Outcomes of Repair of Total Graft Detachment following Descemetʼs Membrane Endothelial Keratoplasty

2021 ◽  
Author(s):  
Avital Adler ◽  
Eliane Rozanes ◽  
Peter Ciechanowski ◽  
Yoav Nahum ◽  
Shmuel Graffi ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Graft Failure ◽  
Salvage Surgery ◽  
Endothelial Keratoplasty ◽  
Medical Centers ◽  
Early Graft ◽  
Secondary Operations ◽  
Early Graft Failure

Abstract Objective To present the outcomes of attempts to salvage total graft detachment following Descemetʼs membrane endothelial keratoplasty (DMEK). Methods A search of the electronic medical records of two tertiary medical centers for all patients who underwent DMEK yielded six cases of postoperative total graft detachment (2.54%). Graft salvage was attempted in all cases using repeated intracameral graft staining, unfolding, and reattachment to the stroma under 20% hexafluoride gas. Results In all cases, a free-floating totally detached graft was identified in the anterior chamber shortly after surgery. Salvage surgery resulted in a central, well-oriented, and fully attached graft. In three cases, the primary graft failed, and in two, the corneas cleared at first but failed after 2 months and 1 year respectively. In one case, the cornea remained clear during 1 year of follow-up but had a very low endothelial cell density. Conclusion Reattachment of fully detached DMEK graft is technically possible, but graft manipulation during the primary and secondary operations is likely to damage the endothelial cells, resulting in primary or early graft failure. If graft salvage is attempted, the probability of primary or early graft failure should be discussed with the patient, and expectations should be tempered accordingly.

scholarly journals Intraoperative Assessment of Coronary Resistances: A New Quality Marker and Potential Tool to Predict Early Graft Failure after Coronary Artery Bypass Grafting?

2021 ◽  
Vol 8 (12) ◽  
pp. 163
Author(s):  
Antonino Salvatore Rubino ◽  
Fabrizio Ceresa ◽  
Liborio Mammana ◽  
Giuseppe Vite ◽  
Gianluca Cullurà ◽  
...  
Keyword(s):  
Graft Failure ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Graft Patency ◽  
Graft Occlusion ◽  
Additional Tool ◽  
Intraoperative Assessment ◽  
Early Graft ◽  
Early Graft Failure

Intraoperative assessment of graft patency is pivotal for successful coronary revascularization. In the present study we aimed to propose a new, easy to perform tool to assess anastomotic quality intraoperatively, and to investigate its potential reliability in predicting early graft failure. Intraoperative graft flowmetry of 63 consecutive patients undergoing CABG were prospectively collected. Transit time flowmetry and its derivatives were recorded. Coronary resistances were calculated according to Hagen–Poiseuille equation both during cardioplegic arrest and after withdrawal from cardiopulmonary bypass. Angiographic evidence of graft occlusion at follow-up was cross-checked with intraoperative recordings. After a mean follow-up of 10.4 ± 6.0 months, 22 grafts were studied, and occlusion was documented in five (22.7%). Occluded grafts showed lower flows and higher resistances recorded during aortic cross-clamping. Coronary resistances, recorded during aortic cross-clamping, greater than 2.0 mmHg/mL/min, showed a sensitivity of 80% and a specificity of 100% to predict graft failure. We propose the routine recording of coronary resistances during aortic cross-clamping as an additional tool to overcome the acknowledged limitation of TTF to predict graft occlusion at 1 year.

Trends in Early Graft Failure Leading to Regrafting After Endothelial Keratoplasty in the United States

Cornea ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Michael J. Fliotsos ◽  
Jack A. Campbell ◽  
Ximin Li ◽  
Marie B. Engstrom ◽  
Christopher G. Stoeger ◽  
...  
Keyword(s):  
United States ◽  
Graft Failure ◽  
The United States ◽  
Endothelial Keratoplasty ◽  
Early Graft ◽  
Early Graft Failure

Platelet Adhesion in Polytetrafluoroethylene (PTFE) Vascular Grafts In Vivo and the Influence of Increased Intramuscular Pressure-An Experimental Model

1983 ◽  
Vol 50 (04) ◽  
pp. 881-884 ◽  
Author(s):  
J T Christenson ◽  
P Qvarfordt ◽  
S-E Strand ◽  
D Arvidsson ◽  
T Sjöberg ◽  
...  
Keyword(s):  
Blood Flow ◽  
Graft Failure ◽  
Small Diameter ◽  
Graft Material ◽  
Intramuscular Pressure ◽  
Initial Flow ◽  
Early Graft ◽  
Wick Technique ◽  
Early Graft Failure

