Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 28.582
Filtrar
1.
J Clin Neurosci ; 90: 36-38, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275576

RESUMO

Ischaemic neuropathy is a rare phenomenon given the rich arterial collateral supply afforded to peripheral nerves by the vasa nervorum. We report an unusual case of unilateral foot drop secondary to long-segment popliteal artery occlusion. Without expedient vessel imaging and revascularisation of the occluded artery, this reversible cause of neurological deficit would likely have resulted in a poor functional outcome for our patient.


Assuntos
Neuropatias Fibulares/etiologia , Artéria Poplítea/patologia , Doenças Vasculares/complicações , Humanos , Isquemia/complicações , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Neuropatias Fibulares/patologia , Artéria Poplítea/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos
2.
Nutrients ; 13(6)2021 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-34199189

RESUMO

Nattokinase (NK) is a serine protease enzyme with fibrinolytic activity. Even if it could be used for the treatment of several diseases, no data have been published supporting its use patients who underwent vascular surgery. In this study, we evaluated both the efficacy and the safety of nattokinase (100 mg/day per os) in patients admitted to vascular surgery. Patients were of both sexes, >18 years of age, with vascular diseases (i.e., deep vein thrombosis, superficial vein thrombosis, venous insufficiency), and naïve to specific pharmacological treatments (anticoagulants or anti-platelets). Patients were divided into three groups. Group 1: patients with deep vein thrombosis, treated with fondaparinux plus nattokinase. Group 2: patients with phlebitis, treated with enoxaparin plus nattokinase. Group 3: patients with venous insufficiency after classical surgery, treated with nattokinase one day later. During the study, we enrolled 153 patients (age 22-92 years), 92 females (60.1%) and 61 males (39.9%;), and documented that nattokinase was able to improve the clinical symptoms (p < 0.01) without the development of adverse drug reactions or drug interactions. Among the enrolled patients, during follow-up, we did not record new cases of vascular diseases. Attention to patients' clinical evolution, monitoring of the INR, and timely and frequent adjustment of dosages represent the cornerstones of the safety of care for patients administered fibrinolytic drugs as a single treatment or in pharmacological combination. Therefore, we can conclude that the use of nattokinase represents an efficient and safe treatment able to both prevent and treat patients with vascular diseases.


Assuntos
Fibrinolíticos/uso terapêutico , Subtilisinas/uso terapêutico , Insuficiência Venosa/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Enoxaparina/uso terapêutico , Feminino , Fibrinolíticos/efeitos adversos , Fondaparinux/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Subtilisinas/efeitos adversos , Procedimentos Cirúrgicos Vasculares , Adulto Jovem
3.
Kyobu Geka ; 74(7): 558-560, 2021 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-34193795

RESUMO

A 67-year-old woman had sudden loss of consciousness and chest and back pain. She was transported by ambulance about two hours later. Computed tomography (CT) showed dissection of the aorta, the brachiocephalic artery and the right common carotid artery (RCCA). RCCA was completely obstructed. Emergency surgery was conducted one hour later. RCCA's blood flow was reestablished prior to hemi-arch replacement. Postoperative CT revealed diminishment of the false lumen and recovery of the blood flow of RCCA, and she was discharged on foot without any complications.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Tronco Braquiocefálico , Encéfalo , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/cirurgia , Feminino , Humanos , Procedimentos Cirúrgicos Vasculares
4.
Arch Esp Urol ; 74(6): 623-627, 2021 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-34219066

