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1.
Bone Joint J ; 103-B(4): 795-803, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33789467

RESUMO

AIMS: Limb salvage for pelvic sarcomas involving the acetabulum is a major surgical challenge. There remains no consensus about what is the optimum type of reconstruction after resection of the tumour. The aim of this study was to evaluate the surgical outcomes in these patients according to the methods of periacetabular reconstruction. METHODS: The study involved a consecutive series of 122 patients with a periacetabular bone sarcoma who underwent limb-salvage surgery involving a custom-made prosthesis in 65 (53%), an ice-cream cone prosthesis in 21 (17%), an extracorporeal irradiated autograft in 18 (15%), and nonskeletal reconstruction in 18 (15%). RESULTS: The rates of major complications necessitating further surgery were 62%, 24%, 56%, and 17% for custom-made prostheses, ice-cream cone prostheses, irradiated autografts and nonskeletal reconstructions, respectively (p = 0.001). The ten-year cumulative incidence of failure of the reconstruction was 19%, 9%, 33%, and 0%, respectively. The major cause of failure was deep infection (11%), followed by local recurrence (6%). The mean functional Musculoskeletal Tumour Society (MSTS) scores were 59%, 74%, 64%, and 72%, respectively. The scores were significantly lower in patients with major complications than in those without complications (mean 52% (SD 20%) vs 74% (SD 19%); p < 0.001). For periacetabular resections involving the ilium, the mean score was the highest with custom-made prostheses (82% (SD 10%)) in patients without any major complication; however, nonskeletal reconstruction resulted in the highest mean scores (78% (SD 12%)) in patients who had major complications. For periacetabular resections not involving the ilium, significantly higher mean scores were obtained with ice-cream cone prostheses (79% (SD 17%); p = 0.031). CONCLUSION: Functional outcome following periacetabular reconstruction is closely associated with the occurrence of complications requiring further surgery. For tumours treated with periacetabular and iliac resection, skeletal reconstruction may result in the best outcomes in the absence of complications, whereas nonskeletal reconstruction is a reasonable option if the risk of complications is high. For tumours requiring periacetabular resection without the ilium, reconstruction using an ice-cream cone prosthesis supported by antibiotic-laden cement is a reliable option. Cite this article: Bone Joint J 2021;103-B(4):795-803.


Assuntos
Acetábulo/cirurgia , Salvamento de Membro/métodos , Osteossarcoma/cirurgia , Ossos Pélvicos/cirurgia , Acetábulo/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transplante Ósseo/métodos , Criança , Feminino , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Osteossarcoma/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem
2.
J Surg Oncol ; 123(5): 1328-1335, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33650694

RESUMO

BACKGROUND AND OBJECTIVES: This study compares long-term patient-reported outcomes between patients that underwent limb-salvage surgery with complex reconstruction by free or pedicled flap (LS) or amputation. Additionally, the need for revision surgery is compared. METHODS: A total of 43 patients were studied at a median follow-up of 9.54 years. Sixteen patients completed questionnaires regarding functional outcome and mental wellbeing. Functional outcomes were measured by using the Toronto Extremity Salvage Score (TESS), QuickDASH, and PROMIS Upper Extremity instruments. Mental wellbeing was assessed using the PROMIS Anxiety and Depression instruments. Revision surgery was assessed for the entire follow-up. RESULTS: The median TESS scores were 96.0 versus 71.7 (p = 0.034) and the PROMIS Upper Extremity scores were 50.1 versus 40.3 (p = 0.039) for the LS and amputation cohorts, respectively. No significant difference was found regarding symptoms of anxiety (52.7 vs. 53.8; p = 0.587) or depression (52.0 vs. 50.5; p = 0.745). Of the patients in the LS cohort 51.6% required at least one reoperation compared to 8.33% in the amputation cohort. CONCLUSIONS: LS surgery maintains functional benefits over amputation after almost a decade of follow-up. Still, mental wellbeing seems to be comparable between these patients, whereas LS procedures are associated with a sixfold increased need for reoperations.


