Utilization of Dual Expandable Cages in Lateral Lumbar Interbody Fusion Surgery.

The aim of this study is to present a case series of adult patients with lumbar degenerative scoliosis who underwent focused minimally invasive spine (MIS) surgery utilizing a new dual expandable cage technology. The study investigates the effectiveness of this approach in reducing the symptoms and progression of lumbar degenerative scoliosis (LDS). Adult patients with lumbar degenerative scoliosis were selected for focused MIS using the newly introduced expandable cage technology. Patient demographics, preoperative evaluations, surgical details, and postoperative outcomes were recorded. The primary outcome measures included the restoration of disc space height, an improvement in clinical outcomes, and a reduction in surgical complications. Analysis of the case series reveals promising outcomes following focused MIS with the utilization of the new expandable cage technology. The technique demonstrated successful restoration of intervertebral disc space heights and improved clinical outcomes in patients with lumbar degenerative scoliosis. Furthermore, a notable reduction in surgical complications was observed. The findings from this case series suggest that MIS with the implementation of the new expandable cage technology holds promise for patients with lumbar degenerative scoliosis. This approach appears to have the potential to effectively restore disc space heights, improve clinical outcomes, and minimize surgical complications. Here, we want to emphasize and add details to the improved clinical outcomes of this technology; however, further research and larger prospective studies are warranted to validate these preliminary results and establish the long-term benefits and safety profile of this innovative technique.

An outcome analysis of endovascular versus open repair of blunt traumatic aortic injuries.

BACKGROUND: Aortic injury is the second most common cause of death after blunt trauma. Thoracic endovascular aortic repair (TEVAR) has been rapidly adopted as an alternative to the traditional open repair (OR) for treatment of traumatic aortic injury (TAI). This paradigm shift has improved the outcomes in these patients. This study evaluated the outcomes of TEVAR compared with OR for patients with TAI. METHODS: We analyzed prospectively collected data from the institutional trauma registry between April 2002 and June 2010. These data were supplemented with a retrospective review of hospital financial accounts. The primary outcome was the presence or absence of any complication, including in-hospital death. Secondary outcomes included fixed, variable, and total hospital costs and intensive care unit (ICU), preoperative, postoperative and total hospital length of stay (LOS). RESULTS: Amongst 106 consecutive patients (74 men; mean age, 36.4 years), 56 underwent OR and 50 underwent TEVAR for treatment of TAI. The proportion of patients who underwent TEVAR compared with OR increased from 0% to 100% during the study period. The TEVAR patients were significantly older than the OR patients (41.1 vs 32.2 years, P=.012). For patients who underwent TEVAR, the estimated odds ratio (95% confidence interval) of complications, including in-hospital mortality was 0.33 (0.11-0.97; P=.045) compared with the OR group. The average number of complications, including in-hospital death, was higher in the OR group than in the TEVAR group (adjusted means, 1.29 vs 0.94). The OR group had a higher proportion of patients with complications, including in-hospital death, compared with the TEVAR group (69.6% vs 48%). Although, the mean adjusted variable costs were higher for TEVAR than for OR (P=.017), the mean adjusted fixed and total costs were not significantly different. Owing to a policy of delayed selective management, the adjusted preoperative LOS was significantly higher for TEVAR (9.8 vs 3.0 days, P=.022). The difference in the ICU or total hospital LOS was not significant. Although the proportion of uninsured patients was similar in both groups, the cohort (n=106) had a significantly higher proportion of uninsured patients (29% vs 5%) compared with the general vascular surgical population at our institution (0.29 vs 0.051, 95% confidence interval for difference in proportions, 0.22-0.40; P<.0001). CONCLUSIONS: Compared with TEVAR, patients who underwent OR had three times higher odds to face a complication or in-hospital death. The mean total cost of TEVAR was not significantly different than OR. The findings support the use of TEVAR over OR for patients with TAI.

Endovascular treatment of hemodialysis access pseudoaneurysms.

OBJECTIVE: Pseudoaneurysm (PSA) formation is a complication of hemodialysis access. Open repair requires PSA resection, interposition graft placement, and insertion of a catheter as a bridge. Endovascular stent graft repair is an alternative that permits immediate use of the access site. The objective of this study was to determine the efficacy of stent grafts for repair of arteriovenous fistula and arteriovenous graft PSA. METHODS: A retrospective review of medical records from October 2007 to March 2011 revealed 24 patients with a PSA who underwent endovascular repair using a stent graft. Indications for repair included PSA with symptoms (n = 11), PSA with skin erosion (n = 8), PSA with failed hemodialysis (n = 3), and PSA after balloon angioplasty of a stenosis (n = 2). Outcome measures were technical success, 30-day and 180-day patency, secondary interventions, and complications. All the statistical analyses were conducted by using software SAS 9.1 (SAS, SAS Institute, Gary, NC). RESULTS: Twenty-seven self-expanding stent grafts (Viabahn, W. L. Gore, n = 25; Fluency, Bard, n = 2) were used to treat hemodialysis access (arteriovenous graft, n = 13; arteriovenous fistula, n = 11) PSA in 24 patients (16 females; mean age, 55.7 years; mean body mass index, 28.4; mean PSA diameter, 19.5 mm). Comorbidities included hypertension (n = 22; 91.7%), diabetes mellitus (n = 8; 33.3%), and coronary artery disease (n = 4; 16.67%). The median time from access creation to repair was 455 days. The technical success rate was 100%. Balloon angioplasty of an outflow stenosis was performed in 56% of stent grafts. The 30- and 180-day patency rate was 100% and 69.2%, respectively. Three secondary interventions were performed for treatment of unrelated stenosis. Treatment failure occurred in five (18.5%) stent grafts due to infection (n = 3) and thrombosis (n = 2). Treatment of PSA with skin erosion was associated with failure due to infection (odds ratio, 5.0; 95% confidence interval, .38, 66.01). The remaining 22 (81.5%) stent grafts remain patent. The mean follow-up time was 268.9 days (median, 97.5). CONCLUSIONS: Endovascular therapy is an effective and durable treatment option for patients with dialysis access PSAs. This technique permits immediate use of the hemodialysis access site as well as identification and treatment of associated stenosis. It may be considered as an alternative to open repair in patients who are anatomically suitable candidates.