RESUMO

OBJECTIVE: Calcification and atherosclerosis of the iliac arteries is very common in dialysis patients, making sometimes impossible the anastomosis of a kidney graft. The objective of this study is to present our kidney transplantation series using vascular prostheses for iliacartery reconstruction and to assess the results obtained in comparison to other published series. MATERIAL AND METHOD: In a single centre where 1090 kidney transplants were performed between January 2013 and December 2019, patients who required vascular reconstruction were identified for their descriptive analysis. RESULTS: In 9 patients (0.83%) arterial anastomosis was performed to a Gore-tex prosthesis (8) or using a bovine pericardium patch (1). Only in 1 case, the vascular bypass was prior to transplantation; in the other 8 the surgery was simultaneous. In 2 cases, an urgent transplantectomy was done because of acute rejection and prosthetic thrombosis. 6 patients had immediate graft function. 5 patients requireda new surgical or endovascular procedure to resolve complications. At 35 months of mean follow-up, 7 patients maintained renal graft function. CONCLUSION: Kidney transplantation with arterial anastomosis to a vascular prosthesis is very rare. Candidates should be carefully selected because of the high risk ofcomplications. Simultaneous vascular reconstruction is preferred.  The functional results are satisfactory.


Assuntos
Transplante de Rim , Animais , Prótese Vascular , Bovinos , Humanos , Artéria Ilíaca , Rim , Estudos Retrospectivos , Procedimentos Cirúrgicos Vasculares
5.
BMJ Case Rep ; 14(5)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059528

RESUMO

Herein, we describe the use of a novel multiplug flow control technique for the curative transarterial embolisation of cerebrovascular malformations using liquid embolic agents (LEAs). The idea behind the use of this technique is to substantially control or arrest flow during LEA injection, with multiple plugs simultaneously formed from microcatheters that are placed within all or multiple feeders, so that the penetration of LEAs is facilitated, with flow control decreasing the washout of a malformation. This technique enables the complete occlusion of a vascular malformation in a shorter injection time than that in other methods because penetration is achieved faster. Details of this technique have been described in the treatment of two cases: one case of unruptured temporal arteriovenous malformation and in the other with a falcotentorial dural arteriovenous fistula, in which the vascular malformations were successfully occluded with transarterial embolisation.


Assuntos
Malformações Arteriovenosas , Malformações Vasculares do Sistema Nervoso Central , Embolização Terapêutica , Malformações Arteriovenosas/terapia , Malformações Vasculares do Sistema Nervoso Central/terapia , Humanos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
6.
EuroIntervention ; 17(3): 193-201, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34167938

RESUMO

A significant proportion of patients presenting with acute coronary syndromes (ACS) have multivessel disease (MVD). Despite the abundance of clinical trials in this area, several questions regarding the procedure of complete coronary revascularisation remain unanswered. This state-of-the-art review summarises the latest evidence on complete revascularisation (CR) in this subset of patients and critically appraises clinical decision making based on non-culprit lesion (NCL) assessment. Future areas of research are put into perspective.


Assuntos
Síndrome Coronariana Aguda , Angioplastia Coronária com Balão , Doença da Artéria Coronariana , Infarto do Miocárdio , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/cirurgia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Humanos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
7.
Semin Vasc Surg ; 34(2): 28-36, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34144744

RESUMO

Quality improvement programs and clinical trial research experienced disruption due to the coronavirus disease 2019 (COVID-19) pandemic. Vascular registries showed an immediate impact with significant declines in second-quarter vascular procedure volumes witnessed across Europe and the United States. To better understand the magnitude and impact of the pandemic, organizations and study groups sent grass roots surveys to vascular specialists for needs assessment. Several vascular registries responded quickly by insertion of COVID-19 variables into their data collection forms. More than 80% of clinical trials have been reported delayed or not started due to factors that included loss of enrollment from patient concerns or mandated institutional shutdowns, weighing the risk of trial participation on patient safety. Preliminary data of patients undergoing vascular surgery with active COVID-19 infection show inferior outcomes (morbidity) and increased mortality. Disease-specific vascular surgery study collaboratives about COVID-19 were created for the desire to study the disease in a more focused manner than possible through registry outcomes. This review describes the pandemic effect on multiple VASCUNET registries including Germany (GermanVasc), Sweden (SwedVasc), United Kingdom (UK National Vascular Registry), Australia and New Zealand (bi-national Australasian Vascular Audit), as well as the United States (Society for Vascular Surgery Vascular Quality Initiative). We will highlight the continued collaboration of VASCUNET with the Vascular Quality Initiative in the International Consortium of Vascular Registries as part of the Medical Device Epidemiology Network coordinated registry network. Vascular registries must remain flexible and responsive to new and future real-world problems affecting vascular patients.