Assuntos
Amputação/métodos , Salvamento de Membro/métodos , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Reoperação , Sarcoma/cirurgia , Extremidade Superior/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Sarcoma/patologia , Resultado do Tratamento
3.
Bone Joint J ; 103-B(3): 553-561, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641415

RESUMO

AIMS: The aims of the study were to analyze differences in surgical and oncological outcomes, as well as quality of life (QoL) and function in patients with ankle sarcomas undergoing three forms of surgical treatment, minor or major limb salvage surgery (LSS), or amputation. METHODS: A total of 69 patients with ankle sarcomas, treated between 1981 and 2017 at two tumour centres, were retrospectively reviewed (mean age at surgery: 46.3 years (SD 22.0); 31 females (45%)). Among these 69 patients 25 were analyzed prospectively (mean age at latest follow-up: 61.2 years (SD 20.7); 11 females (44%)), and assessed for mobility using the Prosthetic Limb Users Survey of Mobility (PLUS-M; for amputees only), the Toronto Extremity Salvage Score (TESS), and the University of California, Los Angeles (UCLA) Activity Score. Individual QoL was evaluated in these 25 patients using the five-level EuroQol five-dimension (EQ-5D-5L) and Fragebogen zur Lebenszufriedenheit/Questions on Life Satisfaction (FLZ). RESULTS: Of the total number of patients in the study, 22 (32%) underwent minor LSS and 22 (32%) underwent major LSS; 25 underwent primary amputation (36%). Complications developed in 26 (38%) patients, and were more common in those with major or minor LSS in comparison to amputation (59% vs 36% vs 20%; p = 0.022). A time-dependent trend towards higher complication risk following any LSS was present (relative risk: 0.204; 95% confidence interval (CI) 0.026 to 1.614; p = 0.095). In the prospective cohort, mean TESS was higher following minor LSS in comparison to amputation (91.0 vs 67.3; p = 0.006), while there was no statistically significant difference between major LSS and amputation (81.6 vs 67.3; p = 0.099). There was no difference in mean UCLA (p = 0.334) between the three groups (p = 0.334). None of the items in FLZ or EQ-5D-5L were different between the three groups (all p > 0.05), except for FLZ item "self-relation", being lower in amputees. CONCLUSION: Complications are common following LSS for ankle sarcomas. QoL is comparable between patients with LSS or amputation, despite better mobility scores for patients following minor LSS. We conclude that these results allow a decision for amputation to be made more easily in patients particularly where the principles of oncological surgery would otherwise be at risk. Cite this article: Bone Joint J 2021;103-B(3):553-561.


Assuntos
Amputação , Tornozelo , Salvamento de Membro/métodos , Qualidade de Vida , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Áustria/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia
4.
Medicine (Baltimore) ; 100(8): e24817, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663101

RESUMO

RATIONALE: Localized chondrosarcoma of the scapula has a favorable long-term survival outcome. Therefore, recovery of shoulder function after surgery is important in middle-aged patients. Currently, three-dimensional (3-D) printing implants can be applied for personalized limb salvage surgery. PATIENT CONCERNS: A 41-year-old woman with a palpable scapular area presented with shoulder pain for 3 months, which was aggravated during shoulder exercise. DIAGNOSES: Chondrosarcoma at left scapular (Malawer S1, Enniking II B, and grade II chondrosarcoma). INTERVENTIONS: Wide excision for a localized chondrosarcoma at the infrascapular lesion was performed and the resected muscles around the scapula were repaired with a 3-D printed segmental scapula prosthesis for recovery of shoulder function. OUTCOMES: The affected shoulder achieved satisfactory function after operation using the 3-D printed segmental scapula prosthesis at 1 year 6 months after the operation. LESSONS: The 3-D printed segmental scapula prosthesis is a useful method for shoulder functional recovery in patients with scapula chondrosarcoma.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Desenho de Prótese/métodos , Implantação de Prótese/métodos , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/patologia , Feminino , Humanos , Salvamento de Membro/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Impressão Tridimensional/instrumentação , Escápula/diagnóstico por imagem , Escápula/patologia , Escápula/cirurgia
5.
Anticancer Res ; 41(2): 1041-1046, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517313

RESUMO

BACKGROUND/AIM: This study aimed to investigate the effectiveness of knee rotationplasty (KRP) as salvage surgery for uncontrolled infection and implant failure of total knee arthroplasty (TKA) for sarcoma around the knee in adolescents and young adults (AYA). PATIENTS AND METHODS: This retrospective cohort study included 33 patients who underwent KRP and were grouped based on the treatment received: initial surgery for sarcoma around the knee (n=18) or as salvage surgery (n=15). Musculoskeletal Tumor Society (MSTS) score, range of motion (ROM) and postoperative results were analyzed. RESULTS: All 15 patients who underwent salvage KRP had TKA as an initial surgery. Although there were five infections in salvage KRP, which originated from the initial TKA, all cases were controllable, no implant failure occurred. MSTS score and ROM were deemed acceptable in both groups. CONCLUSION: Salvage KRP is an effective option for uncontrolled complications of initial TKA for sarcoma around the knee.


