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1.
J Vasc Interv Radiol ; 31(7): 1139-1142.e1, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32534976

RESUMO

Gastric distension through insufflation is a key step in creating a safe percutaneous window during gastrostomy/gastrojejunostomy (G/GJ) placement; however, poor or incomplete gastric distention can occur, despite the use of glucagon, and lead to rapid egress of air from the stomach into the duodenum. This report describes the adjunctive technique using postpyloric balloon occlusion in 29 patients to maximize gastric insufflation during G/GJ tube placement after failure of conventional methods. Balloon occlusion was successful in salvaging 23 of 29 (79.3%) of G/GJ tube placements without any complications.


Assuntos
Oclusão com Balão/instrumentação , Nutrição Enteral/instrumentação , Derivação Gástrica/instrumentação , Gastrostomia/instrumentação , Insuflação/instrumentação , Adolescente , Fatores Etários , Oclusão com Balão/efeitos adversos , Criança , Pré-Escolar , Nutrição Enteral/efeitos adversos , Feminino , Derivação Gástrica/efeitos adversos , Obstrução da Saída Gástrica/etiologia , Gastrostomia/efeitos adversos , Humanos , Lactente , Recém-Nascido , Insuflação/efeitos adversos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
2.
J Trauma Acute Care Surg ; 89(1): 58-67, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32569103

RESUMO

OBJECTIVES: Partial restoration of aortic flow during resuscitative endovascular balloon occlusion of the aorta (REBOA) is advocated by some to mitigate distal ischemia. Our laboratory has validated the mechanics and optimal partial REBOA (pREBOA) flow rates using a prototype device. We hypothesize that pREBOA will increase survival when compared with full REBOA (fREBOA) in prolonged nonoperative management of hemorrhagic shock. METHODS: Twenty swine underwent placement of aortic flow probes, zone 1 REBOA placement, and 20% blood volume hemorrhage. They were randomized to either solid organ or abdominal vascular injury. The pREBOA arm (10 swine) underwent full inflation for 10 minutes and then deflation to a flow rate of 0.5 L/min for 2 hours. The fREBOA arm (10 swine) underwent full inflation for 60 minutes, followed by deflation/resuscitation. The primary outcome is survival, and secondary outcomes are serologic/pathologic signs of ischemia-reperfusion injury and quantity of hemorrhage. RESULTS: Two of 10 swine survived in the fREBOA group (2/5 solid organ injury; 0/5 abdominal vascular injury), whereas 7 of 10 swine survived in the pREBOA group (3/5 solid organ injury, 4/5 abdominal vascular injury). Survival was increased (p = 0.03) and hemorrhage was higher in the pREBOA group (solid organ injury, 1.36 ± 0.25 kg vs. 0.70 ± 0.33 kg, p = 0.007; 0.86 ± 0.22 kg vs. 0.71 ± 0.28 kg, not significant). Serum evidence of ischemia was greater with fREBOA, but this was not significant (e.g., lactate, 16.91 ± 3.87 mg/dL vs. 12.96 ± 2.48 mg/dL at 120 minutes, not significant). Swine treated with pREBOA that survived demonstrated trends toward lower alanine aminotransferase, lower potassium, and higher calcium. The potassium was significantly lower in survivors at 60 minutes and 90 minutes time points (5.97 ± 0.60 vs. 7.53 ± 0.90, p = 0.011; 6.67 ± 0.66 vs. 8.15 ± 0.78, p = 0.029). Calcium was significantly higher at 30 minutes, 60 minutes, and 90 minutes (8.56 ± 0.66 vs. 7.50 ± 0.40, p = 0.034; 8.63 ± 0.62 vs. 7.15 ± 0.49, p = 0.019; 8.96 ± 0.64 vs. 7.00, p = 0.028). CONCLUSION: Prolonged pREBOA at a moderate distal flow rate provided adequate hemorrhage control, improved survival, and had evidence of decreased ischemic injury versus fREBOA. Prophylactic aggressive calcium supplementation may have utility before and during the reperfusion phase.