Assuntos
Pesquisa Biomédica/estatística & dados numéricos , COVID-19/epidemiologia , Sistema de Registros , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , COVID-19/prevenção & controle , COVID-19/transmissão , Ensaios Clínicos como Assunto , Humanos , Utilização de Procedimentos e Técnicas , Melhoria de Qualidade
8.
Semin Vasc Surg ; 34(2): 3-7, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34144745

RESUMO

The spread of coronavirus disease 2019 has drastically altered the medical landscape and profoundly affected the way we conduct our vascular surgery practices. The pandemic was a time of change, not only in the way health care was provided, but also in how people in the health care systems interacted. Social media has rapidly become a crucial communication tool, combining physical distancing and digital connectedness. This article provides an overview of the use of online platforms in vascular surgery as a response of our community to the pandemic.


Assuntos
COVID-19/epidemiologia , Mídias Sociais , Especialidades Cirúrgicas , Telecomunicações , Procedimentos Cirúrgicos Vasculares , Humanos
9.
Semin Vasc Surg ; 34(2): 43-50, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34144747

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has placed significant strain on the health and welfare of all health care professionals, including vascular surgeons. This review summarizes the implications of the pandemic on the health and wellness of surgeons and trainees, with a particular focus on those in vascular surgery (VS). A literature review was completed using common resource databases. We provide a brief history of burnout in VS and explore burnout and wellness in VS during this unprecedented pandemic. We then offer recommendations to address mental health needs by the VS workforce and highlight opportunities to address the gaps in the literature. The impact of COVID-19 on the professional and personal lives of surgeons and trainees in VS is notable. More than half of vascular surgeons reported some degree of anxiety. Factors associated with anxiety and burnout include COVID-19 exposure, moral injury, practice changes, and financial impacts. Trainees appeared to have more active coping strategies with dampened rates of anxiety compared to those in practice. Women appear to be disproportionately affected by the pandemic, with higher rates of anxiety and burnout. Groups underrepresented in medicine seemed to have more resilience when it came to burnout, but struggled with other inequities in the health care environment, such as structural racism and isolation. Strategies for addressing burnout include mindfulness practices, exercise, and peer and institutional support. The COVID-19 pandemic has had a substantial mental health impact on the VS workforce globally, as shifts were made in patient care, surgical practice, and work-home life concerns.


Assuntos
Esgotamento Profissional/epidemiologia , COVID-19/epidemiologia , Saúde Mental/estatística & dados numéricos , Cirurgiões/psicologia , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Esgotamento Profissional/prevenção & controle , COVID-19/prevenção & controle , COVID-19/transmissão , Humanos
10.
Semin Vasc Surg ; 34(2): 37-42, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34144746

RESUMO

The coronavirus disease 2019 (COVID-19) outbreak has profoundly affected all aspects of medicine and surgery. Vascular surgery practice and interventions were also forced to change in order to deal with new COVID-19-related priorities and emergencies. In this setting, difficulties in aortic disease management were two-fold: new vascular complications related to COVID-19 infection and the need to guarantee prompt and correct treatment for the general "non-COVID-19" population. Furthermore, discomfort deriving from precautions to minimize the risk of virus transmission among patients and among health care professionals, the need to separate COVID-19-positive from COVID-19-negative patients, and the high incidence of postoperative complications in COVID-19 cases created a challenging scenario for cardiac operations. The aim of this review was to provide evidence derived from the published literature (case reports, case series, multicenter experience, and expert opinion) on the impact of the COVID-19 outbreak on aortic vascular surgery services and interventions, describing COVID-19-related findings, intraoperative and postoperative outcomes, as well as the impact of the COVID-19 outbreak on noninfectious aortic patients.


