreal dexamethasone implant is a serious complication. To minimize the risk of permanent corneal edema, immediate removal of the implant with a 20-gauge alligator forceps over a 2.75-mm long clear corneal tunnel is important. Those patients with insufficient zonular support, defects, or missing posterior capsular membranes and vitrectomy histories present a high risk of anterior chamber dexamethasone implant migration.


Assuntos
Câmara Anterior/patologia , Dexametasona/administração & dosagem , Implantes de Medicamento/efeitos adversos , Migração de Corpo Estranho/etiologia , Glucocorticoides/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Migração de Corpo Estranho/epidemiologia , Alemanha/epidemiologia , Humanos , Incidência , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
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