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20 Papers for FRCS (Plus a Few More)
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
Both endovascular and open surgical revascularisation have limited long term durability, as illustrated by the higher rate of subsequent revascularisation in patients having early revascularisation than in those initially treated conservatively in the present study.
The Coronaries
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Claudio Muneretto, Chang Guohao, Theo Kofidis
McGinn et al. [3] demonstrated the use of a minimally invasive strategy to revascularize multiple myocardial territories, namely the anterior, lateral and inferior myocardial territories. This allows for the feasibility of surgical revascularization of the vessels, which may not be amenable to PCI, thereby offering an expansion of the types of patients suitable for the hybrid revascularization program. The ability to surgically revascularize the artery (other than the LAD) allows PCI to be carried out on one vessel, with the remaining two receiving internal mammary artery/saphenous vein grafts (Figure 12.4.5, Figure 12.4.6 and Figure 12.4.7). These territories were accessed via the fifth left intercostal space through a 4–6-cm thoracotomy. The coronary targets were stabilized using a positioner and epicardial stabilizer. The team successfully showed that multi-vessel minimally invasive CABG can be done safely and effectively with excellent short-term outcomes. In the first 450 consecutive patients treated via this technique, complete revascularization was achieved in 95% of patients. Perioperative mortality was 1.3% (compared to 2.5% in conventional CABG) and the risks of conversion to sternotomy and cardiopulmonary bypass were 3.8% and 7.6%, respectively.
Complications of open repair of renal artery aneurysms
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Thrombosis of a renal artery bypass graft may be secondary to kinking of the graft; if vein conduit is used, the presence of valves in the region of the anastomosis may lead to stagnation of blood flow and thrombus formation. In this setting, re-operation with graft thrombectomy, repair of any technical defects, and/or a redo bypass may be warranted.19 Though re-operation to address acute occlusion is ideal, it can be fraught with significant morbidity. There have been cases where nonsurgical alternatives have been employed to address acute graft failure from thrombosis. Options for revascularization include direct thrombolysis or percutaneous thrombectomy. Thrombolysis, though likely to restore patency, has many disadvantages.19 The duration of lytic therapy can be lengthy, taking several hours to days; if perfusion to the kidney is compromised for that duration, the kidney might be rendered non-functional. In patients who have recently undergone major abdominal surgery, thrombolysis also poses a high bleeding risk, thus its use in the perioperative setting is limited.19 Percutaneous thrombectomy is advantageous because it can retrieve fresh thrombus readily without enduring the bleeding risk and it does not necessarily preclude re-operation if it proves to be unsuccessful.19 In the event of failed revascularization, nephrectomy may be inevitable.9,20
Ocular Manifestations in an Italian Cohort of Patients with Takayasu Arteritis
Published in Ocular Immunology and Inflammation, 2023
Rosanna Dammacco, Luca Cimino, Luca De Simone, Giovanni Alessio, Franco Dammacco
Although no controlled studies have been published comparing open vs. endovascular revascularization, a better patency of the narrowed vessels is achieved after surgical bypass grafting than after percutaneous endovascular stenting, which is the less invasive procedure. While bypass surgery usually has a higher rate of severe postoperative complications,45–47 endovascular treatment is associated with a significantly higher rate of restenosis (>50%) or occlusion of the reconstructed arteries.45 In our experience, 2 out of the 7 patients (28.6%) who underwent endovascular stenting developed a restenosis, after 11 and 16 months, respectively. Of the 2 patients treated with open bypass, 1 had no complications and his renovascular hypertension greatly improved while the other had an uneventful post-operative course but died from myocardial infarction 5 years after the diagnosis.
Endovascular therapy and free flap transfer in chronic limb-threatening ischemia
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Shoichi Ishikawa, Kiyohito Arai, Takeshi Kurihara, Tomoya Sato, Shigeru Ichioka
The SPINACH study, a multicenter prospective observational study on Japanese patients with critical limb ischemia, suggested the following as factors favoring bypass surgery: WIfI classification W-3, fI-2/3, history of ipsilateral minor amputation, history of revascularization after critical limb ischemia onset, and bilateral critical limb ischemia. Conversely, diabetes mellitus, renal failure, anemia, history of nonadherence to cardiovascular risk management, and contralateral major amputation were identified as adverse factors for bypass surgery [11]. In the present study, most patients had local factors favoring bypass surgery, such as extensive wounds and severe infections, as reported in the SPINACH study [11]. Simultaneously, these patients had systemic diseases, such as diabetes, end-stage renal failure on dialysis, and anemia, which are considered detrimental factors for bypass surgery. In these conflicting circumstances, we opted for endovascular therapy rather than bypass surgery as emergency revascularization because of the patient’s poor general condition and the desirability of a minimally invasive treatment. Previous studies showing similar success rates for endovascular therapy and free flap transfer compared to bypass surgery and free flap transfer [12] supported our deliberations.
Evaluation of anti-inflammatory diphenyldihaloketone EF24 in transient ischemic stroke model
Published in Brain Injury, 2022
Alexander Mdzinarishvili, Hailey Houson, Andria Hedrick, Vibhudutta Awasthi
Acute ischemic stroke is a sudden loss of neurological function due to interruption of blood supply to the brain. Accounting for 87% of all cases with stroke, ischemic stroke is a common cause of death and disability worldwide (1–3). Survivors of stroke not only carry a high risk for recurrence, but also suffer from serious physical disabilities, neurological impairment, and socio-emotional challenges (2,4). Current clinical care of patients with ischemic stroke involves intravenous (IV) thrombolysis and endovascular thrombectomy (EVT) to restore blood supply in the ischemic region of the brain (5). However, successful revascularization adds another vulnerability related to the ischemia-reperfusion injury (IRI) that may result in cerebral edema and intracerebral hemorrhage. IRI occurs due to sudden oxygenation of ischemic tissue and revascularized patients with large ischemic core are more at risk to this additional injury (6). Thus, patients are carefully selected for IV thrombolysis or EVT based on time window and size of ischemic core in computed tomography (CT) findings. Thrombolytic treatment is only possible within 3–4.5 h of onset of symptoms, whereas EVT is only advised for small ischemic core as the risk-benefit ratio in the large core patients is unfavorable (7–9). Consequently, an extremely small number of patients are eligible for revascularization practices (5).