Assuntos
Doenças da Aorta/cirurgia , COVID-19/epidemiologia , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Doenças da Aorta/diagnóstico , COVID-19/prevenção & controle , COVID-19/transmissão , Utilização de Instalações e Serviços , Humanos , Utilização de Procedimentos e Técnicas
11.
Jt Dis Relat Surg ; 32(2): 383-390, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145815

RESUMO

OBJECTIVES: This study aims to evaluate the clinical results and experiences in a community hospital regarding procedures for the replantation and revascularization of fingers. PATIENTS AND METHODS: Between June 2015 and December 2019, a total of 58 patients (51 males, 7 females; mean age: 33.4±6.3 years; range, 23 to 46 years) who were followed after total and/or subtotal amputation and replantation were retrospectively analyzed. The patients were evaluated at nine months in terms of cold intolerance, static two-point discrimination, and functional results using the range of motion (ROM) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. RESULTS: The majority of the patients presented with work-related injuries (70%), most commonly by the mechanism of guillotine (64%), and to the dominant hand (76%) and the third finger (36%) most frequently. The overall success rate of digit salvage was 72.9% (n=51). Of 19 digits with unsuccessful surgical outcomes, seven were from total and 12 were from subtotal amputations. In the long-term, cold intolerance was observed in 14 patients (24.1%) according to the cold intolerance severity scale. The mean static two-point discrimination value was 6.0±0.7 mm and the mean QuickDASH score was 22.3±5.0. The mean ROM measured at nine months after surgery in the metacarpophalangeal and interphalangeal joints of the third and fourth digits was significantly lower than that in the others (p<0.05). CONCLUSION: The predictors of survival of a replanted digit indicated in this study can be used as a guide and decision-making aid for any attempts for replantation.


Assuntos
Amputação Traumática/cirurgia , Traumatismos dos Dedos/cirurgia , Hospitais Comunitários , Reimplante , Procedimentos Cirúrgicos Vasculares , Adulto , Temperatura Baixa/efeitos adversos , Feminino , Traumatismos dos Dedos/fisiopatologia , Articulações dos Dedos/fisiopatologia , Dedos/irrigação sanguínea , Dedos/fisiopatologia , Humanos , Masculino , Articulação Metacarpofalângica/fisiopatologia , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Inquéritos e Questionários , Tato , Resultado do Tratamento , Adulto Jovem
12.
BMJ Case Rep ; 14(6)2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187800

RESUMO

We report the case of a 78-year-old woman who presented with cardiovascular risk factors and a history of an atypical transient ischaemic attack. She was referred by her primary care physician to the vascular surgery department at our institution for evaluation of progressive weakness, fatigue, arm claudication and difficulty assessing the blood pressure in her right arm. She was being considered for surgical revascularisation, but a careful history and review of her imaging studies raised suspicion for vasculitis, despite her normal inflammatory markers. She was eventually diagnosed with biopsy-proven giant cell arteritis with diffuse large-vessel involvement. Her symptoms improved with high-dose glucocorticoids.


Assuntos
Arterite de Células Gigantes , Idoso , Braço , Diagnóstico por Imagem , Feminino , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Procedimentos Cirúrgicos Vasculares
13.
Tech Vasc Interv Radiol ; 24(1): 100734, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34147193

RESUMO

With wider recognition of left renal vein compression / obstruction, especially as an incidental finding, the significance as it relates to the patient's symptoms needs to be evaluated in light of variable practices and results of treatment. This communication deals with problems of diagnosis, clinical significance, options and indications for treatment.


