Metastatic Neck Disease
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The plan to resect the carotid should always be a pre-operative decision and almost never should a situation arise where this is contemplated for the first time peri-operatively. Pre-operative work up is essential to plan the resection. Balloon occlusion of the artery with single photon emission computer tomography (SPECT) is performed to prognosticate the possibility of neurological deficit following resection. If the test shows adequate cross-flow and does not cause symptoms, there is a lesser need to shunt the artery during resection. If the cross-flow is inadequate, the internal carotid artery should be shunted for the duration of the resection. In all cases, we recommend reconstruction of the artery using an appropriate graft to reduce chances of neurological complications. Most studies report using the saphenous vein graft (Figure 18.9). Intra-operative ligation without reconstruction is fraught with a high risk of complications owing to the haemodynamic instability that can occur. This is likely even in those patients who demonstrate good cross-flow and a stump pressure of more than 70 mmHg.
The management of venous malformations
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
Traditionally, surgical resection was effectively used for encapsulated and small lesions. However, in patients with diffuse and multifocal lesions, the surgical approach is relatively contraindicated, as damage to surrounding anatomic structures and massive hemorrhage may ensue. In 2016, Malgor et al. retrospectively evaluated the long-term outcomes of open surgical treatment in 49 patients (53 limbs) with KTS.29 Great saphenous vein stripping and lateral embryonic vein, small saphenous vein, and accessory saphenous vein surgical removal were performed in 17 (32%), 15 (28%), 10 (19%), and nine (17%) lower extremities, respectively. Data from this study showed that two patients developed deep vein thrombosis, one had a pulmonary embolism (PE), and one patient had peroneal nerve palsy. Kaplan–Meier analysis demonstrated that freedom from disabling pain at 1, 3, and 5 years was 95%, 77%, and 59%, respectively.29 Respective rates for freedom from secondary procedures were 86%, 78%, and 74%. In addition, at the last follow-up visit, the venous clinical severity score had decreased from 9.4 ± 3.27 to 6.0 ± 3.20 (P < 0.001). Data from this study showed that the surgical approach in patients with KTS is safe and durable (Figure 57.4).29
Deaths Following Cardiac Surgery and Invasive Interventions
Mary N. Sheppard in Practical Cardiovascular Pathology, 2022
The most common is poor cardiac function which results from embolism and/or anoxia, hypoperfusion, exacerbation of pre-existing disease, iatrogenic factors and stress. This leads to multi-organ failure with cerebral anoxia, acute renal tubular necrosis, acute pancreatitis and adrenal cortical infarction. Systemic and coronary emboli may occur. Embolized material includes thrombi, fat, bone marrow, air, calcium, atheroma, talc, silicone, platelets and other debris from the perfusion apparatus. Hypoperfusion can lead to cerebral infarction or ischaemic damage to the bowel, without thrombosis or emboli present in these organs. Prolonged bypass can lead to consumption coagulopathy and haemorrhage from cannulation sites. Saphenous vein graft failure is most common within 30 days of operation and is dependent on several factors including vein size and excessive length, distal runoff and slow flow, and hypercoagulability and thrombosis. Alternatively, arterial grafts such as the LIMA and radial arterial grafts remain patent longer and have patency rates exceeding 90% at 10 years.
The predictive role of modified TIMI risk index in patients with ST-segment elevation myocardial infarction
Published in Acta Cardiologica, 2019
Adnan Kaya, Muhammed Keskin, Tolga Sinan Güvenç, Mustafa Adem Tatlısu, Osman Kayapınar
The main findings of this study can be summarised as: i) There is a gradual increase in both in-hospital and long-term mortality with increasing mTRI categories. ii) Patients with a mTRI more than 60 have a high risk for mortality despite revascularisation and should be followed-up closely. iii) Patients with a higher mTRI had similar revascularisation rates with those with lower mTRI groups, but stent implantation rate is significantly lower in this group. A higher incidence of saphenous vein graft occlusion and presence of 3-vessels disease deserving surgical revascularisation might have led to this situation. iv) Discriminative capacity of mTRI was moderate to good for both in-hospital and long-term mortality, and across all the subgroups except patients aged less than 65 years. v) Discriminative capacity of mTRI is higher than TRI for both in-hospital mortality and long-term mortality, with the discriminative capacity of the latter is poor for the majority of subgroups analysed.
Blunt injury of popliteal artery
Published in Acta Chirurgica Belgica, 2019
Jui-Tsung Chang, Chih-Yuan Lin, Yi-Ting Tsai, Yi-Chang Lin
An 18-year-old teenager was immediately brought to the emergency department after falling from a motorcycle. Upon arrival, the patient was alert in consciousness and complained about right knee pain and leg numbness. On physical examination, there was ecchymosis on the right popliteal region (Figure 1) and the range of motion in right knee was normal. The pulsation of right dorsalis pedis artery was weak but no neurological deficit of both legs was found. The computerized tomographic angiography of lower limbs disclosed total occlusion of the right popliteal artery with patent collateral perfusion and distal runoff in right lower leg (Figure 2). Emergent vascular exploration showed one segmental arterial transection with an intramural hematoma (Figure 3). Then, the patient underwent reconstruction with great saphenous vein graft and experienced reperfusion injury after the operation.
Great saphenous vein stump: a risk factor for superficial/deep venous thrombosis and an indication for prophylactic anticoagulation? - a retrospective analysis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Yasir Khan, Muhammad Arslan Cheema, Hafez Mohammad Ammar Abdullah, Yasar Sattar, Shujaul Haq, Asoka Balaratna, Khadija Cheema, Waqas Ullah
CABG is one of the more common cardiac surgeries performed. 100,000 to 200,000 patients per year receive CABG in the US [1]. A saphenous vein graft is often used in a CABG. The donor site of the graft can be an inciting event for superficial venous thrombosis (SVT) in legs status post-surgery [2,3]. Injury to a vein act can start the thrombotic process that can progress from SVT to deep venous thrombosis (DVT) [4]. It has been reported that up to 44% of patients with SVT go on to develop a DVT [5]. The concerning part of this is that up to one-third of the patients who develop SVT may go on to develop asymptomatic pulmonary embolism (PE), and up to 13% of these patients also develop symptomatic DVT [5].
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