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Gastrointestinal System
Published in Calver Pang, Ibraz Hussain, John Mayberry, Pre-Clinical Medicine, 2017
Calver Pang, Ibraz Hussain, John Mayberry
A patient undergoes an endovascular abdominal aortic aneurysm repair. During the procedure a catheter is inserted into the femoral artery and directed to the aortic aneurysm where the graft extends to the gonadal artery. Which of the following organs is unlikely to lose its blood supply?
General surgery
Published in Janesh K Gupta, Core Clinical Cases in Surgery and Surgical Specialties, 2014
Matthew Clark, Jevan Taylor, Steven Thrush
Depending on a number of factors, around 5 to 8 per cent of patients die from elective abdominal aortic aneurysm repair, and important complications occur in around 15 to 20 per cent of patients. Both morbidity and mortality figures can be modified – excellent surgeons in excellent centres may achieve very good results, but selecting lower-risk patients will also appear to give the same outcome.
Synchronous colorectal cancer and abdominal aortic aneurysm treated simultaneously. Is a one-stage surgery a feasible treatment?
Published in Acta Chirurgica Belgica, 2023
Sara Alonso-Batanero, Carlos R. Díaz-Maag, María Parra-Rina, Jesús García-Alonso, Francisco S. Lozano Sanchez
There is still much uncertainty but the introduction of Endovascular Abdominal Aortic Aneurysm Repair (EVAR) marked a milestone that improved the management of AAA. EVAR is recommended if anatomically suitable in large or symptomatic AAA with concomitant colorectal cancer followed by staged cancer surgery, to allow treatment of the malignancy with minimal delay [7]. Although it has been associated with a considerable risk of thrombotic events [8]. The single-stage approach prolongs surgical time and could result in an aortic graft infection, especially when open aneurysm repair is applied. However, with EVAR this probability of graft infection could be lower. Additionally, laparoscopic and robotic surgery shortens recovery times and involves small incisions and less pain for the patient than open surgery. Minimally invasive surgery such as EVAR and laparoscopic or robotic resection of CCR, have changed the therapeutic strategy by allowing the simultaneous treatment of both pathologies to be safer. The patient of the clinical case was offered both options (surgery in two stages or surgery in one stage), and the possible advantages and disadvantages of both options were explained in detail as in the discussion. Finally, he chose the one-time surgery to avoid the stress of undergoing two surgeries and their corresponding recovery.
Clinical and economic burden of postsurgical complications of high-risk surgeries: a cohort study in Thailand
Published in Journal of Medical Economics, 2020
Khachen Kongpakwattana, Piyameth Dilokthornsakul, Teerapon Dhippayom, Nathorn Chaiyakunapruk
Postsurgical morbidity is linked to increased mortality. In the US, patients experiencing one or more postsurgical complications after undergoing high-risk pancreatic resection, esophageal resection or abdominal aortic aneurysm repair have 2.2, 4.6, or 2.4 times higher risk of death than those without post-surgical morbidity19. These are similar to findings from our study. We have found that major post-surgical complications increase risk of in-hospital death by 4.5 times in GI surgical patients and 2.2 times in CV surgical patients, compared to respective patients with no morbidity. Therefore, clinicians and policy makers should focus on the prevention of postsurgical complications to improve post-surgical survival.
Liver function assessment by indocyanine green plasma disappearance rate in patients with intra-abdominal hypertension after “non-hepatic” abdominal surgery
Published in Current Medical Research and Opinion, 2018
This study consists of a single-center, prospective, observational data analysis from measurements obtained in a case series of 51 patients admitted to the adult surgical ICU of a tertiary hospital (UHC Sestre milosrdnice, Zagreb, Croatia) after major abdominal surgery (esophageal, gastric, small intestine and colorectal surgery, pancreatic resection, abdominal aortic aneurysm repair) for more than 24 h in a 1-year period (September 22, 2008 to October 7, 2009). The study was approved by the local institutional Ethical Committee (E.P. broj: 03-1/08) and by the Ethical Committee of the School of Medicine of University of Zagreb (U.b. 04-76/2008-734). The written informed consent was obtained from patients or legal representatives. Patients with liver disease and liver resection were excluded. Upon admission to the ICU, disease severity was evaluated by APACHE II, SOFA and SAPS II scores. IAP was measured by transvesical technique with instillation of 25 ml of normal saline, according to the procedure described by the World Society of Abdominal Compartment Syndrome. ICG-PDR was measured using the LiMON device (PULSION Medical Systems, Munich, Germany) according to the manufacturer’s recommendation with 0.25 mg/kg of ICG solution (concentration of 5 mg ICG/ml water) given via a central venous catheter as a bolus and immediately flushed with normal saline. Each patient was monitored with an ICG finger clip, which was connected to the liver function monitor (LiMON) via an optical probe. Injected ICG is detected from fractional pulsatile changes in optical absorption. The optical peak absorption of 805 and 890 nm allows continuous measurements of PDR-ICG. The monitor determines automatically the PDR-ICG by monoexponential transformation of the original ICG concentration curve and backward extrapolation to the time point “zero” (100%), describing the decay as a percentage change per time.