Winsteaddrachmann7147

The aim of this meta-analysis is to determine the morbidity and mortality outcomes of adult patients with aortic arch disease managed with extra-anatomical bypass avoiding median sternotomy and cardiopulmonary bypass, with simultaneous or staged hybrid zone 1 endovascular aortic repair.

Systematic literature searches of the MEDLINE, EMBASE, and Cochrane databases were carried out to identify relevant studies on zone 1 hybrid arch repair. Extracted data were analyzed by random effects models. Primary outcomes included 30-day or in-hospital mortality. Longitudinal survival was analyzed up to 7years from date of operation. Secondary outcomes included in-hospital morbidity, as well as late endoleak and reintervention.

Twenty studies incorporating 348 patients were included. In-hospital or 30-day mortality was 10.1% (95% confidence interval, 6.7-14.9%). Overall operative technical success was 89.8% (83.7-93.8%). Early type 1 endoleak rate was 14.0% (7.4-24.7%). Stroke prevalence was 9.5% (6.1-14.3%). Spinal cord paraplegia prevalence was 3.8% (1.9-7.6%). Retrograde aortic dissection prevalence was 4.1% (1.5-10.6%). Survival at 1year postoperatively was 77.2% (66.1-85.4%). Survival at 3years postoperatively was 73.7% (59.2-84.4%). Survival beyond 4years postoperatively (range 58-80months) was 65.9% (53.6-76.4%). Late type 1 endoleak prevalence was 11.8% (5.5-23.7%). Overall rate of reintervention was 11.6% (6.4-20.1%).

Zone 1 hybrid repair has evidence for satisfactory short- and long-term morbidity/mortality outcomes and may be considered as an alternative approach to aortic arch disease.

Zone 1 hybrid repair has evidence for satisfactory short- and long-term morbidity/mortality outcomes and may be considered as an alternative approach to aortic arch disease.

Blunt thoracic aortic injury (BTAI) is associated with a high mortality and large trauma burden. Trauma and resuscitation after injury affect cardiovascular status, which may in turn affect aortic diameter. Measurement of aortic diameter is necessary to guide stent-graft sizing as part of BTAI management. Inaccurate measurement may lead to stent-graft complications. This pilot study aimed to assess the effect of acute major trauma on stent-graft sizing and stent-graft complications, in the context of BTAI and to assess whether any effect could be predicted.

Patients who were admitted to a UK major trauma center between January 2007 and December 2017, and were diagnosed with BTAI, were identified. The thoracic aortic diameter was measured at six points on initial and surveillance computed tomography imaging. Data on patient demographics, admission heart rate, mean arterial pressure (MAP), and serum lactate were gathered.

Thirty-two patients were identified. Twenty met inclusion criteria. Of these, 12 wer BTAI, acute major trauma, and resuscitation in a significant and variable manner. Measurements of the aorta in a patient with BTAI in the acute trauma setting should be viewed with uncertainty. A lack of complications in the short term is suggestive of a wide tolerance range regarding stent-graft sizing, but long-term results are unknown.

Pulsatile tinnitus is often a chronic and debilitating condition and normally has a vascular origin. We describe a case of pulsatile tinnitus due to an aberrant branch of the external carotid artery (ECA), which has not been reported previously.

A 67-year-old female with chronic unilateral pulsatile tinnitus, which could be controlled completely with direct pressure on a small tortuous superficial branch behind her left ear. This was confirmed with doppler to be an unusually tortuous occipital branch of the ECA. Under local anesthesia, this vessel was identified with intraoperative doppler and ligated.

Complete resolution of tinnitus immediately, with consistent results 3 months postoperatively.

Pulsatile tinnitus due to aberrances in the occipital ECA branch is rare, and in this case, was successfully treated with minor surgery.

Pulsatile tinnitus due to aberrances in the occipital ECA branch is rare, and in this case, was successfully treated with minor surgery.We present an unreported complication that occurred during an accidental loss of the ipsilateral limb's wire during EVAR. During an endovascular repair of an abdominal aortic aneurysm (EVAR), unintentional loss of the ipsilateral limb's wire during deployment and withdrawal of the endogaft's main body occurred. The snare's loops were entrapped while attempting to catch the wire through the limb. Multiple maneuvers were performed to detach the snare, but all were unsuccessful. We then performed a conversion to open repair. In conclusion, commercially available endografts should include standard radiopaque markers in the ipsilateral limb to facilitate retrograde cannulation. Retrieval via the snare should not be performed proximal to the gate of the limb.

"Structural factors" relating to organization of hospitals may affect procedural outcomes. This study's aim was to clarify associations between structural factors and outcomes after carotid endarterectomy (CEA) and carotid endarterectomy stenting (CAS).

A systematic review of studies published in English since 2005 was conducted. Structural factors assessed were as follows population size served by the vascular department; number of hospital beds; availability of dedicated vascular beds; established clinical pathways; surgical intensive care unit (SICU) size; and specialty of surgeon/interventionalist. Primary outcomes were as follows mortality; stroke; cardiac complications; length of hospital stay (LOS); and cost.

There were 11 studies (n=95,100 patients) included in this systematic review. For CEA, reduced mortality (P<0.0001) and stroke rates (P=0.001) were associated with vascular departments serving >75,000 people. Larger hospitals were associated with lower mortality, stroke rate, and cardiion of vascular services, reducing risks and costs associated with carotid interventions.

Gonadal artery aneurysm represents an extremely rare condition often unrecognized until rupture.

