Access-Site Complications in Mechanical Thrombectomy for Acute Ischemic Stroke: A Review of Prospective Trials.

BACKGROUND: A shift has occurred in interventional cardiology from transfemoral to transradial access due to a 70%-80% decrease in complications. This shift has not yet taken place in other interventional specialties, perhaps owing to the lack of generalizability of findings in the cardiology data. PURPOSE: Our aim was to assess data from the recent mechanical thrombectomy prospective trials to better understand the access-site complication rate. DATA SOURCES: Articles were systematically sourced from the National Center for Biotechnology Information PubMed archive. STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, prospective, randomized controlled trials published after 2008 with mention of major and/or minor femoral access-site complications in neuroendovascular mechanical thrombectomies were included. DATA ANALYSIS: Major and minor femoral access-site complications were extracted. A total complication rate was calculated with major access-site complications alone and combined with minor access-site complications. DATA SYNTHESIS: Seven prospective studies of 339 total screened met the inclusion criteria. Eleven major access-site complications were identified in of 660 total interventions, revealing a major access-site complication rate of 1.67% for patients undergoing mechanical thrombectomy with transfemoral access. If minor access-site complications were included, 35 total incidents were detected in 763 interventions, resulting in a total complication rate of 4.59%. LIMITATIONS: Multiple unspecified vessel and procedure-related complications were mentioned in the studies. CONCLUSIONS: The overall rate of major access-site complications was 1.67% in this review, which is not low and poses a risk to patients. We suggest further investigation into the feasibility and complication rates of alternative access sites for neurointerventional procedures.

Tendo Achillis procedures for chronic ulcerations in diabetic patients with transmetatarsal amputations.

Recurrent ulceration following transmetatarsal amputation commonly results from hypertrophic bone formation or equinus deformity. In the current study, 31 diabetic patients underwent 33 Achilles tendon procedures for recurrent ulcerations at the distal stump of their transmetatarsal amputation. Primary healing was achieved in 21 procedures (64%) and secondary healing in 9 procedures (27%) for an overall healing rate of 91%. Two procedures failed to resolve the original ulceration (6%). The average follow-up examination was 27 months. The authors conclude that Achilles tendon procedures are an effective means of managing ulcerations in transmetatarsal amputation feet exhibiting an equinus deformity.

Anatomical and histologic investigation of the syndesmotic area in the ankle joint.

The syndesmotic area in the ankle joint is analyzed by reviewing the literature and by examining its gross anatomy and histology. Seventy-five ankles were dissected and examined, with an emphasis on the syndesmotic area. The gross anatomical results of this study differ somewhat with those of other authors. The average height, attachments, consistency, color, and shape are reported. In addition to gross examination, four ankles were examined histologically, and the findings are discussed. The results of this study define in detail the anatomy of the syndesmotic area.

Necrotizing fasciitis.

Necrotizing fasciitis can be a devastating infectious process when diagnosis and early aggressive therapy is delayed. The etiologic factors that may play a role in or affect this necrotizing infectious process are reviewed. An interesting case is presented of bilateral, lower extremity, necrotizing fasciitis in a patient with diabetes mellitus, peripheral vascular disease and profound sensory neuropathy.