Is there a continuing role for traditional surgery?

2015 ◽  
Vol 30 (2_suppl) ◽  
pp. 29-35 ◽  
Author(s):  
Patrick A Coughlin ◽  
David C Berridge
Keyword(s):  
Varicose Veins ◽  
Clinical Success ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Surgical Techniques ◽  
Cost Effective ◽  
Long Term Results ◽  
Foam Sclerotherapy ◽  
Effective Manner

Despite recent NICE guidance there remains a definite role for surgery in the management of varicose veins. A lot of the available evidence that has driven the transformation of care towards endovenous treatments is of good quality yet published by enthusiasts. No endovenous studies have reported long term results as far out from intervention as the open studies, yet in the meta-analysis from Murad et al, the authors suggested from their results that when surgery was compared with all endoluminal ablation therapies, surgery was associated with a non-significant reduction in the risk of varicose vein recurrence (RR0.63; 95%CI 0.37--1.07). Much of the longer-term data on recurrence following open surgery for primary varicose veins dates back well over 15 years ago. This is prior to the inclusion of routine duplex assessment and sub-specialty designation. The recent Cochrane review (13 randomised controlled studies, 3081 patients). The overall conclusion was that UGFS, EVLT and RFA were at least as effective as surgery in the treatment of the LSV. This meta-analysis did not include the CLASS (Comparison of LAser, Surgery and foam Sclerotherapy as a treatment for varicose veins) trial in whichmeasures of clinical success were similar among the groups. Only 48% of the patients screened were eligible for the CLASS study and of these, only 24% of the eligible patients agreed to take part in the study. Similarly in the study by Carradice out of a total of 772 patients assessed for suitability, 442 did not meet the inclusion criteria. There is no doubt that endovenous surgery will increasingly become first line treatment for patients with symptomatic superficial venous reflux specifically in patients with SSV reflux. However, given the device related limitations with endothermal techniques specifically with regard to adverse anatomical features allied to the poorer results of UGFS within the treatment of LSV reflux, there is without doubt still a role for more traditional open surgical techniques that can be delivered with good short and long term outcomes and still being delivered in a cost effective manner.

Three year results of endovascular therapy with a new generation nitinol stent for femoro-popliteal artery lesions - a single-center outcome analysis of a subcohort of MISAGO 2 study

VASA ◽  
2013 ◽  
Vol 42 (5) ◽  
pp. 340-349 ◽  
Author(s):  
Ivan Kralj ◽  
Irene Boos ◽  
Uwe Müller-Bühl
Keyword(s):  
Popliteal Artery ◽  
Clinical Success ◽  
Ankle Brachial Index ◽  
Long Term Results ◽  
Outcome Analysis ◽  
Stent Fracture ◽  
Nitinol Stent ◽  
New Generation ◽  
Stent Stenosis

Background: Advances in stent technology have widened the field of indications for stent treatment of femoro-popliteal artery lesions, however the use of stents in bending arterial segments is restricted because some first- and second-generation nitinol stent designs did not respond well to the mechanical forces of femoro-popliteal segments in motion which pose a substantial risk of stent fracture inducing in-stent-stenosis. New generation nitinol stents are supposed to overcome these limitations but long-term results are rare. Patients and methods: In forty-five patients (mean age 68 y, range 50 - 85) with peripheral arterial disease (TASC II A-C, Rutherford category 2 - 5) forty-six lesions of the superficial femoral artery (37) or popliteal artery (9) were treated [25 high-grade stenoses, mean length 53 mm (range 30 - 145 mm); 21 chronic total occlusions, mean length 74 mm (range 30 - 180 mm)]. 74 % of lesions were located in the mobile bending arterial segments in the distal femoral or the popliteal segment. Clinical reevaluation performed at discharge, at 6, 12, 24, and 36 months included at least the measurement of ankle-brachial index (ABI) and duplex sonography. Results: Procedural success rate was 100 %. At 6, 12, 24, and 36 months, cumulative primary patency rate was 93.5 %, 84.8 %, 80.5 %, and 74.3 % (SE<10); freedom from target lesion revascularization rate was 95.7 %, 89.2 %, 84.9 %, and 79.3 % (SE<10); Rutherford category and ABI improved in all patients and clinical success was maintained in more than 85 % of patients. Conclusions: Sustained technical and clinical success and good clinical long-term results were achieved with Misago™ nitinol stent implantation in femoro-popliteal lesions with moderate risk for in-stent-stenosis, and in the distal femoral and popliteal mobile segment.