Assuntos
Salvamento de Membro/métodos , Infecções Relacionadas à Prótese/cirurgia , Reoperação/métodos , Sarcoma/cirurgia , Adolescente , Adulto , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Joelho/fisiopatologia , Masculino , Desenho de Prótese , Falha de Prótese , Amplitude de Movimento Articular , Estudos Retrospectivos , Rotação , Sarcoma/fisiopatologia , Resultado do Tratamento , Adulto Jovem
6.
Isr Med Assoc J ; 23(1): 28-32, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33443339

RESUMO

BACKGROUND: Patients with critical limb ischemia (CLI) involving the below-the-knee (BTK) arteries are at increased risk of limb loss. Despite improvement in endovascular modalities, it is still unclear whether an aggressive approach results in improved limb salvage. OBJECTIVES: To assess whether an aggressive approach to BTK arterial disease results in improved limb salvage. METHODS: A comparative study of two groups was conducted. Group 1 included patients treated between 2012 and 2014, primarily with transfemoral angioplasty of the tibial arteries. Group 2 included patients treated between 2015-2019 with a wide array of endovascular modalities (stents, multiple tibial artery and pedal angioplasty, retrograde access). Primary endpoint was freedom from amputation at 4 years. RESULTS: A total of 529 BTK interventions were performed. Mean age was 71 ± 10.6 years, 382 (79%) were male. Patients in group 1 were less likely to be taking clopidogrel (66% vs. 83%, P < 0.01) and statins (72 % vs. 87%, P < 0.01). Several therapeutic modalities were used more often in group 2 than in group 1, including pedal angioplasty (24 vs. 43 %, P = 0.01), tibial and pedal retrograde access (0 vs. 10%, P = 0.01), and tibial stenting (3% vs. 25%, P = 0.01). Revascularization of two or more tibial arteries was performed at a higher rate in group 2 (54% vs. 50%, P = 0.45). Estimated freedom from amputation at 40 months follow-up was higher in group 2 (53% vs. 63%, P = 0.05). CONCLUSIONS: An aggressive, multimodality approach in treating BTK arteries results in improved limb salvage.


Assuntos
Amputação , Angioplastia , Procedimentos Endovasculares , Isquemia , Perna (Membro) , Salvamento de Membro , Doença Arterial Periférica , Complicações Pós-Operatórias , Artérias da Tíbia , Idoso , Amputação/métodos , Amputação/estatística & dados numéricos , Angioplastia/efeitos adversos , Angioplastia/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Israel , Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Salvamento de Membro/instrumentação , Salvamento de Membro/métodos , Salvamento de Membro/estatística & dados numéricos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Doença Arterial Periférica/complicações , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Stents , Artérias da Tíbia/diagnóstico por imagem , Artérias da Tíbia/fisiopatologia , Artérias da Tíbia/cirurgia , Grau de Desobstrução Vascular
7.
Eur J Vasc Endovasc Surg ; 61(2): 270-279, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33358346

RESUMO

OBJECTIVE: Antegrade crossing techniques via transfemoral access are often challenging and may be associated with technical and clinical failure when treating patients with critical limb ischaemia (CLI). The objective of this study was to summarise all available literature regarding retrograde endovascular treatment of patients with CLI and to investigate the technical success and complication rate of retrograde access. METHODS: A systematic literature search was performed in PubMed, Scopus, and Cochrane Central until May 2020. A meta-analysis of 31 observational studies (29 retrospective and two prospective; 26 and five studies with low and moderate risk of bias, respectively) was conducted with random effects modelling. The incidence of adverse events peri-procedurally and during follow up were calculated. RESULTS: The 31 studies enrolled 1 910 patients who were treated endovascularly for femoropopliteal and/or infrapopliteal lesions causing CLI. Most of the patients had diabetes while more than half of the overall population had coronary artery disease and dyslipidaemia. All lesions were located in the infra-inguinal segment and most were chronic total occlusions (96%; 95% CI 85%-100%). Seven studies reported moderate or severe calcification in approximately half of the cases (45%; 95% CI 30%-60%). The overall technical success of the retrograde approach was 96% (18 studies; 95% CI 92%-100%). Perforation, flow limiting dissection, distal embolisation, and local haematoma at the retrograde access site were infrequent and observed in 2.1%, 0.6%, 0.1%, and 1.3% of the patients, respectively. The six month primary patency rate was 78% (five studies; 95% CI 46%-99%), the six month limb salvage rate was 77% (four studies; 95% CI 70%-84%). CONCLUSION: The results indicated that the retrograde or bidirectional antegrade/retrograde approach is safe and effective and facilitates angioplasty when antegrade treatment fails. However, prospective studies with standardised wound care and surveillance protocols are needed to investigate retrograde techniques in patients with CLI who failed antegrade revascularisation, to improve long term limb salvage and survival.


