Simple Separate Sutures Versus Continuous Sutures on Hepatic Artery Anastomosis in Liver Transplant: A Prospective Study.

OBJECTIVES: Liver transplant is the definitive treatment for liver failure of various causes. There are various operation methods, of which the conventional approach is most frequently performed. In the conventional technique, 4 anastomoses are required, and different subtleties in these techniques are known to cause different rates of complications. We assessed the outcome of a simple separate (ie, interrupted) suture technique compared with a the continuous suture technique in 194 patients. MATERIALS AND METHODS: There were 194 patients included in this single-center, controlled study. The exclusion criteria were patients who died during the surgical procedure and patients with incomplete medical records. The data recorded were age, sex, past medical history of liver disease, tobacco use, comorbidities, and whetherthe livertransplant was for the first time or retransplant. All patients included in this study were recipients of liver transplants from deceased donors. The patients were categorized as those who received either simple sutures (n = 16) or continuous sutures (n = 178). The continuous suture operations were performed first, and the simple suture operations were performed at a later time (ie, the 2 groups were temporally separated). The results included the duration of surgery, hepatic artery thrombosis rate, hepatic artery stenosis rate, 2-year survival, and further complications. RESULTS: No evidence of hepatic artery thrombosis or hepatic artery stenosis was observed in the study groups. The duration of surgery was equal in both groups. The 2-year mortality rate was significantly higher in the simple suture group. CONCLUSIONS: The continuous suture method seems to be accompanied by a similar duration of operation and rate of complications compared with the simple suture process.

Venoplasty and Venous Stenting in Patients with Chronic Venous Insufficiency in the Lower Extremities.

Background: Venoplasty and stenting is a minimally invasive therapy that can be used for patients with deep venous insufficiency in the lower extremities. This study aimed at investigating the effect of venoplasty and venous stenting in patients with chronic venous insufficiency in the lower limbs. Methods: This prospective case-series study recruited patients with chronic deep venous insufficiency in the lower limbs candidated for venoplasty in the Vascular Clinic of Sina Hospital in Tehran, Iran. Venoplasty and stenting was done if the deep venous system in the lower extremities had stenosis or obstruction on venography. The patients were visited 1, 3, and 6 months after venoplasty to assess their symptoms, venous clinical severity, and venous disability. Primary and secondary patency was evaluated with Doppler ultrasound. Results: Seventy-three patients were included in the study. The follow-up of the patients' clinical symptoms showed significant improvement rates of about 90%, 88.7%, 92.5%, and 100% in claudication, edema, pain, and ulcers-respectively- only 1 month after the procedure. The stent patency rates were 93.2, 91.5, and 92.4 in the 1st, 2nd, 3rd, and 6th postprocedural months, correspondingly. The venous clinical severity score and the venous disability score before the procedure were 14.2 and 2.73, respectively, which were decreased to 5 and 1.1, correspondingly, at 6 months' follow-up (p value < 0.001). Conclusion: Venoplasty and stenting in our patients with chronic deep venous insufficiency in the lower extremities conferred a significant improvement in clinical symptoms and a high percentage of patency.