Strategic planning in grassland farming: Principles andapplications

1997 ◽  
pp. 191-197
Author(s):  
W.J. Parker ◽  
N.M. Shadbolt ◽  
D.I. Gray
Keyword(s):  
Strategic Planning ◽  
Performance Indicators ◽  
Cost Effective ◽  
Key Performance Indicators ◽  
Strategic Plans ◽  
Effective Manner ◽  
Farm Business ◽  
Pastoral Farming ◽  
Financial Environment

Three levels of planning can be distinguished in grassland farming: strategic, tactical and operational. The purpose of strategic planning is to achieve a sustainable long-term fit of the farm business with its physical, social and financial environment. In pastoral farming, this essentially means developing plans that maximise and best match pasture growth with animal demand, while generating sufficient income to maintain or enhance farm resources and improvements, and attain personal and financial goals. Strategic plans relate to the whole farm business and are focused on the means to achieve future needs. They should be routinely (at least annually) reviewed and monitored for effectiveness through key performance indicators (e.g., Economic Farm Surplus) that enable progress toward goals to be measured in a timely and cost-effective manner. Failure to link strategy with control is likely to result in unfulfilled plans. Keywords: management, performance

scholarly journals Combined Replacement of Aortic Valve and Ascending Aorta—A 70-Year Evolution of Surgical Techniques

Aorta ◽  
2021 ◽  
Author(s):  
Igor Vendramin ◽  
Uberto Bortolotti ◽  
Davide Nunzio De Manna ◽  
Andrea Lechiancole ◽  
Sandro Sponga ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Elderly Patients ◽  
Aortic Valve Disease ◽  
Surgical Techniques ◽  
Ascending Aorta ◽  
Valve Disease ◽  
Long Term Results ◽  
The Past ◽  
Technical Advances

AbstractSimultaneous replacement of the ascending aorta and aortic valve has always been a challenging procedure. Introduction of composite conduits, through various ingenious procedures and their modifications, has changed the outlook of patients with aortic valve disease and ascending aorta pathology. In the past 70 years, progress of surgical techniques and prosthetic materials has allowed such patients to undergo radical procedures providing excellent early and long-term results in both young and elderly patients. This article aims to review the most important technical advances in the treatment of aortic valve disease and ascending aorta aneurysms recognizing the important contributions in this field.

LONG TERM RESULTS OF PAEDIATRIC ROSS PROCEDURE: A NEW METHODOLOGY OF TIME-TO-EVENT DATA META-ANALYSIS

2016 ◽  
Vol 32 (10) ◽  
pp. S170-S171
Author(s):  
W. Ben Ali ◽  
T. Ducruet ◽  
I. El-Hamamsy ◽  
D. Bouchard ◽  
N.C. Poirier
Keyword(s):  
Meta Analysis ◽  
Long Term Results ◽  
Ross Procedure ◽  
Event Data ◽  
Time To Event ◽  
Time To Event Data

Endovenous management of varicose veins

2004 ◽  
Vol 19 (4) ◽  
pp. 163-169 ◽  
Author(s):  
S Soumian ◽  
A H Davies
Keyword(s):  
Varicose Veins ◽  
Signs And Symptoms ◽  
Venous Hypertension ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Foam Sclerotherapy ◽  
High Prevalence ◽  
Promising Treatment ◽  
Developed World

Objective: Chronic venous disease has made a considerable socio-economical impact in the developed world due to its high prevalence and cost of management. Venous hypertension gives rise to significant signs and symptoms that are indications for treatment. Though the mainstay of treatment currently is surgery, it may not be the ideal choice in some cases considering the heterogeneous spectrum of venous disease. Recent alternative endovenous treatments have shown a lot of promise in successfully treating this condition. The aim of this review was to assess the long-term effectiveness of these treatments. Methods: A Medline-based review of literature was carried out. Results: Foam sclerotherapy seems to be a very promising treatment for venous disease, as short-term results have shown good results in terms of outcomes, low morbidity and cost. New endovenous techniques such as radiofrequency and laser ablation are attractive considering the absence of groin scar and subsequent neovascularization, as well as very little bruising and discomfort. Conclusions: There is no clear evidence yet regarding the long-term effectiveness of these relatively new endovenous techniques.