Assuntos
Procedimentos Endovasculares , Pelve/irrigação sanguínea , Síndrome do Quebra-Nozes/terapia , Procedimentos Cirúrgicos Vasculares , Insuficiência Venosa/terapia , Tomada de Decisão Clínica , Procedimentos Endovasculares/efeitos adversos , Humanos , Seleção de Pacientes , Radiografia Intervencionista , Síndrome do Quebra-Nozes/diagnóstico por imagem , Síndrome do Quebra-Nozes/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
14.
Orv Hetil ; 162(24): 943-951, 2021 06 13.
Artigo em Húngaro | MEDLINE | ID: mdl-34120102

RESUMO

Összefoglaló. Bevezetés: Az endovascularis intervenciókat kezdetben radiológusok alkalmazták, manapság, megfelelo képzést követoen, jó eredménnyel végeznek ilyen beavatkozásokat érsebészek is. Ezt a világszerte uralkodóvá váló szemléletet kívántuk meghonosítani a Szegedi Tudományegyetemen, melynek bevezetése nélkül elorevetítheto az érsebészet muködésének átalakulása az érrekonstrukciós beavatkozások csökkenésével. Célkituzés: Egyetemünkön radiológus- és érsebész-munkacsoport végez perifériás érintervenciókat. Célunk a két intézet alsó végtagi endovascularis tevékenységének összehasonlítása volt. Módszer: Vizsgálatunkba a Szegedi Tudományegyetemen 2012. 01. 01. és 2019. 12. 31. között alsó végtagi endovascularis beavatkozásokon átesett betegeket válogattuk be. A betegeket a rizikófaktoraik, a kezelt anatómiai régiók, a hospitalizációs ido és a szövodmények tekintetében hasonlítottuk össze. Egyéves utánkövetés során vizsgáltuk a 'redo' mutétek , az amputációk és a halálozások gyakoriságát. Eredmények: A beavatkozásokat 653 esetben radiológus, 573 esetben érsebész végezte. Az érmutoben infrainguinalis (63,2%), a radiológián suprainguinalis érintervenciók (68,6%) történtek nagyobb arányban. A percutan végzett beavatkozásokat vizsgálva a hospitalizációs idoben (2,5 ± 4,4 nap vs. 2,4 ± 2,5 nap, p = 0,78), valamint a minimálisan invazív módon végzett beavatkozások utáni szövodmények gyakoriságában (30/653 - 4,6% és 11/257 - 4,3%, p = 0,837) nem volt különbség a két betegcsoport között. 'Redo' mutétek (73/485 - 15,1% és 33/562 - 5,9%, p<0,001) és amputációk (31/485 - 6,4% és 12/562 - 2,1%, p<0,001) gyakrabban fordultak elo az érmutoben kezelt betegek körében, ebben a csoportban azonban a kritikus végtagischaemia elofordulása is gyakoribb volt (45,4% és 38,6%, p = 0,016). A mortalitásban nem volt szignifikáns különbség (5,8% és 3,9%, p = 0,16). Következtetés: A szoliter érelváltozások kezelését mindkét intézet hasonló hatásfokkal végezte. A több anatómiai régiót érinto betegség miatt érmutoben végzett beavatkozások utáni szövodmények elofordulása kissé magasabbnak bizonyult. Orv Hetil. 2021; 162(24): 943-951. INTRODUCTION: Endovascular interventions were initially performed by radiologists. Nowadays properly trained vascular surgeons also effectively perform these interventions. We wished to apply this widespread practice at our university because without this advancement the number of reconstructive surgeries was expected to decrease significantly. OBJECTIVE: Both radiologists and vascular surgeons perform endovascular interventions at our university. We compared the outcomes of lower extremity endovascular interventions between the two institutes. METHOD: We included patients who underwent lower extremity endovascular interventions between 01. 01. 2012 and 31. 12. 2019. We compared the risk factors, treated anatomical regions, hospitalization time and complication rate. During the one-year follow-up, we examined the occurrence of redo surgeries, amputations and mortality. RESULTS: 653 interventions were performed by radiologists and 573 by vascular surgeons. Vascular surgeons carried out more interventions in the infrainguinal region (63.2%), while radiologists in the suprainguinal region (68.6%). The hospitalization time after percutaneous interventions (2.5 ± 4.4 days vs. 2.4 ± 2.5 days, p = 0.78), and the rate of complications after minimally invasive interventions did not show significant difference (30/653 - 4.6% vs. 11/257 - 4.3%, p = 0.837). Redo surgeries (73/485 - 15.1% vs. 33/562 - 5.9%, p<0.001) and amputations (31/485 - 6.4% vs. 12/562 - 2.1%, p<0.001) occurred more frequently in the surgical group. However, the incidence of chronic limb ischaemia was also higher (45.4% vs. 38.6%, p = 0.016). There was no significant difference in the mortality (5.8% vs. 3.9%, p = 0.16). CONCLUSION: Both institutes had similar efficacy in performing peripheral interventions on solitary vascular lesions. Complications occurred more frequently in the surgical group, but the majority of these patients had extended atherosclerotic diseases. Orv Hetil. 2021; 162(24): 943-951.