Assuntos
Procedimentos Endovasculares/métodos , Extremidades/irrigação sanguínea , Isquemia/cirurgia , Salvamento de Membro/métodos , Doença Arterial Periférica/cirurgia , Extremidades/cirurgia , Humanos , Isquemia/etiologia , Doença Arterial Periférica/complicações , Resultado do Tratamento
8.
Eur J Vasc Endovasc Surg ; 61(2): 258-269, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33334672

RESUMO

OBJECTIVE: There are currently two treatments available for patients with chronic limb threatening ischaemia (CLTI): open surgical bypass (OSB) and percutaneous transluminal angioplasty with/without stenting (PTA/S). The aim of this study was to compare short and long term outcomes between PTA/S and OSB in CLTI patients with long (GLASS grade III and IV) femoropopliteal disease. METHODS: This was a two centre retrospective study including all consecutive patients with CLTI undergoing first time lower extremity intervention at two distinct vascular surgical centres. Between 1 January 2012 and 1 January 2018, 1 545 CLTI consecutive limbs were treated for femoropopliteal GLASS grade III and IV lesions at two vascular surgical centres. Using covariables from baseline and angiographic characteristics, a propensity score was calculated for each limb. Thus, comparable patient cohorts (235 in PTA/S and 235 in OSB group) were identified for further analysis. The primary outcomes were freedom from re-intervention in the treated extremity and major amputation. Secondary outcomes were all hospital complications among the two patient groups. RESULTS: Total overall complication rates were significantly higher in the OSB group (20.42% vs. 5.96%, p < .001), especially wound infection/seroma rate that required prolonged hospitalisation and further treatment (7.65% vs. 0%, p < .001). After the median follow up of 61 months, re-intervention rates were significantly higher in the PTA/S group (log rank test, 44.68% vs. 29.79%, p = .002), but there was no significant difference in terms of major amputation rates between the two group of patients (log rank test, PTA/S 27.23% vs. OSB 22.13%, p = .17). CONCLUSION: Bypass surgery seems to be superior to PTA/S for GLASS grade III and IV femoropopliteal lesions in patients with CLTI in terms of long term re-intervention rates, but with considerably higher rates of post-operative complications. A larger cohort of patients in currently ongoing randomised trials, as well as prospective cohort studies are necessary to confirm these findings.


Assuntos
Isquemia/cirurgia , Salvamento de Membro/métodos , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Artéria Poplítea/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Procedimentos Endovasculares , Feminino , Seguimentos , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Doença Arterial Periférica/patologia , Artéria Poplítea/patologia , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
9.
Clin Podiatr Med Surg ; 38(1): 55-71, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33220744

RESUMO

Non-weight bearing is mandatory after soft tissue reconstructions of the weight-bearing and the high-pressure areas in the lower extremity. The most common method of patient mobilization after surgical reconstruction of chronic foot and ankle wounds has been to place patients non-weight bearing with crutches, walkers, or a wheelchair. Often patients are older, have more complex medical comorbidities, are deconditioned, and simply cannot comply with the prescribed weight-bearing status with these methods, which leads to deconditioning, depression, or noncompliance. Noncompliance quickly leads to failure of the reconstructive effort and the serious threat of limb loss.


Assuntos
Deambulação Precoce , Fixadores Externos , Salvamento de Membro/métodos , Amputação , Membros Artificiais , Pé Diabético/cirurgia , Humanos , Extremidade Inferior/lesões , Extremidade Inferior/cirurgia , Osteomielite/cirurgia , Retalhos Cirúrgicos
10.
Clin Podiatr Med Surg ; 38(1): 99-110, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33220747

RESUMO

The induced membrane technique is a simple, effective, and reproducible treatment method for segmental bone defects. It is a 2-stage approach that requires eventual autologous bone graft to manage the deficit. The first stage requires debridement of all nonviable tissue while preserving a healthy soft tissue envelope. A polymethylmethacrylate is implanted between the osseous segments to maintain length. The osseous defect can be stabilized internally or externally. During the second stage, a vascularized induced membrane is formed and produces multiple growth factors. The induced membrane technique is a valuable option for limb salvage in cases of segmental bone defects.