Assuntos
Aorta , Oclusão com Balão/instrumentação , Fígado/lesões , Traumatismo por Reperfusão/terapia , Ressuscitação/instrumentação , Choque Hemorrágico/terapia , Animais , Modelos Animais de Doenças , Suínos
4.
Vascular ; 28(5): 612-618, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32356682

RESUMO

OBJECTIVES: Resuscitative endovascular balloon occlusion of the aorta is an alternative to resuscitative thoracotomy in non-compressible torso haemorrhage. Low-profile, compliant balloon catheter systems have been developed, which can be deployed without the need for fluoroscopy. However, concern exists for over inflation and aortic injury, especially as compliant balloon material can stretch reducing syringe feedback and limiting the effectiveness of a safety valve. An alternative material would be a semi-compliant balloon material, but its performance is unknown. The aim of this study was to compare the inflation characteristics of compliant versus semi-compliant balloon systems and to determine whether a pressure relief safety valve can be practically applied to a semi-compliant balloon catheter as a safety device. METHODS: This was an ex vivo study using porcine segments of thoracic aorta. The study consisted of two phases. The first phase involved intermittent inflation of six compliant balloon and six semi-compliant balloon balloons until balloon or aortic rupture. In the second phase, six semi-compliant balloons with the pressure-relief valve set at 0.45 atmospheres were inflated in the aortas until the valve release, followed by injection with additional 30 mL. Data including pressure, volume, balloon working length, diameter and circumferential stretch ratio were collected. RESULTS: At failure, mean balloon volume was almost double in compliant balloon group vs semi-compliant balloon group - 49.83 mL (±23.25) and 25.16 mL (±8.93), respectively (p = 0.004), with 36% increase in working length in the compliant balloon group - 81.17 mm (±19.11) vs 59.49 (±4.86) for semi-compliant balloon (p = 0.023). When plotted, the relationship pattern between volume and pressure fit a linear model for the compliant balloon, and a quadratic model for the semi-compliant balloon. Following attempted over inflation with the pressure valve, there was no change in parameters before and after attempted over inflation. CONCLUSIONS: The inflation profile differs between balloon designs. In contrast to semi-compliant balloons, compliant balloons will accommodate more volume to mitigate increase in pressure. This does not completely eliminate the risk of over inflation. The inflation characteristics of the semi-compliant balloon permit pairing it with a safety valve, which could lead to a development of a safer balloon technology in the future.


Assuntos
Aorta Torácica , Oclusão com Balão/instrumentação , Procedimentos Endovasculares/instrumentação , Dispositivos de Acesso Vascular , Animais , Desenho de Equipamento , Análise de Falha de Equipamento , Pressão , Sus scrofa
5.
J Trauma Acute Care Surg ; 89(3): 464-473, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32467463

RESUMO

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable technique for management of noncompressible torso hemorrhage. The major limitation of the current unilobed fully occlusive REBOA catheters is below-the-balloon ischemia-reperfusion complications. We hypothesized that partial aortic occlusion with a novel bilobed partial (p)REBOA-PRO would result in the need for less intraaortic balloon adjustments to maintain a distal goal perfusion pressure as compared with currently available unilobed ER-REBOA. METHODS: Anesthetized (40-50 kg) swine randomized to control (no intervention), ER-REBOA, or pREBOA-PRO underwent supraceliac aortic injury. The REBOA groups underwent catheter placement into zone 1 with initial balloon inflation to full occlusion for 10 minutes followed by gradual deflation to achieve and subsequently maintain half of the baseline below-the-balloon mean arterial pressure (MAP). Physiologic data and blood samples were collected at baseline and then hourly. At 4 hours, the animals were euthanized, total blood loss and urine output were recorded, and tissue samples were collected. RESULTS: Baseline physiologic data and basic laboratories were similar between groups. Compared with control, interventions similarly prolonged survival from a median of 18 minutes to over 240 minutes with comparable mortality trends. Blood loss was similar between partial ER-REBOA (41%) and pREBOA-PRO (51%). Partial pREBOA-PRO required a significantly lower number of intraaortic balloon adjustments (10 ER-REBOA vs. 3 pREBOA-PRO, p < 0.05) to maintain the target below-the-balloon MAP. The partial ER-REBOA group developed significantly increased hypercapnia, fibrin clot formation on TEG, liver inflammation, and IL-10 expression compared with pREBOA-PRO. CONCLUSION: In this highly lethal aortic injury model, use of bilobed pREBOA-PRO for a 4-hour partial aortic occlusion was logistically superior to unilobed ER-REBOA. It required less intraaortic balloon adjustments to maintain target MAP and resulted in less inflammation.