Assuntos
Cirurgiões , Procedimentos Cirúrgicos Vasculares , Humanos , Hungria , Incidência , Extremidade Inferior
15.
BMC Infect Dis ; 21(1): 420, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947338

RESUMO

BACKGROUND: The Hawthorne Effect is the change in behaviour by subjects due to their awareness of being observed and is evident in both research and clinical settings as a result of various forms of observation. When the Hawthorne effect exists, it is short-lived, and likely leads to increased productivity, compliance, or adherence to standard protocols. This study is a qualitative component of an ongoing multicentre study, examining the role of Incisional Negative Pressure Wound Therapy after vascular surgery (INVIPS Trial). Here we examine the factors that influence hygiene and the role of the Hawthorne effect on the adherence of healthcare professionals to standard hygiene precautions. METHODS: This is a qualitative interview study, investigating how healthcare professionals perceive the observation regarding hygiene routines and their compliance with them. Seven semi-structured focus group interviews were conducted, each interview included a different staff category and one individual interview with a nurse from the Department for Communicable Disease Control. Additionally, a structured questionnaire interview was performed with environmental services staff. The results were analysed based on the inductive qualitative content analysis approach. RESULTS: The analysis revealed four themes and 12 subthemes. Communication and hindering hierarchy were found to be crucial. Healthcare professionals sought more personal and direct feedback. All participants believed that there were routines that should be adhered to but did not know where to find information on them. Staff in the operating theatre were most meticulous in adhering to standard hygiene precautions. The need to give observers a clear mandate and support their work was identified. The staff had different opinions concerning the patient's awareness of the importance of hygiene following surgery. The INVIPS Trial had mediated the Hawthorne effect. CONCLUSION: The results of this study indicate that the themes identified, encompassing communication, behaviour, rules and routines, and work environment, influence the adherence of healthcare professionals to standard precautions to a considerable extent of which many factors could be mediated by a Hawthorne effect. It is important that managers within the healthcare system put into place an improved and sustainable hygiene care to reduce the rate of surgical site infections after vascular surgery.


Assuntos
Modificador do Efeito Epidemiológico , Pessoal de Saúde , Controle de Infecções/métodos , Procedimentos Cirúrgicos Vasculares , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Higiene
16.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(2): 199-204, 2021 Apr 28.
Artigo em Chinês | MEDLINE | ID: mdl-33966698

RESUMO

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


Assuntos
Tumor do Corpo Carotídeo , Humanos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
17.
Am J Case Rep ; 22: e931569, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33931576