Endoscopic Ultrasound-Guided Drainage and Treatment of Symptomatic Pancreatic Fluid Collection following Acute or Acute-on-Chronic Pancreatitis – A Single Center Case Series

2018 ◽  
Vol 143 (06) ◽  
pp. 577-585
Author(s):  
Dominik Kaczmarek ◽  
Jacob Nattermann ◽  
Christian Strassburg ◽  
Tobias Weismüller
Keyword(s):  
Success Rate ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Fluid Collection ◽  
Clinical Success Rate ◽  
Long Term Results ◽  
Pancreatic Fluid Collection ◽  
Endoscopic Procedures ◽  
Pancreatic Fluid

Abstracts Introduction Pancreatic fluid collection (PFC) is a common complication of acute pancreatitis. Endoscopic ultrasound (EUS)-guided drainage, which is often followed by direct endoscopic necrosectomy (DEN), has become the primary approach to treat PFC, including pancreatic pseudocysts (PP) and walled-off necrosis (WON). We aimed to determine retrospectively the short- and long-term results of patients treated in our endoscopy unit and to identify parameters that are associated with treatment efficacy and outcome. Methods The data of 41 consecutive patients with post-pancreatitic PFC, who underwent endoscopic transmural intervention between 2014 and 2016, were analyzed retrospectively. After an initial EUS-guided puncture, one or more plastic stents were placed and DEN was performed if necrotic tissue remained. Results The mean diameter of the PFC was 74.0 ± 4.8 mm. Of the PFCs, 29.3% were classified as PP and 70.7% as WON. Altogether, 196 transmural endoscopic procedures were performed, including 73 endoscopic necrosectomies in a subgroup of 21 patients (20 WON, 1 PP). Initial technical success was achieved in 97.6% of patients and the short-term clinical success rate was 90.2%. The long-term clinical success rate was 82.9%, since four patients died from septic shock and/or multiple organ failure and three patients developed recurrent PFC some months after the initial discharge from endoscopic treatment. Procedural complications were registered in 9 patients during 10 of 196 endoscopic procedures (5.1%): bleeding (6), cardiorespiratory insufficiency (2), perforation with pneumoperitoneum (1), aspiration with respiratory insufficiency (1), and non-perforating superficial damage of the gastric wall (1). Neither the size of the PFC nor the initial value of C-reactive protein (CRP) or other biochemical markers were correlated with efficacy or outcome of treatment. Only the cumulative number of days with CRP > 50 mg/L significantly correlated with the number of follow-up endoscopic sessions and DEN. Fungal colonization of PFC correlated significantly (p < 0.05) with the risk of mortality (44% vs. 0%), need for intensive care treatment (66.7% vs. 25%), and sepsis (55.6% vs. 12.5%). Conclusions We confirm that EUS-guided drainage followed by DEN in patients with solid necrotic material is an effective and relatively safe therapeutic approach. Prolonged elevation of CRP and fungal colonisation of the PFC are associated with a worse course of the disease.

Is catheter-directed foam sclerotherapy more effective than the usual foam sclerotherapy for treatment of the great saphenous vein?

