ABSTRACT
BACKGROUND: Abdominal aortic aneurysm (AAA) repair in patients with organ transplant remains a challenge. We looked at AAA repair in patients with organ transplants at our tertiary liver and kidney transplant unit. METHODS: A retrospective analysis of a prospectively maintained database was undertaken from January 2008 to July 2018. We looked at patient demographics, type of repair, and technical success including reinterventions, perioperative transplant organ function, and 30-day and 1-year survival rate. Eight of 662 patients who underwent AAA repair had a solid organ transplant. Of these, 5 were kidney transplants, 2 liver transplants, and 1 had kidney and liver transplant; 75% were male; and average age was 63.4 (range: 49-83). All patients had asymptomatic AAAs, and 6 were treated with standard endovascular repair, 1 standard repair with iliac branch device, and 1 open repair. Adjunctive techniques such as CO2 angiograms, deployment of main body through contralateral iliac, low-profile sheaths, custom-made stent grafts, and temporary axillo-femoral shunting were used to protect transplant organs. Thirty-day survival was 100% with 1 death at 5 months from liver failure, and 1 patient has a persistent type-2 endoleak 3 years after the procedure. CONCLUSION: Abdominal aortic aneurysm repair in patients with organ transplants can be undertaken using adjunctive endovascular and open surgical techniques.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Kidney Transplantation , Liver Transplantation , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/diagnostic imaging , Blood Vessel Prosthesis Implantation/adverse effects , Databases, Factual , Endovascular Procedures/adverse effects , England , Female , Humans , Kidney Transplantation/adverse effects , Liver Transplantation/adverse effects , Male , Middle Aged , Postoperative Complications/etiology , Retrospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: The correct positioning of the laser tip at the saphenofemoral or saphenopopliteal junction during endovenous laser therapy is paramount to ensure a safe and effective procedure. The aim of this study was to demonstrate how patient positioning and tumescence infiltration can affect this safe junctional distance. METHODS: A retrospective review of a prospectively maintained database was carried out for all patients who received endovenous laser treatment for symptomatic varicose veins between February 2008 and February 2014 in one surgeon's practice in a teaching hospital vascular unit. The junctional distance of the laser tip from the saphenofemoral or saphenopopliteal junction was measured two times during the procedure: before tumescence and before laser deployment with the patient in a Trendelenburg position. RESULTS: Junctional distance was found to have increased in 62% cases (490 patients; great saphenous vein [GSV], 348; small saphenous vein [SSV], 142). Of these, 17% (84) required the laser tip to be advanced (GSV, 56; SSV, 28) to maintain a desired junctional distance of 0.75 to 2 cm. In 185 patients (23%), the junctional distance was noted to have been reduced (GSV, 155; SSV, 30), with 58% (GSV, 79; SSV, 28) requiring the laser tip to be withdrawn to the desired junctional distance; 23% of patients (185) had no change in the junctional distance. CONCLUSIONS: This study has demonstrated the effect of tumescence infiltration and Trendelenburg positioning on laser tip placement, and thus a final junctional measurement before activation of the laser is recommended to maintain a safe and optimal junctional distance.
Subject(s)
Anesthesia, Local , Head-Down Tilt , Laser Therapy/instrumentation , Patient Positioning/methods , Saphenous Vein/surgery , Varicose Veins/surgery , Anatomic Landmarks , Databases, Factual , Hospitals, Teaching , Humans , Laser Therapy/adverse effects , Postoperative Complications/etiology , Retrospective Studies , Saphenous Vein/diagnostic imaging , Treatment Outcome , Ultrasonography , Varicose Veins/diagnostic imagingABSTRACT
INTRODUCTION: The aim of this study was to assess the durability of superficial femoral artery (SFA) stents and factors that affect stent patency. METHODS: A retrospective assessment of 214 SFA stent procedures between 2003 and 2012 was conducted from a prospectively compiled database. Patency rates and patient outcomes were compiled from case notes and computerized records. Stent patency was confirmed by either duplex scan or clinical examination (palpable distal pulse). Survival and patency were compared across a range of factors using Kaplan-Meier plots and log-rank tests. Factors found to be significant were further assessed by Cox regression models. RESULTS: Data were analyzed for 214 limbs in 205 patients. Inclusion criteria included those patients who received an SFA stent for treatment of claudication or critical limb ischemia (CLI) with follow-up data. This gave a study group of 151 limbs divided into 76 claudicant and 75 patients with CLI (male-female ratio = 103:48, mean age 71 years, standard deviation 11.7). Seventy-one percent of procedures were elective and 29% were emergency procedures; 53% of procedures were carried out on a day case basis. Median follow-up was 11 months (range 1 day-89 months). Patency was significantly worse for patients with CLI (P = .009), with a 1- and 3-year patency of 63% and 34% compared to 79% and 60% in patients with claudication. Significant factors associated with patency included oral therapy controlled diabetes (P = .003), lesions located in either the mid-SFA (P = .029) or the mid-popliteal (P = .013), and periprocedural complications (P = .005). There was no significant difference in patency rates between insulin-dependent and nondiabetic patients (hazard ratio: 1.0, 95% confidence interval: 0.4-5.6, P = .983). The overall amputation rate for the total study group was 5%. Patients with 1- and 3-year survival were 98% and 96% in the claudication group and 74% and 51%, respectively, in the CLI group. CONCLUSION: SFA stents have superior outcomes in claudicants. Patency is related to severity of disease, diabetes, and location of disease.
Subject(s)
Endovascular Procedures/instrumentation , Femoral Artery/physiopathology , Intermittent Claudication/therapy , Ischemia/therapy , Peripheral Arterial Disease/therapy , Stents , Vascular Patency , Adult , Aged , Aged, 80 and over , Amputation, Surgical , Critical Illness , Databases, Factual , Elective Surgical Procedures , Emergencies , Endovascular Procedures/adverse effects , Female , Femoral Artery/diagnostic imaging , Humans , Intermittent Claudication/diagnosis , Intermittent Claudication/physiopathology , Ischemia/diagnosis , Ischemia/physiopathology , Kaplan-Meier Estimate , Limb Salvage , Male , Middle Aged , Multivariate Analysis , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/physiopathology , Proportional Hazards Models , Prosthesis Design , Radiography , Retrospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Compression of the brachial plexus causing neurogenic symptoms is involved in most cases referred to vascular surgeons for consideration of treatment of thoracic outlet syndrome (TOS). The causative factor of the compression can be difficult to diagnose with multiple pathologies implicated. METHODS: We present 2 rare cases of supraclavicular lipomata causing compression of the neurovascular structures in the thoracic outlet. The only 6 other cases of brachial plexus lipomata were described to our knowledge in the literature worldwide. RESULTS: We highlight that there are a small number of neurogenic TOS cases where the causative pathology can be successfully managed by surgery with expectation of a good recovery. CONCLUSIONS: Surgeons operating on these lesions can expect good symptom resolution for their patients.