SummaryThrombogenicity of graft material is involved in early graft failure in small diameter grafts. The frequently seen postoperative swelling of the leg after distal revascularization may cause an increased intramuscular pressure and early graft failure.Pairs of 4 mm polytetrafluoroethylene (PTFE) grafts were implanted. Autologous platelets were labeled with mIn-oxine. Platelet adhesiveness onto the grafts were analyzed from gamma camera images. Intramuscular pressures were measured with wick technique. Blood flow was measured. One graft served as control the other as test graft. Ninety minutes after declamping the i. m. pressure was increased in the test-leg to 30 mmHg, and later to 60 mmHg.In the control-graft platelet uptake increased to a maximum 60 min after declamping. Blood flow and i.m. pressure remained uneffected. The test-grafts were initially similar but when i.m. pressure was increased to 30 mmHg activity in the grafts increased significantly. Blood flow decreased with 12% of initial flow. When i. m. pressure was raised to 60 mmHg platelet uptake continued to increase.An increased intramuscular pressure of 30 mmHg or more significantly increase the amount of platelets adhering onto PTFE grafts, emphasizing the need for measuring intramuscular pressures after lower limb vascular revascularizations.

Correlation of laboratory and ECG changes with early graft failure after CABG

2005 ◽  
Vol 53 (S 01) ◽  
Author(s):  
A Schnell ◽  
A Künzli ◽  
B Seifert ◽  
O Reuthebuch ◽  
M Lachat ◽  
...  
Keyword(s):  
Graft Failure ◽  
Ecg Changes ◽  
Early Graft ◽  
Early Graft Failure

Virchow Triad, but Not Use of an Aortic Connector Device, Predicts Early Graft Failure after Off-Pump Coronary Bypass

2004 ◽  
Vol 7 (5) ◽  
pp. E428-E433 ◽  
Author(s):  
Robert Poston ◽  
Charles White ◽  
Katrina Read ◽  
Junyan Gu ◽  
Andrew Lee ◽  
...  
Keyword(s):  
Graft Failure ◽  
Coronary Bypass ◽  
Off Pump ◽  
Early Graft ◽  
Early Graft Failure ◽  
Aortic Connector

scholarly journals Prediction model for early graft failure after liver transplantation using aspartate aminotransferase, total bilirubin and coagulation factor

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jinsoo Rhu ◽  
Jong Man Kim ◽  
Kyunga Kim ◽  
Heejin Yoo ◽  
Gyu-Seong Choi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Prediction Model ◽  
Aspartate Aminotransferase ◽  
Graft Failure ◽  
Living Donor ◽  
Total Bilirubin ◽  
Deceased Donor ◽  
Time Dependent ◽  
Early Graft ◽  
Early Graft Failure

AbstractThis study was designed to build models predicting early graft failure after liver transplantation. Cox regression model for predicting early graft failure after liver transplantation using post-transplantation aspartate aminotransferase, total bilirubin, and international normalized ratio of prothrombin time was constructed based on data from both living donor (n = 1153) and deceased donor (n = 359) liver transplantation performed during 2004 to 2018. The model was compared with Model for Early Allograft Function Scoring (MEAF) and early allograft dysfunction (EAD) with their C-index and time-dependent area-under-curve (AUC). The C-index of the model for living donor (0.73, CI = 0.67–0.79) was significantly higher compared to those of both MEAF (0.69, P = 0.03) and EAD (0.66, P = 0.001) while C-index for deceased donor (0.74, CI = 0.65–0.83) was only significantly higher compared to C-index of EAD. (0.66, P = 0.002) Time-dependent AUC at 2 weeks of living donor (0.96, CI = 0.91–1.00) and deceased donor (0.98, CI = 0.96–1.00) were significantly higher compared to those of EAD. (both 0.83, P < 0.001 for living donor and deceased donor) Time-dependent AUC at 4 weeks of living donor (0.93, CI = 0.86–0.99) was significantly higher compared to those of both MEAF (0.87, P = 0.02) and EAD. (0.84, P = 0.02) Time-dependent AUC at 4 weeks of deceased donor (0.94, CI = 0.89–1.00) was significantly higher compared to both MEAF (0.82, P = 0.02) and EAD. (0.81, P < 0.001). The prediction model for early graft failure after liver transplantation showed high predictability and validity with higher predictability compared to traditional models for both living donor and deceased donor liver transplantation.

