ABSTRACT
BACKGROUND: Colonic stenting has failed to show an improvement in mortality rates in comparison with emergency surgery for acute large-bowel obstruction. However, it remains unclear which patients are more likely to benefit from this procedure. OBJECTIVE: The aim of this study is to identify factors that may be predictive of successful outcome of colonic stenting in acute large-bowel obstruction. DESIGN: All patients undergoing colonic stenting for acute large-bowel obstruction between 1999 and 2013 were studied. The demographics and characteristics of the obstructing lesion were analyzed. SETTINGS: This investigation was conducted at a district general hospital. PATIENTS: A total of 126 (76 men; median age, 76 y; range, 42-94 y) with acute large-bowel obstruction were included in the analysis. INTERVENTION: The insertion of a self-expanding metal stent was attempted for each patient to relieve the obstruction. MAIN OUTCOME MEASURES: The primary outcomes measured were technical success in the deployment of the stent, clinical decompression, and perforation rates. RESULTS: Technical deployment of the stent was accomplished in 108 of 126 (86%) patients; however, only 89 (70%) achieved clinical decompression. Successful deployment and clinical decompression was associated with colorectal cancer (p = 0.03), shorter strictures (p = 0.01), and wider angulation distal to the obstruction (p = 0.049). Perforation was associated with longer strictures (p = 0.03). LIMITATIONS: This study was limited by its retrospective nature. CONCLUSION: Colonic stenting in acute large-bowel obstruction is more likely to be successful in shorter, malignant strictures with less angulation distal to the obstruction. Longer benign strictures are less likely to be successful and may be associated with an increased risk of perforation.
Subject(s)
Colonic Diseases/complications , Endoscopy, Gastrointestinal , Intestinal Obstruction , Intestinal Perforation , Intestine, Large , Postoperative Complications/epidemiology , Stents , Acute Disease , Aged , Cohort Studies , Colonic Diseases/classification , Colonic Diseases/pathology , Decompression, Surgical/methods , Endoscopy, Gastrointestinal/adverse effects , Endoscopy, Gastrointestinal/instrumentation , Endoscopy, Gastrointestinal/methods , Female , Humans , Intestinal Obstruction/diagnosis , Intestinal Obstruction/epidemiology , Intestinal Obstruction/etiology , Intestinal Obstruction/physiopathology , Intestinal Obstruction/surgery , Intestinal Perforation/epidemiology , Intestinal Perforation/etiology , Intestine, Large/injuries , Intestine, Large/pathology , Intestine, Large/surgery , Male , Outcome Assessment, Health Care , Prognosis , Risk Adjustment , Risk Factors , United KingdomABSTRACT
We describe the management of a 30-year-old male with type I neurofibromatosis who required an above-knee amputation for bleeding, infection, swelling, and multiple severe joint instability. Postoperatively, he continued to bleed from the stump site. Angiography revealed multiple small distal bleeding aneurysms. Hemostasis was eventually achieved with standard microcoil embolization.
Subject(s)
Amputation Stumps/surgery , Amputation, Surgical/adverse effects , Endovascular Procedures , Neurofibromatosis 1/therapy , Postoperative Hemorrhage/therapy , Vascular Diseases/surgery , Adult , Amputation Stumps/blood supply , Amputation Stumps/diagnostic imaging , Debridement , Embolization, Therapeutic , Humans , Male , Negative-Pressure Wound Therapy , Neurofibromatosis 1/complications , Neurofibromatosis 1/diagnosis , Neurofibromatosis 1/surgery , Postoperative Hemorrhage/diagnostic imaging , Postoperative Hemorrhage/etiology , Radiography , Reoperation , Sepsis/etiology , Sepsis/surgery , Treatment Outcome , Vascular Diseases/diagnostic imaging , Vascular Diseases/etiologyABSTRACT
BACKGROUND: The surgical treatment of bone tumours can result in large peri-operative blood loss, due to their large sizes and hypervascularity. Pre-operative embolisation has been successfully used to downgrade vascularity, thus reducing peri-operative blood loss and its associated complications. METHODS: Pre-operative embolisation was successfully undertaken on twenty-six patients with a variety of primary and secondary bone tumours. RESULTS: Mean blood loss was 796 mL and we experienced no complications. CONCLUSION: Pre-operative arterial embolisation of large, richly vascular bone tumours in anatomically difficult positions, is a safe and effective method of downstaging vascularity and reducing blood loss.
ABSTRACT
PURPOSE: Lower limb angioplasty is commonly performed via antegrade common femoral artery (CFA) puncture, followed by selective superficial femoral artery (SFA) catheterization. Arterial access can be complicated by a "hostile groin" (scarring, obesity, or previous failed CFA puncture). We prospectively investigated color duplex ultrasound (CDU)-guided SFA access for radiological interventions. METHODS: Antegrade CDU-guided CFA and SFA puncture were compared in 30 patients requiring intervention for severe leg ischemia who had hostile groins. Demographics, screen time, radiation dose, intervention, and complications were prospectively recorded. RESULTS: Treatment in 30 patients involved 44 angioplasties (40 transluminal, 4 subintimal) and 2 diagnostic angiograms. Fifteen of these patients had CDU-guided CFA punctures; in 8 of these patients CDU-guided CFA puncture "failed" (i.e., there was failure to pass a guidewire or catheter into the CFA or SFA), necessitating immediate direct CDU-guided SFA puncture. Overall, the mean screen time and radiation dosage, via direct CDU-guided SFA puncture in 30 patients, was 4.8 min and 464 Gy cm(2) respectively. With CDU-guided CFA puncture, mean screen time (10 min), radiation dose (2023 Gy cm(2)), and complications (13%) were greater when compared with the SFA puncture results overall and in the same patients at subsequent similar procedures (2.7 min, 379 Gy cm(2) (p < 0.05), no complications in this subgroup). Five complications occurred: 2 each at CFA and SFA entry sites, and 1 angioplasty embolus. CONCLUSIONS: The CDU-guided SFA puncture technique was both more effective than CDU-guided CFA access in patients with scarred groins, obesity, or failed CFA punctures and safer, with reduced screen times, radiation doses, and complications.