Assuntos
Aorta , Oclusão com Balão/instrumentação , Fígado/lesões , Traumatismo por Reperfusão/terapia , Ressuscitação/instrumentação , Choque Hemorrágico/terapia , Animais , Doenças da Aorta , Modelos Animais de Doenças , Feminino , Distribuição Aleatória , Suínos , Lesões do Sistema Vascular/complicações
6.
Med Sci Monit ; 26: e919059, 2020 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-32231175

RESUMO

BACKGROUND The purpose of our research was to evaluate the relationships between blood viscosity and recanalization of coiled intracranial aneurysms. MATERIAL AND METHODS The study included consecutives patients treated endovascularly by a team of experienced neurosurgeons and neuroradiologists due to brain aneurysm. A total of 50 patients (the average age was 57.48 years, SD=13.71) were assigned to 2 groups: group A with recanalization (4 male and 8 female patients) and group B without recanalization (10 male and 28 female patients) were examined. All patients underwent a 6-month follow-up of the whole-blood viscosity test with a Brookfield DV III+pro cone-plate viscometer using the Rheocalc program. Differences between groups were assessed using the Statistica 12 computer program (StatSoft Inc., Tulsa, OK, USA). RESULTS Studies have shown no significant difference in the age range between group A and B (P=0.31). In group A, higher viscosity values were found for whole blood [median: 4.14 dyn×sec/cm² (mPa×sec) quartile range 0.42], compared to group B [median: 3.92 dyn×sec/cm² (mPa×sec); quartile range 0.40; (P=0.04)]. This difference was significant (P=0.04). Additionally, the level of hematocrit was positively related with recanalization, the higher the hematocrit, the more frequent recanalization. A very strong and statistically significant relationship occurred between the frequency of recanalization and smoking (P<0.001). CONCLUSIONS The occurrence of higher values of whole blood viscosity which increase turbulent flow through the vessels may be a risk for recanalization of the coiled intracranial aneurysm.


Assuntos
Oclusão com Balão/efeitos adversos , Viscosidade Sanguínea/fisiologia , Procedimentos Endovasculares/efeitos adversos , Aneurisma Intracraniano/terapia , Fumar/epidemiologia , Adulto , Idoso , Oclusão com Balão/instrumentação , Oclusão com Balão/métodos , Angiografia Cerebral , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Seguimentos , Hematócrito , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/fisiopatologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fumar/fisiopatologia , Resultado do Tratamento
7.
J Surg Res ; 253: 18-25, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32311580

RESUMO

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular adjunct to hemorrhage control. Success relies on institutional support and focused training in arterial access. We hypothesized that hospitals with higher REBOA volumes will be more successful than low-volume hospitals at aortic occlusion with REBOA. METHODS: This is a retrospective study from the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery Registry from November 2013 to January 2018. Patients aged ≥18 y who underwent REBOA were included. Successful placement of REBOA catheters (defined as hemodynamic improvement with balloon inflation) was compared between high-volume (≥80 cases; two hospitals), mid-volume (10-20 cases; four hospitals), and low-volume (<10 cases; 14 hospitals) hospitals, adjusting for patient factors. RESULTS: Of 271 patients from 20 hospitals, 210 patients (77.5%) had successful REBOA placement. Most patients were male (76.0%) and sustained blunt trauma (78.1%). cardiopulmonary resuscitation (CPR) was ongoing at the time of REBOA placement in 34.5% of patients. Inpatient mortality was 67.4%, unchanged by hospital volume. Multivariable logistic regression found increased odds of successful REBOA placement at high-volume versus low-volume hospitals (odds ratio [OR], 7.50; 95% confidence interval [CI], 2.10-27.29; P = 0.002) and mid-volume versus low-volume hospitals (OR, 7.82; 95% CI, 1.52-40.31; P = 0.014) and decreased odds among patients undergoing CPR during REBOA placement (OR, 0.10; 95% CI, 0.03-0.34; P < 0.001) when adjusting for age, sex, mechanism of injury, prehospital CPR, CPR on admission, transfer status, hospital location of REBOA placement, Glasgow Coma Scale ≤ 13, and injury severity. CONCLUSIONS: Hospitals with higher REBOA volumes were more likely to achieve hemodynamic improvement with REBOA inflation. However, mortality and complication rates were unchanged. Independent of hospital volume, ongoing CPR is associated with a decreased odds of successful REBOA placement.