Microcannula Utilization for Injectable Facial Fillers: Standard of Care?

2018 ◽  
Vol 35 (4) ◽  
pp. 189-197 ◽  
Author(s):  
Kian Karimi ◽  
Chester F. Griffiths ◽  
Alex Reivitis ◽  
Austin Davis-Hunter ◽  
Elizabeth Zhang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Standard Of Care ◽  
Dermal Filler ◽  
Popular Method ◽  
Patient Reported ◽  
Clinical Series ◽  
Filler Injections

The microcannula technique has become an increasingly popular method for injecting cosmetic fillers. Previous studies have illustrated that the microcannula technique allows filler to be injected with less pain, swelling, and essentially no bruising. This study is a retrospective clinical series examining 247 patients who have undergone dermal filler injections using the microcannula technique from 2011 to 2016 with a single injector, Kian Karimi. The purpose of this study is to assess the frequency of adverse events associated with injections such as bruising and swelling. All 666 recorded patient visits from 2011 to 2016 were analyzed using electronic medical records based on the criteria that the patients had cosmetic filler using the microcannula technique by the surgeon investigator. Of the 666 filler treatments using the microcannula technique, 3 treatments (0.5%) produced adverse events on the day of service, and 32 treatments (4.8%) produced adverse events at 2-week follow-up. In total, 5.4% of treatments produced adverse events. At the 2-week follow-up, 5.7% of treatments using the 25-gauge microcannula produced adverse events ( P = .830); 3.9% of treatments using the 27-gauge microcannula produced adverse events ( P = .612]). Only 3 patients were treated with the 30-gauge microcannula, and 1 patient reported adverse events on the day of service. None of the treatments using the 30-gauge microcannula produced adverse events at the 2-week follow-up ( P = .160). The data support that the microcannula technique is a safe and effective alternative to hypodermic needles for the injection of dermal filler to minimize common adverse events.

scholarly journals Midterm Safety of Carbon Dioxide Insufflation of the Knee During Arthroscopic Cartilage–Based Procedures

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110354
Author(s):  
Judson L. Penton ◽  
Travis R. Flick ◽  
Felix H. Savoie ◽  
Wendell M. Heard ◽  
William F. Sherman
Keyword(s):  
Carbon Dioxide ◽  
Clinical Outcomes ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Knee Arthroscopy ◽  
Case Series ◽  
Osteochondral Allograft ◽  
Systemic Complications ◽  
Allograft Transplantation

Background: When compared with fluid arthroscopy, carbon dioxide (CO2) insufflation offers an increased scope of view and a more natural-appearing joint cavity, and it eliminates floating debris that may obscure the surgeon’s view. Despite the advantages of CO2 insufflation during knee arthroscopy and no reported cases of air emboli, the technique is not widely used because of concerns of hematogenous gas leakage and a lack of case series demonstrating safety. Purpose/Hypothesis: To investigate the safety profile of CO2 insufflation during arthroscopic osteochondral allograft transplantation of the knee and report the midterm clinical outcomes using this technique. We hypothesized that patients undergoing CO2 insufflation of the knee joint would have minimal systemic complications, allowing arthroscopic cartilage work in a dry field. Study Design: Case series; level of evidence, 4. Methods: A retrospective chart review was performed of electronic medical records for patients who underwent arthroscopic osteochondral allograft transplantation of the knee with the use of CO2 insufflation. Included were patients aged 18 to 65 years who underwent knee arthroscopy with CO2 insufflation from January 1, 2015, to January 1, 2021, and who had a minimum follow-up of 24 months. All procedures were performed by a single, fellowship-trained and board-certified sports medicine surgeon. The patients’ electronic medical records were reviewed in their entirety for relevant demographic and clinical outcomes. Results: We evaluated 27 patients (14 women and 13 men) with a mean age of 38 and a mean follow-up of 39.2 months. CO2 insufflation was used in 100% of cases during the placement of the osteochondral allograft. None of the patients sustained any systemic complications, including signs or symptoms of gas embolism or persistent subcutaneous emphysema. Conclusion: The results of this case series suggest CO2 insufflation during knee arthroscopy can be performed safely with minimal systemic complications and provide an alternative environment for treating osteochondral defects requiring a dry field in the knee.

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