Assuntos
Reação a Corpo Estranho , Fraturas Ósseas/cirurgia , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Membranas/crescimento & desenvolvimento , Membranas/metabolismo , Lesões dos Tecidos Moles/cirurgia , Autoenxertos , Regeneração Óssea , Osso Esponjoso/transplante , Desbridamento , Humanos , Salvamento de Membro/métodos
11.
Medicine (Baltimore) ; 99(46): e22391, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181638

RESUMO

Although plantar thermography can evaluate the immediate perfusion result after an endovascular therapy (EVT) has been performed, a relevant wound outcome study is still lacking.This study was to investigate whether angiosome-based plantar thermography could predict wound healing and freedom from major amputation after EVT in patients with critical limb ischemia (CLI).All 124 patients with CLI (Rutherford category 5 and 6) who underwent EVT from January 2017 to February 2019 were prospectively enrolled. All patients received thermography both before and after EVT. Both wound healing and freedom from major amputation at the 6-month follow-up period were recorded. There were 61 patients in the healing group and 63 patients in the non-healing group, whereas the major amputation total was 14 patients. The mean pre- and post-EVT temperature of the foot was significantly higher in the healing group than in the non-healing group (30.78 °C vs 29.42 °C, P = .015; and 32.34 °C vs 30.96 °C, P = .004, respectively). DIFF2 was significantly lower in the non-healing group (-1.38 vs -0.90, P = .009). DIFF1 and DIFF2 were significantly lower in the amputation group (-1.85 °C vs -1.11 °C, P = .026; and -1.82 °C vs -1.08 °C, P = .004). Multivariate analysis showed that DIFF2 stood out as an independent predictor for freedom from major amputation (hazard ratio 0.51, P = .045). Receiver operating characteristic curve analysis showed a DIFF2 cut-off value of -1.30 °C, which best predicts freedom from major amputation.Plantar thermography is associated with wound healing and helps predict freedom from major amputation in CLI patients undergoing EVT.


Assuntos
Extremidades/cirurgia , Isquemia/cirurgia , Termografia/métodos , Idoso , Idoso de 80 Anos ou mais , Amputação , Procedimentos Endovasculares/métodos , Extremidades/fisiopatologia , Feminino , Humanos , Isquemia/complicações , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Termografia/estatística & dados numéricos
12.
Khirurgiia (Mosk) ; (8): 55-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869616

RESUMO

OBJECTIVE: To study the immediate results of therapy and indirect revascularization in patients with critical ischemia of the lower limbs. MATERIAL AND METHODS: The results of medication and surgical treatment were analyzed in 210 patients with critical ischemia of the lower limbs. Atherosclerosis obliterans was diagnosed in 142 patients, thromboangiitis obliterans - in 68 patients. Lesion of femoropopliteal segment was observed in 32 (15.2%) cases, popliteal-tibial segment - 68 (32.8%) patients, tibial and foot segment - 62 (29.5%) cases, foot - 31 (14.8%) cases, multiple-level lesion - 17 (8.1%) cases. Survey consisted of Doppler ultrasound, CT angiography, rheovasography with analysis of rheographic index (RI) and pulse oximetry. Circulatory parameters were compared with identical values in 48 almost healthy persons ("reference group"). The results of medication and surgical treatment were evaluated by using of the scale of Rutherford R.B. et al. (1997). RESULTS: Conservative treatment was performed in 48 patients (control group). The following types of indirect revascularization operations were performed to stimulate regional circulation: bone trepanation in 42 patients, lumbar sympathectomy in 51 patients, bone trepanation + lumbar sympathectomy in 38 patients, bone trepanation with intraosseous irradiation in 31 cases. CONCLUSION: Indirect revascularization improves early postoperative outcomes, ensures maintaining support function of the limb and active lifestyle in patients with critical ischemia of the lower limbs. Technical simplicity of these procedures facilitates widespread introduction of indirect revascularization in multi-field hospitals.


Assuntos
Arteriopatias Oclusivas/cirurgia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/tratamento farmacológico , Arteriosclerose Obliterante/diagnóstico por imagem , Arteriosclerose Obliterante/tratamento farmacológico , Arteriosclerose Obliterante/cirurgia , Osso e Ossos/cirurgia , Tratamento Conservador , Humanos , Isquemia/diagnóstico por imagem , Isquemia/tratamento farmacológico , Salvamento de Membro/métodos , Extremidade Inferior/diagnóstico por imagem , Estudos Retrospectivos , Simpatectomia , Tromboangiite Obliterante/diagnóstico por imagem , Tromboangiite Obliterante/tratamento farmacológico , Tromboangiite Obliterante/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
13.
Eur J Vasc Endovasc Surg ; 60(5): 687-695, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32778491