Assuntos
Oclusão com Balão/métodos , Reanimação Cardiopulmonar/educação , Procedimentos Endovasculares/educação , Hemorragia/terapia , Complicações Pós-Operatórias/prevenção & controle , Traumatismos Torácicos/terapia , Adulto , Aorta/cirurgia , Oclusão com Balão/efeitos adversos , Oclusão com Balão/instrumentação , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Educação Médica Continuada/organização & administração , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Hemorragia/etiologia , Hemorragia/mortalidade , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/organização & administração , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Cirurgiões/educação , Traumatismos Torácicos/complicações , Traumatismos Torácicos/mortalidade , Resultado do Tratamento , Dispositivos de Acesso Vascular/efeitos adversos , Adulto Jovem
8.
J Trauma Acute Care Surg ; 89(3): 474-481, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32345903

RESUMO

Noncompressible torso hemorrhage in trauma is particularly lethal. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has the potential to stabilize these patients, but currently is contraindicated for major thoracic bleeding. The goal of this study was to evaluate the effect of REBOA on the hemodynamic and metabolic profile as well as its effect on early survival in a porcine model of thoracic hemorrhage and shock. METHODS: Forty-eight male Yorkshire swine (60-80 kg) underwent 30% hemorrhage and were randomized to three thoracic injuries, with and without zone 1 REBOA occlusion: pulmonary parenchymal injury, thoracic venous injury, or subclavian artery injury. Following hemorrhage, thoracic injuries were induced (time of major thoracic injury) and allowed to bleed freely. The REBOA groups had zone 1 occlusion after the thoracic injury, with deflation at the end of prehospital. All groups had whole blood resuscitation at the end of prehospital and were euthanized at end of the hospital care phase. Survival, total blood loss, mean arterial pressure, end-tidal CO2, and arterial blood gas parameters were analyzed. Statistical significance was determined by t tests and two-way repeated-measures analysis of variance. RESULTS: The use of REBOA improved the hemodynamics in all three injury patterns, with no differences observed in the outcomes of short-term survival and thoracic blood loss between the REBOA and non-REBOA groups. All groups showed equivalent changes in markers of shock (pH, HCO3, and base excess) prior to resuscitation. CONCLUSION: In this animal study of hemorrhage and major thoracic bleeding, the addition of zone 1 REBOA did not significantly affect short-term survival or blood loss, while providing hemodynamic stabilization. Therefore, in noncompressible thoracic bleeding, without immediate surgical capability, long-term outcomes may be improved with REBOA, and thoracic hemorrhage should not be considered contraindications to REBOA use.


Assuntos
Aorta , Oclusão com Balão/instrumentação , Ressuscitação/instrumentação , Choque Hemorrágico/terapia , Traumatismos Torácicos/terapia , Animais , Modelos Animais de Doenças , Hemodinâmica , Masculino , Suínos , Pesquisa Médica Translacional , Lesões do Sistema Vascular
10.
J Trauma Acute Care Surg ; 89(2S Suppl 2): S83-S87, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32176174

RESUMO

We believe that the rapid and widespread adoption of resuscitative endovascular balloon occlusion of the aorta as well as enthusiasm for catheter-based strategies has led to increased interest in basic endovascular techniques among trauma surgeons. The aim of this article was to describe the most commonly performed endovascular procedures for trauma patients, the basic capital equipment and room set up, and a parsimonious inventory of disposable supplies needed to perform each procedure. Together, these make a standardized trauma-specific endovascular inventory. LEVEL OF EVIDENCE: Economic/decision, level V.


Assuntos
Oclusão com Balão/instrumentação , Procedimentos Endovasculares/instrumentação , Traumatologia/instrumentação , Aorta/diagnóstico por imagem , Aortografia , Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Humanos , Ressuscitação/métodos , Traumatologia/educação , Traumatologia/métodos
12.
Dig Dis Sci ; 65(9): 2483-2491, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32002756