RESUMO

BACKGROUND Advanced malignancies in the lower abdomen easily invade the retroperitoneal and pelvic space and often metastasize to the paraaortic and pelvic lymph nodes (LNs), resulting in paraaortic and/or pelvic tumor (PPT). CASE REPORT A total of 7 cases of aggressive malignant PPT resection and orthotopic replacement of the abdominal aorta and/or iliac arteries with synthetic arterial graft (SAG) were experienced during 16 years. We present our experience with aggressive resection of malignant PPTs accompanied by arterial reconstruction with SAG in detail. The primary diseases included 2 cases endometrial cancer and 2 cases of rectal cancer, and 1 case each of ovarian carcinosarcoma, vaginal malignant melanoma, and sigmoid cancer. Surgical procedures are described in detail. Briefly, the abdominal aorta and iliac arteries were anastomosed to the SAG by continuous running suture using unabsorbent polypropylene. Five Y-shaped and 2 I-shaped SAGs were used. This en bloc resection actually provided safe surgical margins, and tumor exposures were not pathologically observed in the cut surfaces. Graphical and surgical curability were obtained in all cases in which aggressive malignant PPT resections were performed. The short-term postoperative course of our patients was uneventful. From a vascular perspective, the SAGs remained patent over the long term after surgery, and long-term oncologic outcomes were satisfactory. CONCLUSIONS To our knowledge, this case series is the first report of aggressive malignant PPT resection accompanied by arterial reconstruction with SAG. This procedure is safe and feasible, shows curative potential, and may play a role in multidisciplinary management of malignant PPTs.


Assuntos
Neoplasias Pélvicas , Procedimentos Cirúrgicos Reconstrutivos , Aorta Abdominal/cirurgia , Feminino , Humanos , Artéria Ilíaca/cirurgia , Neoplasias Pélvicas/cirurgia , Procedimentos Cirúrgicos Vasculares
18.
J Clin Neurosci ; 88: 277-280, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33992197

RESUMO

BACKGROUND: Little is known about the safety of off-label use of an 8Fr Angio-Seal VIP for large-bore arteriotomies in patients treated with mechanical thrombectomy (MT) and intravenous thrombolysis (IVT) for acute ischaemic stroke (AIS). We aimed to identify differences in the groin complication rate using an 8Fr Angio-Seal VIP for common femoral arteriotomy closures following the use of 8Fr and 9Fr sheaths. METHODS: All AIS patients who underwent MT at our tertiary neuroscience unit between January 2018 and March 2020 were retrospectively reviewed. RESULTS: 161 patients were included in the study, of whom 56 and 105 patients underwent an arteriotomy using an 8Fr sheath (36 of them receiving IVT) and a 9Fr sheath (57 of them receiving IVT). Overall, 17 groin complications were identified (10.5%) in 5 patients (8.9%) who had had 8Fr sheaths inserted and 12 patients (11.4%) who had had 9Fr sheaths inserted. Major complications were identified in only 2 patients (1.2%), one patient in each of the 8Fr and 9Fr cohorts suffering a pseudoaneurysm requiring intervention. No retroperitoneal haematoma, infection, acute limb ischaemia or ipsilateral DVT was identified. No significant difference in groin complications was observed between the 8Fr and 9Fr femoral arteriotomy cohorts or between the MT patients that did or did not receive adjunctive IVT. CONCLUSION: In the setting of MT with IVT, off-label use of an 8Fr Angio-Seal VIP for closure of a femoral arteriotomy following use of a 9Fr sheath has a similar safety profile to the licensed use of an 8Fr Angio-Seal VIP for closure of a femoral arteriotomy following use of an 8Fr sheath or smaller.