2018 ◽  
Vol 33 (9) ◽  
pp. 646-652 ◽  
Author(s):  
Orsini Camillo
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Statistical Significance ◽  
Long Term Results ◽  
Complication Rates ◽  
Foam Sclerotherapy ◽  
Occlusion Rate ◽  
Long Term Experience

Objective This retrospective study presents the long-term results of catheter-directed foam sclerotherapy of the great saphenous vein. Method From January 2003 to June 2017, 277 patients with varices and great saphenous vein incompetence were treated with echo-guided foam sclerotherapy. Forty-six patients were treated with long-catheters guided by foam sclerotherapy. Foaming was carried out with sodium-tetra-decyl-sulphate. Results Results were examined in the two groups: A (long-catheters) and B (other procedures). The median overall follow-up was 52.1 months. In the A-group, the complete occlusion rate was 34/46 pts (73.9%) and partial occlusion was 10/46 (21.7%). In the B-group, respectively, 130/231 (56.2%) and 90/231 (38.9%). Comparisons between groups were statistically significant (p = 0.023; p = 0.021). Failures involved, respectively, 2/46 (4.3%) and 11/231 (4.7%) with no statistical significance. The complication rates were similar in the two groups. Conclusions In this long-term experience (median follow-up exceeding four years), foam-guided sclerotherapy of the great saphenous vein with a long-catheter turned out to be more effective than the usual foam-guided sclerotherapy.

scholarly journals Preoperative Somatostatin Analogues in Patients with Newly-diagnosed Acromegaly: A Systematic Review and Meta-analysis of Comparative Studies

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Chengxian Yang ◽  
Ge Li ◽  
Shenzhong Jiang ◽  
Xinjie Bao ◽  
Renzhi Wang
Keyword(s):  
Systematic Review ◽  
Comparative Studies ◽  
Meta Analysis ◽  
Somatostatin Analogues ◽  
Long Term Results ◽  
Current Evidence ◽  
Cochrane Library ◽  
Cure Rate ◽  
Short Term

Abstract Biochemical remission after transsphenoidal surgery is still unsatisfied in acromegaly patients with macroadenomas, especially with invasive macroadenomas. Concerning the impact of preoperative somatostatin analogues (SSAs) on surgical outcomes, previous studies with limited cases reported conflicting results. To assess current evidence of preoperative medical treatment, we performed a systematic review and meta-analysis of comparative studies. A literature search was conducted in Pubmed, Embase, and the Cochrane Library. Five randomized controlled trials (RCT) and seven non-RCT comparative studies were included. These studies mainly focused on pituitary macroadenomas though a small number of microadenoma cases were included. For safety, preoperative SSAs were not associated with elevated risks of postoperative complications. With respect to efficacy, the short-term cure rate was improved by preoperative SSAs, but the long-term cure rate showed no significant improvement. For invasive macroadenomas, the short-term cure rate was also improved, but the long-term results were not evaluable in clinical practice because adjuvant therapy was generally required. In conclusion, preoperative SSAs are safe in patients with acromegaly, and the favorable impact on surgical results is restricted to the short-term cure rate in macroadenomas and invasive macroadenomas. Further well-designed RCTs to examine long-term results are awaited to update the finding of this meta-analysis.

scholarly journals Replacement and Maintenance Decision Analysis for Hydraulic Machinery Facilities at Reservoirs under Imperfect Maintenance

Energies ◽  
2020 ◽  
Vol 13 (10) ◽  
pp. 2507
Author(s):  
Sou-Sen Leu ◽  
Tao-Ming Ying
Keyword(s):  
Cost Effective ◽  
Maintenance Cost ◽  
Imperfect Maintenance ◽  
Term Operation ◽  
Engineering Economics ◽  
Hydraulic Machinery ◽  
Effective Manner ◽  
The Cost ◽  
Replacement Time

After the long-term operation of reservoir facilities, they will become nonoperational due to the material deterioration and the performance degradation. One of crucial decisions is to determine the maintenance or replacement of the facilities in a cost-effective manner. Conventional replacement models seldom consider the maintenance effect. The facilities after maintenance are generally not as good as new, but are relatively restored. The target of this study is to establish a replacement decision model of the reservoir facilities under imperfect maintenance. By combining the theories of reliability analysis, imperfect maintenance, and engineering economics, the best timing of replacement that achieves cost-effectiveness is analyzed and proposed. Lastly, based on the design of experiments (DOE) and simulation, the regression curve chart for the economical replacement decision is established. Once the failure rate, the age of recovery after maintenance, and the ratio of maintenance cost to replacement cost are estimated based on historical data, the cost-effective replacement time of hydraulic machinery facilities will be efficiently determined.

Sign in / Sign up

Export Citation Format

Share Document