RESUMO

Hepatic Encephalopathy (HE) is a complication of liver disease, consisting of brain dysfunction often due to portosystemic shunting of blood flow in the liver. HE can range from minimal HE, presenting with normal neurological function, to overt HE, with neurological and neuropsychiatric abnormalities. Various clinical grading systems are used to differentiate HE to provide the appropriate treatments. Traditional treatment of HE aims to identify and resolve precipitating factors through targeting hyperammonemia and administering antibiotics or probiotics. While retrograde transvenous obliteration (RTO), including balloon-occluded retrograde transvenous obliteration, coil-assisted retrograde transvenous obliteration or plug-assisted retrograde tranvenous obliteration, is an established procedure to manage gastric varices, little is known about its potential to treat HE. RTO is a procedure to occlude a spontaneous portosystemic shunt, minimizing shunting of portal blood to systemic circulation. Though there is not a large study with HE patients who have undergone RTO; the results appear promising in reducing HE. Side effects, however, should be considered in the treatment of HE such as the transient worsening of portal hypertension and the formation of additional shunts. While additional studies are needed to assess the long-term success, RTO appears to be an effective alternative method to alleviate clinical symptoms of HE when pharmacological therapies and other conservative medical managements have failed.


Assuntos
Oclusão com Balão , Embolização Terapêutica , Encefalopatia Hepática/terapia , Circulação Hepática , Oclusão com Balão/efeitos adversos , Oclusão com Balão/instrumentação , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/fisiopatologia , Humanos , Índice de Gravidade de Doença , Resultado do Tratamento
14.
J Trauma Acute Care Surg ; 88(2): 298-304, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31996655

RESUMO

BACKGROUND: Partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) and intermittent REBOA (iREBOA) are techniques to extend the therapeutic duration of REBOA by balloon titration for distal flow or cyclical balloon inflation/deflation to allow transient distal flow, respectively. We hypothesized that manually titrated pREBOA would reduce blood losses and ischemic burden when compared with iREBOA. METHODS: Following 20% blood volume controlled hemorrhage, 10 anesthetized pigs underwent uncontrolled hemorrhage from the right iliac artery and vein. Once in hemorrhagic shock, animals underwent 15 minutes of complete zone 1 REBOA followed by 75 minutes of either pREBOA or iREBOA (n = 5/group). After 90 minutes, definitive hemorrhage control was obtained, animals were resuscitated with the remaining collected blood, and then received 2 hours of critical care. RESULTS: There were no differences in mortality. Animals randomized to iREBOA spent a larger portion of the time at full occlusion when compared with pREBOA (median, 70 minutes; interquartile range [IQR], 70-80 vs. median, 20 minutes; IQR, 20-40, respectively; p = 0.008). While the average blood pressure during the intervention period was equivalent between groups, this was offset by large fluctuations in blood pressure and significantly more rescue occlusions for hypotension with iREBOA. Despite lower maximum aortic flow rates, the pREBOA group tolerated a greater total amount of distal aortic flow during the intervention period (median, 20.9 L; IQR, 20.1-23.0 vs. median, 9.8 L; IQR, 6.8-10.3; p = 0.03) with equivalent abdominal blood losses. Final plasma lactate and creatinine concentrations were equivalent, although iREBOA animals had increased duodenal edema on histology. CONCLUSION: Compared with iREBOA, pREBOA reduced the time spent at full occlusion and the number of precipitous drops in proximal mean arterial pressure while delivering more distal aortic flow but not increasing total blood loss in this highly lethal injury model. Neither technique demonstrated a survival benefit. Further refinement of these techniques is necessary before clinical guidelines are issued.


Assuntos
Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Ressuscitação/métodos , Choque Hemorrágico/terapia , Ferimentos e Lesões/terapia , Animais , Aorta/cirurgia , Oclusão com Balão/efeitos adversos , Oclusão com Balão/instrumentação , Modelos Animais de Doenças , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Ressuscitação/efeitos adversos , Ressuscitação/instrumentação , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Análise de Sobrevida , Sus scrofa , Fatores de Tempo , Índices de Gravidade do Trauma , Resultado do Tratamento , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico
15.
J Minim Invasive Gynecol ; 27(1): 94-99, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31212071