RESUMO

OBJECTIVE: The Global Vascular Guideline on chronic limb threatening ischaemia (CLTI) has introduced the Global Limb Anatomic Staging System (GLASS) as a new angiographic scoring system. However, the relationship between GLASS and outcomes following revascularisation has not previously been studied. METHODS: Using pre-intervention angiograms the relationship between GLASS and immediate technical failure (ITF), amputation free survival (AFS), limb salvage (LS), overall survival (OS), and freedom from major adverse limb events (FF-MALE) was examined in 377 patients undergoing endovascular therapy (EVT, n = 213) or bypass surgery (BS, n = 164) in the Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL)-1 trial (randomised 1999-2004). RESULTS: There was no significant difference in GLASS between cohorts. There was a significant relationship between ITF and GLASS in EVT (I 14%, II 15%, III 28%, p = .049). GLASS was significantly related to AFS (hazard ratio [HR], 1.37; 95% CI 1.01-1.85; p = .042), LS (HR 1.96; 95 % CI 1.12-3.43; p = .018), and FF-MALE (HR 1.49; 95% CI 1.04-1.87; p = .028) in the EVT cohort. In BS patients, there was no relationship between GLASS and these outcomes. FF-MALE was significantly worse after EVT than BS in GLASS II (p = .038) and III (p = .001). Among the subgroup of patients with femoropopliteal (FP) disease (BS, n = 109 or EVT, n = 159), FF-MALE was significantly higher after BS than EVT (p < .001). The superiority of BS over EVT with increasing GLASS FP grade was greater in the analysis of patients using vein grafts. CONCLUSION: In the BASIL-1 cohort, GLASS is associated with outcomes following EVT but not BS. Although further validation in contemporary CLTI cohorts is required, GLASS seems likely be useful in shared decision making and for stratifying patients in future trials.


Assuntos
Angioplastia/efeitos adversos , Isquemia/diagnóstico , Salvamento de Membro/efeitos adversos , Doença Arterial Periférica/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Enxerto Vascular/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Feminino , Artéria Femoral/patologia , Artéria Femoral/cirurgia , Seguimentos , Humanos , Isquemia/mortalidade , Isquemia/patologia , Isquemia/cirurgia , Salvamento de Membro/métodos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/patologia , Doença Arterial Periférica/cirurgia , Artéria Poplítea/patologia , Artéria Poplítea/cirurgia , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
14.
Eur J Vasc Endovasc Surg ; 60(5): 721-729, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32807672

RESUMO

OBJECTIVE: Popliteal artery aneurysm (PAA) is the second most common arterial aneurysm. Vascunet is an international collaboration of vascular registries. The aim was to study treatment and outcomes. METHODS: This was a retrospective analysis of prospectively registered population based data. Fourteen countries contributed data (Australia, Denmark, Finland, France, Hungary, Iceland, Italy, Malta, New Zealand, Norway, Portugal, Serbia, Sweden, and Switzerland). RESULTS: During 2012-2018, data from 10 764 PAA repairs were included. Mean values with between countries ranges in parenthesis are given. The incidence was 10.4 cases/million inhabitants/year (2.4-19.3). The mean age was 71.3 years (66.8-75.3). Most patients, 93.3%, were men and 40.0% were active smokers. The operations were elective in 73.2% (60.0%-85.7%). The mean pre-operative PAA diameter was 32.1 mm (27.3-38.3 mm). Open surgery dominated in both elective (79.5%) and acute (83.2%) cases. A medial surgical approach was used in 77.7%, and posterior in 22.3%. Vein grafts were used in 63.8%. Of the emergency procedures, 91% (n = 2 169, 20.2% of all) were for acute thrombosis and 9% for rupture (n = 236, 2.2% of all). Thrombosis patients had larger aneurysms, mean diameter 35.5 mm, and 46.3% were active smokers. Early amputation and death were higher after acute presentation than after elective surgery (5.0% vs. 0.7%; 1.9% vs. 0.5%). This pattern remained one year after surgery (8.5% vs. 1.0%; 6.1% vs. 1.4%). Elective open compared with endovascular surgery had similar one year amputation rates (1.2% vs. 0.2%; p = .095) but superior patency (84.0% vs. 78.4%; p = .005). Veins had higher patency and lower amputation rates, at one year compared with synthetic grafts (86.8% vs. 72.3%; 1.8% vs. 5.2%; both p < .001). The posterior open approach had a lower amputation rate (0.0% vs. 1.6%, p = .009) than the medial approach. CONCLUSION: Patients presenting with acute ischaemia had high risk of amputation. The frequent use of endovascular repair and prosthetic grafts should be reconsidered based on these results.


