Prolonged Arterial Spasm in an Ear Replantation Without Venous Anastomosis

Abstract. Background: In this study, we investigated the patency of endovascular stent grafts in haemodialysis patients with arteriovenous grafts, the modes of patency loss, and the risk factors for re-intervention. Patients and methods: Haemodialysis patients with graft-vein anastomotic stenosis of their arteriovenous grafts who were treated with endovascular stent-grafts between 2008 and 2013 were entered into this retrospective study. Primary and secondary patency, modes of patency loss, and risk factors for intervention were recorded. Results: Cumulative circuit primary patency rates decreased from 40.0 % at 6 months to 7.3 % at 24 months. Cumulative target lesion primary patency rates decreased from 72.1 % at 6 months to 22.0 % at 24 months. Cumulative secondary patency rates decreased from 81.3 % at 12 months to 31.6 % at 36 months. Patients with a history of cerebrovascular accident had a significantly higher risk of secondary patency loss, and graft puncture site stenosis jeopardised the results of stent-graft treatment. Conclusions: Our data can help to improve outcomes in haemodialysis patients treated with stent-grafts for venous anastomosis of an arteriovenous graft.

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Lymphatico‐venous anastomosis in chronic ulcer with venous insufficiency: A case report

Microsurgery ◽

10.1002/micr.30753 ◽

2021 ◽

Author(s):

Emanuele Cigna ◽

Diletta Maria Pierazzi ◽

Simone Sereni ◽

Marco Marcasciano ◽

Luigi Losco ◽

...

Keyword(s):

Case Report ◽

Venous Insufficiency ◽

Chronic Ulcer ◽

Venous Anastomosis

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Mechanical Anastomotic Coupling Device versus Hand-sewn Venous Anastomosis in Head and Neck Reconstruction—An Analysis of 1694 Venous Anastomoses

Indian Journal of Plastic Surgery ◽

10.1055/s-0041-1731622 ◽

2021 ◽

Vol 54 (02) ◽

pp. 118-123

Author(s):

Rajan Arora ◽

Kripa Shanker Mishra ◽

Hemant T. Bhoye ◽

Ajay Kumar Dewan ◽

Ravi K. Singh ◽

...

Keyword(s):

Venous Thrombosis ◽

Head And Neck ◽

Free Tissue Transfer ◽

Effective Alternative ◽

Head And Neck Reconstruction ◽

Venous Anastomosis ◽

Neck Reconstruction ◽

Coupling Device ◽

Tissue Transfer ◽

Flap Loss

Abstract Background There is a steep learning curve to attain a consistently good result in microvascular surgery. The venous anastomosis is a critical step in free-tissue transfer. The margin of error is less and the outcome depends on the surgeon’s skill and technique. Mechanical anastomotic coupling device (MACD) has been proven to be an effective alternative to hand-sewn (HS) technique for venous anastomosis, as it requires lesser skill. However, its feasibility of application in emerging economy countries is yet to be established. Material and Method We retrospectively analyzed the data of patients who underwent free-tissue transfer for head and neck reconstruction between July 2015 and October 2020. Based on the technique used for the venous anastomosis, the patients were divided into an HS technique and MACD group. Patient characteristics and outcomes were measured. Result A total of 1694 venous anastomoses were performed during the study period. There were 966 patients in the HS technique group and 719 in the MACD group. There was no statistically significant difference between the two groups in terms of age, sex, prior radiotherapy, prior surgery, and comorbidities. Venous thrombosis was noted in 62 (6.4%) patients in the HS technique group and 7 (0.97%) in the MACD group (p = 0.000). The mean time taken for venous anastomosis in the HS group was 17 ± 4 minutes, and in the MACD group, it was 5 ± 2 minutes (p = 0.0001). Twenty-five (2.56%) patients in the HS group and 4 (0.55%) patients in MACD group had flap loss (p = 0.001). Conclusion MACD is an effective alternative for HS technique for venous anastomosis. There is a significant reduction in anastomosis time, flap loss, and return to operation theater due to venous thrombosis. MACD reduces the surgeon’s strain, especially in a high-volume center. Prospective randomized studies including economic analysis are required to prove the cost-effectiveness of coupler devices.