Assuntos
Artéria Femoral/cirurgia , Hemostasia Cirúrgica/instrumentação , AVC Isquêmico/cirurgia , Trombectomia/métodos , Idoso , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Punções/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/instrumentação , Procedimentos Cirúrgicos Vasculares/métodos
19.
Biomed Res Int ; 2021: 5527988, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33996998

RESUMO

Methods: Between January 2016 and October 2018, sixty-four consecutive patients who underwent a total of 66 stenting procedures were screened for symptomatic and asymptomatic atherosclerotic VAOS. Of these patients, 57 had complete follow-up data. The baseline patient demographics and morphological features of the VAO were recorded. Potential factors influencing ISR, including conventional cerebrovascular disease risk factors, were assessed, together with outcome events including recurrent transient ischemic attack (TIA), stroke, and vascular-related mortality. Results: The average follow-up period was 13.2 ± 4.6 months. Technical success was achieved in all interventions. The degree of stenosis was reduced from 77.2 ± 6.1% to 13.7 ± 8.9% after the procedure. ISR was detected in eight treated vessels (14.0%) and occlusion in two (5.3%) arteries. Of the 57 patients, one had an ischemic stroke and 5 had TIAs. The angle of the VAO at the subclavian artery was associated with the risk of restenosis (preoperative, P = 0.04; postoperative, P = 0.02). Conclusions: Stenting is a feasible and effective treatment for VAOS. The angle of the VAO at the subclavian artery may contribute to the development of ISR.


Assuntos
Stents/efeitos adversos , Artéria Subclávia/anatomia & histologia , Doenças Vasculares , Procedimentos Cirúrgicos Vasculares , Artéria Vertebral/anatomia & histologia , Idoso , Aterosclerose , Constrição Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Doenças Vasculares/epidemiologia , Doenças Vasculares/etiologia , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/instrumentação
20.
Cardiovasc Intervent Radiol ; 44(7): 1017-1027, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33948700

RESUMO

PURPOSE: Restenosis remains a limitation of endovascular angioplasty with a patency of 30% in BTK at 12 months. Several studies on drug-coated balloons have not demonstrated any improvements in terms of patency and target lesions revascularization in BTK lesions. This prospective single-centre cohort study evaluates the safety and efficacy of a new generation low-dose drug-coated balloon (DCB) with a reduced crystalline structure to treat below the knee (BTK) lesions in patients with critical limb ischemia (CLI). MATERIALS AND METHODS: Between November 2016 and November 2017, 30 consecutive patients (mean 68.8 ± 12.7 years, 6 female) with BTK lesions and CLI were included in this single-centre, prospective non-randomized cohort study. All patients with rest pain and/or ischemic wound associated with BTK lesions were included in the study. Mean lesion length was 133.6 ± 94.5 mm and 18(60%) were chronic total occlusions. The primary safety outcome parameter was a composite of all-cause mortality and major amputation at 6 months. The primary efficacy outcome parameter was the primary angiographic patency at 6 months (defined as freedom from clinically driven target lesion revascularization and the absence of significant restenosis (> 50%) as determined by core laboratory angiography assessment. Immediate technical success, late lumen loss (LLL), clinical target lesion revascularization (TLR) and ulcer healing rates at 12 months were also evaluated. RESULTS: Immediate technical success was 97%(29/30): one patient had an acute thrombosis at the completion of index procedure. Primary safety outcome parameter was 94%(28/30): one patient underwent major amputation and one patient died of other comorbidities at 2 months. Another patient had a major amputation at 7.5 months. Angiographic follow-up was available in 20 patients. Primary angiographic patency was 57%(12/21 lesions), and LLL was 0.99 ± 0.68 mm at 6 months. Freedom from TLR was 89% at 12 months. The rate of ulcer healing was 76% at 12 months. CONCLUSION: Ranger DCB balloons to treat CLI patients demonstrated a positive trend with good safety outcomes parameters. Further randomized studies are needed to understand the usefulness compared to POBA.


Assuntos
Angioplastia com Balão/métodos , Materiais Revestidos Biocompatíveis , Isquemia/cirurgia , Salvamento de Membro/métodos , Paclitaxel/farmacologia , Artéria Poplítea/transplante , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Antineoplásicos Fitogênicos/farmacologia , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...