RESUMO

STUDY OBJECTIVE: Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy, and a significant concern in the management of this condition is the control and prevention of bleeding. We aimed to determine the efficacy and value of an indwelling, intrauterine Foley balloon catheter in controlling and preventing intraoperative and postoperative bleeding in patients with CSP. DESIGN: Retrospective case series. SETTING: University-affiliated hospital. PATIENTS: Between January 1, 2015 and May 31, 2017, 70 patients presented with CSP. INTERVENTIONS: All patients underwent uterine curettage under hysteroscopic guidance and ultrasound monitoring. Patients were then assigned to 2 groups: the study group, with an indwelling Foley balloon catheter placed in the uterine cavity during surgery and retained for 24 to 48 hours, and the control group, without catheter placement. Data were collected to compare the 2 groups in terms of intraoperative and postoperative complications, surgical time, and status of menstruation resumption. MEASUREMENTS AND MAIN RESULTS: The average daily volume of postoperative blood loss during the first 3 postoperative days in the study group was 23.1 mL compared with 31.5 mL observed in the control group (p = .041). Moreover, the study group had significantly shorter average duration of bleeding (p = .027) and fewer menstruation abnormalities than the control group. Uterine ultrasonography performed after resumption of menstruation showed that none of the enrolled patients had any intrauterine abnormalities. CONCLUSIONS: The use of an indwelling, intrauterine Foley balloon catheter has positive results in the management of CSP.


Assuntos
Oclusão com Balão , Cesárea/efeitos adversos , Cicatriz/cirurgia , Hemorragia Pós-Operatória/terapia , Gravidez Ectópica/terapia , Cateterismo Urinário , Adulto , Oclusão com Balão/efeitos adversos , Oclusão com Balão/instrumentação , Oclusão com Balão/métodos , Estudos de Casos e Controles , Cateteres de Demora/efeitos adversos , Cicatriz/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Hemorragia Pós-Operatória/etiologia , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Útero/cirurgia
16.
J Robot Surg ; 14(3): 473-477, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31463880

RESUMO

Catastrophic bleeding is a feared complication of robotic abdominal procedures that involve dissection in close proximity to major vessels. In the event of uncontrollable hemorrhage, standard practice involves emergency undocking with conversion to laparotomy. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a rapid and life-saving technique gaining acceptance in the trauma setting for the management of catastrophic hemorrhage. The purpose of this study was to evaluate feasibility of REBOA for emergency hemostasis during robotic surgery. The surgical robot was docked to a REBOA mannequin to simulate an upper abdominal surgery. A femoral arterial line was placed in the mannequin. Supplies needed for REBOA insertion were opened and arranged on the surgical back table. The surgeon was seated at the console with an assistant scrubbed. A catastrophic vascular injury was announced. The time it took the surgeon to achieve aortic occlusion by the REBOA was recorded. Four surgeons participated and performed three timed trials each. Each surgeon, irrespective of experience with REBOA or years in surgical practice, was able to obtain aortic occlusion in less than 2 min. The mean time to aortic occlusion for all surgeons was 111 s. No manipulation of the robotic arms was required to perform the procedure. Aortic occlusion was achieved rapidly with REBOA. Ability to achieve prompt aortic control was not associated with surgical experience or prior familiarity with the REBOA device. Prophylactic femoral access and preparation of supplies facilitates prompt placement of the occlusion balloon. REBOA should be considered as a viable alternative to open laparotomy for temporary hemorrhage control during robotic surgery.


Assuntos
Abdome/cirurgia , Aorta , Oclusão com Balão/métodos , Hemorragia/etiologia , Hemorragia/terapia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Treinamento por Simulação/métodos , Oclusão com Balão/instrumentação , Emergências , Estudos de Viabilidade , Humanos , Manequins , Índice de Gravidade de Doença
17.
Vasc Endovascular Surg ; 54(3): 214-219, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31878841

RESUMO

OBJECTIVES: This study aimed to assess the feasibility and results of double-lumen balloon-assisted embolization of visceral artery aneurysms (VAAs). METHODS: Nine patients (mean age, 55.3 ± 10.8 years) diagnosed with VAA (superior mesenteric, n = 5; splenic, n = 2; renal, n = 2) and undergoing double-lumen balloon-assisted embolization were included in this study. Magnetic resonance angiogram (MRA) was used in the 6-month follow-up to assess the aneurysms and patency of the parent arteries. RESULTS: All patients were successfully treated with no reports of morbidity or mortality. Residual filling of the aneurysm neck was detected in 2 patients at the end of the procedure, but those parts were found to be stable in the sixth-month MRA. In 1 patient with renal aneurysm, a stent had to be deployed using a double-lumen balloon catheter because of the prolapse of the coil into the main artery. In another patient with a very large-necked superior mesenteric artery aneurysm, additional coils could be used at the same time thanks to the double-lumen balloon as the coils were not stabilized enough during embolization with the microcatheter coils. Liquid embolic agent was also used in this patient from the same lumen because of the large diameter of the aneurysm. CONCLUSIONS: Double-lumen balloons, which are mostly used in neurointerventional procedures, can be efficiently used as in the treatment of VAAs due to their ability to deploy stent and perform coil-liquid embolization through 1 lumen.