A literature review was undertaken on Pubmed from 1990 to 2020 to identify reported cases of ovarian and uterine artery aneurysms, including the index case presented here. Data about the clinical presentation, diagnostic approach, and treatment were collected.

Twenty-one articles reporting on data about 22 patients, including the index case, were included. The patients's median age was 46.7years (range 30-80) and aneurysm maximal diameter 2.6cm (range 0.75-5cm). Except for one asymptomatic patient, the aneurysm's clinical presentation was abdominal/back pain in the majority of cases (n = 20, 90.9%). Rupture with retroperitoneal hematoma occurred in 16 cases (72.7%) and hemorrhagic shock in one case (4.5%). No history of vaginal bleeding was reported in any case. The majority of the aneurysms were diagnosed in women of childbearing age in 50% (n = 11) of cases during the peripartum period and in 22.7% (n = 5) of cases during the postmenstruation period. The remaining cases (n = 6, 27.3%) were detected during the postmenopausal period. The majority of patients (n = 15, 68.2%) were emergently treated with an endovascular approach by embolization, achieving the total exclusion of the aneurysm in 86.7% of cases (13 patients). In 7 cases (31.8%), surgical ligation was performed, of which 2 (9.1%) were for the failure of a primarily attempted coils embolization. The spontaneous thrombosis of the uterine aneurysm was noted 3months after the initial diagnosis in one patient.

The Gonadal artery aneurysms are unrecognized entities until an acute rupture occurs. Endovascular treatment by embolization is progressively becoming the first-line treatment with satisfactory results.

The Gonadal artery aneurysms are unrecognized entities until an acute rupture occurs. Endovascular treatment by embolization is progressively becoming the first-line treatment with satisfactory results.Epithelioid hemangioendothelioma (EHE) is a rare case of a tumor with different clinical behaviors and a difficult anatomopathological diagnosis. The diagnosis of EHE is usually confirmed by postoperative histopathologic examination. Actually, it is a challenge to put a correct diagnosis and to propose aggressive treatment. We report a case of an EHE of the left lower limb discovered in a 53-year-old claudicant woman. Surgical resection, arterial, and venous bypass were performed. The histology demonstrated EHE with a low mitotic index, emerging for the femoral vein.

This study aims to review and compare the clinical presentation, management, and outcome in patients with tumor-related (TR) and nontumor-related (NTR) aorto-esophageal fistula (AEF) and aorto-bronchial fistula (ABF) with particular focus on the thoracic endovascular aortic repair.

We retrospectively reviewed a series of 16 consecutive patients with TR (n=8) and NTR (n=8), ABF (n=6), and AEF (n=10) admitted to our hospital from 2011 to2019.

The median age was 62years (range 46-81), with 11 men. The most common predisposing factor was esophageal or gastric cardia cancer (n=6), followed by open repair of the thoracic aorta (n=5). Endoluminal vacuum therapy (Endo-SPONGE®) accounted for 3 cases of AEFs. Thoracic endovascular aortic repair (TEVAR) was applied in 13 patients (4 with ABFs and 9 with AEFs). The primary technical success of the TEVARs was 100%. One patient (8%) was complicated with postoperative middle cerebral artery syndrome and left-sided hemiparesis. The respective in-hospital, 6-month, and 1-year mortality rates were 0% (n=0), 25% (n=2), and 25% (n=2) for the NTR group and 63% (n=5), 88% (n=7), and 100% (n=8) for the TR group. After a mean period of 13months, 5 (31%) patients were still alive, and one patient lost to follow-up after 11months. The survivors (n=5) had all nontumor-related ABF. Progression of underlying cancer and hemodynamic shock were the most common causes of death.

TEVAR represents a reliable option in the treatment of NTR ABFs. In the cases of TR fistulas and NTR AEFs, TEVAR should be applied more selectively. The associated mortality remains very high.

TEVAR represents a reliable option in the treatment of NTR ABFs. In the cases of TR fistulas and NTR AEFs, TEVAR should be applied more selectively. The associated mortality remains very high.Endovascular recanalization of occluded venous femoropopliteal bypass grafts is widely used because of easy access. This case report describes pseudoaneurysm developing 4 weeks after endovascular recanalization of an occluded in situ venous femoropopliteal graft. The patient was treated for a popliteal aneurysm with a venous femoropopliteal bypass graft, which subsequently occluded. Four weeks after DEB PTA, the occluded graft developed 3 pseudoaneurysms. Impaired vessel wall healing after intraluminal paclitaxel administration could have contributed to this. This case adds a perspective to the choice of treatment of occluded venous femoropopliteal bypass grafts.

Arteriovenous fistulas (AVFs) are favored for hemodialysis (HD) access. However, in many instances, AVFs fail to mature. We examined the utility of postoperative color duplex ultrasound (CDU) in assessing AVF maturation and determining the need for balloon-assisted maturation (BAM).

A total of 633 patients underwent AVF creation at a single institution from 2015 to 2018. A total of 339 patients (54%) underwent CDU at a median of 8weeks postoperatively. We collected the following parameters vein diameter, volume flow (VF), peak systolic velocities in arterial inflow and venous outflow, and presence of stealing branches. A peak systolic velocity ratio (SVR) of ≥2 correlated with ≥50% stenosis in venous outflow, and SVR ≥3 correlated with ≥50% stenosis at the anastomosis. AVFs were considered mature when they were successfully cannulated on dialysis. A generalized linear mixed model (GLMM) was created to compare duplex criteria associated with successful use of AVF (maturation) to those AVFs that required further intervention or failed to mature.