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Attempted Prevention or Treatment of Intracranial Arterial Spasm

Neurosurgery ◽

10.1227/00006123-198002000-00016 ◽

1980 ◽

Vol 6 (2) ◽

pp. 198-210 ◽

Cited By ~ 62

Author(s):

Robert H. Wilkins

Keyword(s):

Arterial Spasm

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Prostacyclin and cerebral vessel relaxation

Journal of Neurosurgery ◽

10.3171/jns.1982.57.3.0334 ◽

1982 ◽

Vol 57 (3) ◽

pp. 334-340 ◽

Cited By ~ 40

Author(s):

Kamal S. Paul ◽

Eric T. Whalley ◽

Christine Forster ◽

Richard Lye ◽

John Dutton

Keyword(s):

Angiotensin Ii ◽

Arterial Spasm ◽

Cerebral Vessel ◽

Content Type ◽

Wide Range ◽

Potent Vasodilator ◽

Dose Dependent Fashion ◽

Basilar Arteries ◽

High Concentrations

✓ The authors have studied the ability of prostacyclin to reverse contractions of human basilar arteries in vitro that were induced by a wide range of substances implicated in the etiology of cerebral arterial spasm. Prostacyclin (10−10 to 10−6M) caused a dose-related reversal of contractions induced by 5-hydroxytryptamine, noradrenaline, angiotensin II, prostaglandin (PG)F2α, and U-46619 (a thromboxane-A2 mimetic). These agents were tested at concentrations or volumes that produced almost maximum or maximum responses and those that produced approximately 50% of the maximum response. Contractions induced by maximum concentrations of angiotensin II and U-46619 were least affected by prostacyclin. In addition, contractions induced by thromboxane-A2 generated from guinea-pig lung were reversed in a dose-dependent fashion by prostacyclin. This ability of prostacyclin to physiologically antagonize contractions of the human basilar artery in vitro induced by high concentrations of various spasmogenic agents suggests that such a potent vasodilator agent or more stable analogue may be of value in the treatment of such disorders as cerebral arterial spasm following subarachnoid hemorrhage.

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Economic Comparison of Hand-Sutured and Coupler-Assisted Microvascular Anastomoses

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1606540 ◽

2017 ◽

Vol 34 (01) ◽

pp. 071-076 ◽

Cited By ~ 4

Author(s):

Linden Head ◽

Douglas McKay

Keyword(s):

Economic Analysis ◽

Operative Time ◽

Capital Expenditure ◽

Operating Time ◽

Free Tissue Transfer ◽

Capital Expenditures ◽

Purchasing Decisions ◽

Venous Anastomosis ◽

Literature Reviews ◽

Economic Comparison

Background Compared with hand-sewn anastomoses, microvascular anastomotic coupling devices (MACDs) provide equivalent flap survival and reduced operative time. To date, an economic analysis of MACDs has not been reported. The objective of this study was to evaluate the economics of a venous anastomosis performed using a coupling device compared with a hand-sewn anastomosis. Methods Economics were modeled for a single free tissue transfer (FTT) requiring one venous anastomosis performed with either hand-sewn sutures or with a coupler-assisted anastomosis using the GEM COUPLER. Fixed and variable costs incurred with each anastomotic technique were identified with an activity-based cost analysis. Price lists were retrieved from suppliers to quantify disposable costs and capital expenditures. Two literature reviews were executed to identify microsurgical operating room (OR) costs and operating time reductions with coupler-assisted anastomoses. Results For each venous anastomosis, the use of the anastomotic coupler increased disposable costs by $284.40 compared with a hand-sutured anastomosis. Total fixed and variable OR costs were $30.82 per minute. Operating time was reduced by a mean of 16.9 minutes with a coupler-assisted anastomosis, decreasing OR costs by $519.29. Total savings of $234.89 were generated for each coupler-assisted anastomosis, recuperating the device's capital expenditure after 13 uses. Conclusion Compared with a hand-sewn venous anastomosis, an MACD produces savings with each case and quickly recoups the device's capital expenditure. Despite its limitations and simplicity, this study provides a practical economic analysis that can help inform purchasing decisions, particularly for smaller volume centers where the economic rationale may be less clear.

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