Assuntos
Aneurisma/terapia , Oclusão com Balão/instrumentação , Dispositivos de Acesso Vascular , Vísceras/irrigação sanguínea , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Oclusão com Balão/efeitos adversos , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
18.
Cardiol Young ; 29(11): 1380-1386, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31502534

RESUMO

BACKGROUND: Although percutaneous closure of patent ductus arteriosus is an established safe procedure, protrusion of the device to descending aorta may occur in various degrees during these procedures, especially in small infants. The aim of our study is to evaluate the benefits of balloon-assisted device releasing technique in the era of preventing device protrusion and conditions related to protrusion. METHODS: One hundred and fifty-five infants, who underwent patent ductus arteriosus closure with Amplatzer duct occluder I device between January, 2012 and December, 2018, were retrospectively analysed. Balloon-assisted device releasing technique was used in 20 cases (group 1, 12.9%), between January, 2015 and December, 2018. Procedures in which the technique had been used were compared with the remaining ones (group 2, 87.1%, n = 135) with regard to device stabilisation, aortic disc protrusion to the aorta, iatrogenic coarctation, and device embolisation. RESULTS: There was no significant difference by means of gender, age, weight, and the ductal diameter, whereas the average mean pulmonary artery pressure was significantly higher in group 1. Device protrusion and related complications were significantly higher in group 2; thus, additional catheterisations or surgical interventions were required, while no additional intervention was required in group 1. CONCLUSION: The balloon-assisted device releasing technique provides a good device stabilisation and prevents protrusion of the device and related complications during percutaneous patent ductus arteriosus closure in selected cases.


Assuntos
Aorta Torácica/lesões , Oclusão com Balão/instrumentação , Cateterismo Cardíaco/instrumentação , Permeabilidade do Canal Arterial/cirurgia , Complicações Intraoperatórias/prevenção & controle , Dispositivo para Oclusão Septal/efeitos adversos , Lesões do Sistema Vascular/prevenção & controle , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Permeabilidade do Canal Arterial/diagnóstico , Desenho de Equipamento , Falha de Equipamento , Feminino , Seguimentos , Humanos , Doença Iatrogênica/prevenção & controle , Lactente , Masculino , Estudos Retrospectivos , Lesões do Sistema Vascular/etiologia
19.
J Card Surg ; 34(7): 620-623, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31212364

RESUMO

Heart Teams are increasingly confronted with decision-making in anatomically and clinically complex surgical candidates. Herein, we discuss the versatility of the endoaortic occlusion device (Intraclude; Edwards Lifesciences Inc) for the management of a various array of complex primary and reoperative cardiac cases. Three clinical scenarios are illustrated (ascending aortic pseudoaneurysm, mitral valve surgery after previous CABG, extensive thoracic aortic surgery with continuous visceral perfusion), suggesting the effectiveness of the patient-specific strategy to minimize operative morbidity. Evolution of surgical techniques needs to be considered in decision-making among alternative treatment strategies.


Assuntos
Falso Aneurisma/cirurgia , Aorta , Aneurisma Aórtico/cirurgia , Oclusão com Balão/instrumentação , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/cirurgia , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte de Artéria Coronária , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
20.
BMJ Case Rep ; 12(6)2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31164381

RESUMO

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been implemented in numerous countries. However, its use has not been widespread in (South) Africa, and when used, not well reported on. Further, REBOA has been performed with devices designed for other purposes. In this case report, we describe the use of a purpose designed device for image-free use in emergent haemorrhage control and resuscitation in a patient with multicavity penetrating trauma. Implications for the use of REBOA in these challenging cases is discussed, and a novel method of insertion of a REBOA catheter is presented.


Assuntos
Traumatismos Abdominais/cirurgia , Oclusão com Balão/instrumentação , Traumatismos Torácicos/cirurgia , Ferimentos Perfurantes/cirurgia , Traumatismos Abdominais/complicações , Aorta/lesões , Procedimentos Endovasculares , Desenho de Equipamento , Evolução Fatal , Humanos , Escala de Gravidade do Ferimento , Masculino , África do Sul , Traumatismos Torácicos/complicações , Tronco/lesões , Centros de Traumatologia , Adulto Jovem
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