Assuntos
Aneurisma/cirurgia , Isquemia/cirurgia , Salvamento de Membro/estatística & dados numéricos , Artéria Poplítea/patologia , Trombose/cirurgia , Doença Aguda/epidemiologia , Doença Aguda/terapia , Idoso , Amputação/estatística & dados numéricos , Aneurisma/complicações , Aneurisma/epidemiologia , Aneurisma/patologia , Austrália/epidemiologia , Brasil/epidemiologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Europa (Continente)/epidemiologia , Feminino , Carga Global da Doença , Humanos , Incidência , Isquemia/epidemiologia , Isquemia/etiologia , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Artéria Poplítea/cirurgia , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Trombose/epidemiologia , Trombose/etiologia , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Enxerto Vascular/métodos , Enxerto Vascular/estatística & dados numéricos , Grau de Desobstrução Vascular
15.
Eur J Vasc Endovasc Surg ; 60(5): 711-719, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32807678

RESUMO

OBJECTIVE: The aim of this study was to investigate outcomes for lower limb revascularisation for limb salvage within the National Health Service (NHS) in England. METHODS: This was a retrospective observational study of administrative data. Data were extracted from the Hospital Episodes Statistics database for England. Data were included for a seven year period (1 April 2011-31 March 2018 inclusive) for all patients aged ≥ 18 years receiving surgery for peripheral arterial occlusive disease. Data were extracted for patient age, sex and frailty level, the NHS trusts undertaking the procedure, the technique used (angioplasty, bypass, endarterectomy, or hybrid), the mode of admission (elective or emergency), the surgical speciality, the financial year of admission, length of hospital stay during the procedure, subsequent emergency re-admission, revascularisation procedures within 30 days and subsequent amputation and mortality within one year and within five years. The primary outcome was one year amputation free survival. For analysis, data were separated into diabetic and non-diabetic patients. Multilevel modelling was used to adjust for hierarchy and observed confounding when investigating outcomes. RESULTS: Data were available for 98 109 procedures across 124 hospital trusts. For non-diabetic patients (odds ratio 1.142, 95% confidence interval 1.068-1.222), one year amputation free survival was higher for angioplasty than for bypass. For diabetic patients, there was no difference in the primary outcome. One year amputation rates, 30 day emergency re-admission rates, and length of stay were all lower for angioplasty, and 30 day revascularisation rates were lower for bypass for both diabetic and non-diabetic patients. CONCLUSION: Outcomes were generally better for angioplasty than for bypass surgery for lower limb revascularisation for both diabetic and non-diabetic patients. The findings should be interpreted with caution given the likely different clinical presentations of those selected for each procedure. Future clinical trials may provide more definitive data.


Assuntos
Angioplastia/efeitos adversos , Isquemia/cirurgia , Salvamento de Membro/efeitos adversos , Doenças Vasculares Periféricas/cirurgia , Enxerto Vascular/efeitos adversos , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Angioplastia/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Humanos , Isquemia/mortalidade , Tempo de Internação/estatística & dados numéricos , Salvamento de Membro/métodos , Salvamento de Membro/estatística & dados numéricos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Doenças Vasculares Periféricas/mortalidade , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Enxerto Vascular/estatística & dados numéricos
16.
Khirurgiia (Mosk) ; (7): 97-101, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736472

RESUMO

Mine-explosive trauma is one of the most serious types of combat lesion and injuries in peacetime. We report a patient with mine-explosive trauma of the lower limbs followed by injury of the vascular bundle. Well-coordinated work of a multidisciplinary team of specialists at all stages of treatment is presented. The management was effective to save patient's life, avoid amputation and restore lower limb function.


Assuntos
Traumatismos por Explosões/cirurgia , Traumatismos da Perna/cirurgia , Salvamento de Membro/métodos , Extremidade Inferior/cirurgia , Lesões do Sistema Vascular/cirurgia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/lesões , Equipe de Assistência ao Paciente , Recuperação de Função Fisiológica , Resultado do Tratamento
17.
BMJ Case Rep ; 13(7)2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641312

RESUMO

A 17-year-old man with osteosarcoma of the proximal humerus was planned for possible limb salvage surgery after standard neoadjuvant chemotherapy. However, during the surgical phase of treatment, the COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreak occurred changing the healthcare landscape due to uncertainty regarding the virus, risk of COVID-19 infection and complications, and implementation of an enhanced community quarantine restricting movement of people within cities. Instead of limb salvage surgery, the patient underwent a forequarter amputation. Exposure to the virus in a high-risk hospital setting was minimised with patient discharge after a short hospital stay and home convalescence monitored by video conferencing. Multidisciplinary sarcoma team meetings with family members and a sarcoma navigator nurse were crucial in managing expectations and deciding on appropriate treatment in the setting of a novel infectious disease causing a pandemic.


Assuntos
Amputação/métodos , Neoplasias Ósseas , Cisplatino/administração & dosagem , Infecções por Coronavirus , Doxorrubicina/administração & dosagem , Úmero , Salvamento de Membro/métodos , Osteossarcoma , Pandemias , Pneumonia Viral , Adolescente , Antineoplásicos , Betacoronavirus , Neoplasias Ósseas/patologia , Neoplasias Ósseas/terapia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Úmero/diagnóstico por imagem , Úmero/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Estadiamento de Neoplasias , Osteossarcoma/patologia , Osteossarcoma/terapia , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
18.
Eur J Vasc Endovasc Surg ; 60(5): 696-702, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32595060

RESUMO

OBJECTIVE: This study aimed to determine the clinical impact of the Global Limb Anatomical Staging System (GLASS) and develop a model to determine the grade of difficulty for target artery path (TAP) using GLASS stage. METHODS: This was a single centre retrospective study. Endovascular treatment (EVT) was performed for 400 lesions in 257 patients with critical limb threatening ischaemia (CLTI) between April 2009 and March 2018. All lesions were divided into three groups (GLASS Ⅰ, Ⅱ, and Ⅲ), which were compared in terms of patient characteristics, lesion characteristics, technical success, and procedural complications. All observations were then randomly assigned to the derivation set or validation set at a ratio of 2:1 (derivation set: 166 patients; validation set: 91 patients). Predictors of technical success for TAP were identified by multivariable analysis. Each predictor was assigned a score based on its regression coefficient, and the total score was calculated. This value was used to categorise all lesions into the following four groups: low (score 0), intermediate (score 1), difficult (score 2), and very difficult (score ≥ 3). RESULTS: No significant differences in patient characteristics were observed between the three GLASS groups. In GLASS Ⅲ group, anatomic/limb severity and procedural complications were observed frequently, and the technical success rate was lower than that in the other groups. Through multivariable analysis, absence of pedal modifier (P)0 or P1, GLASS Ⅲ, total occlusion, and severe calcification predicted technical failure. The four groups stratified according to GLASS score demonstrated stepwise and highly reproducible difference in the probability of technical success for TAP. The area under the receiver operating characteristic (ROC) curve was 0.95 in the development group and 0.93 in the validation sample. CONCLUSION: In GLASS Ⅲ, anatomic/limb severity was more complex and procedural complications were more frequent. The GLASS scoring system reliably predicts the technical success of de novo TAP in patients with CLTI.


Assuntos
Procedimentos Endovasculares/efeitos adversos , Isquemia/diagnóstico , Salvamento de Membro/efeitos adversos , Doença Arterial Periférica/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Isquemia/cirurgia , Salvamento de Membro/métodos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias/etiologia , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
20.
J Vasc Surg ; 72(3): 790-798, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32497747

RESUMO

The global SARS-CoV-2/COVID-19 pandemic has required a reduction in nonemergency treatment for a variety of disorders. This report summarizes conclusions of an international multidisciplinary consensus group assembled to address evaluation and treatment of patients with thoracic outlet syndrome (TOS), a group of conditions characterized by extrinsic compression of the neurovascular structures serving the upper extremity. The following recommendations were developed in relation to the three defined types of TOS (neurogenic, venous, and arterial) and three phases of pandemic response (preparatory, urgent with limited resources, and emergency with complete diversion of resources). • In-person evaluation and treatment for neurogenic TOS (interventional or surgical) are generally postponed during all pandemic phases, with telephone/telemedicine visits and at-home physical therapy exercises recommended when feasible. • Venous TOS presenting with acute upper extremity deep venous thrombosis (Paget-Schroetter syndrome) is managed primarily with anticoagulation, with percutaneous interventions for venous TOS (thrombolysis) considered in early phases (I and II) and surgical treatment delayed until pandemic conditions resolve. Catheter-based interventions may also be considered for selected patients with central subclavian vein obstruction and threatened hemodialysis access in all pandemic phases, with definitive surgical treatment postponed. • Evaluation and surgical treatment for arterial TOS should be reserved for limb-threatening situations, such as acute upper extremity ischemia or acute digital embolization, in all phases of pandemic response. In late pandemic phases, surgery should be restricted to thrombolysis or brachial artery thromboembolectomy, with more definitive treatment delayed until pandemic conditions resolve.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Síndrome do Desfiladeiro Torácico/diagnóstico , Triagem/normas , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Descompressão Cirúrgica/normas , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Tratamento de Emergência/métodos , Tratamento de Emergência/normas , Humanos , Controle de Infecções/normas , Comunicação Interdisciplinar , Salvamento de Membro/métodos , Salvamento de Membro/normas , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Telemedicina/normas , Síndrome do Desfiladeiro Torácico/etiologia , Síndrome do Desfiladeiro Torácico/terapia , Terapia Trombolítica/métodos , Terapia Trombolítica/normas , Tempo para o Tratamento/normas
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