The challenge of stent placement within cannulation zones of Arteriovenous Fistulae

2020 ◽  
pp. 112972982095474
Author(s):  
Alexandros Mallios ◽  
Pierre Bourquelot ◽  
William C Jennings
Keyword(s):  
Surgical Management ◽  
Stent Placement ◽  
Complete Resection ◽  
Access Management ◽  
Arteriovenous Fistulae ◽  
Surgical Interventions ◽  
The Future

Background: Stent placement in the cannulation zone of AVF is becoming alarmingly frequent and sometimes in cases where surgical management would be more appropriate. When complications arise repair can be particularly challenging. We present our experience and management of this problem. Methods: We report our experience on three patients (two females and one male, mean age 72) that were referred to our department for problems related to stents placed at the cannulation segments. Results: All patients required complex surgical interventions. In two of them maintenance of access was possible but required the use of a graft. In one complete resection of the AVF and all stents was necessary, and the patient remained on dialysis through catheter. Conclusion: Stent placement at the cannulation zones may complicate access management in the future and should be avoided if possible.

Surgical management of carotid body tumor – Is Shamblin classification sufficient to predict surgical outcome?

Vascular ◽  
2016 ◽  
Vol 25 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Y Law ◽  
YC Chan ◽  
SW Cheng
Keyword(s):  
Surgical Management ◽  
Carotid Body ◽  
Incidental Finding ◽  
Neck Mass ◽  
Complete Resection ◽  
Carotid Body Tumor ◽  
Class Iii ◽  
Surgical Interventions ◽  
Shamblin Classification

Background The study aims to conduct a review of the surgical management of carotid body tumor. Methods Consecutive patients with CBT who received surgical interventions from January 1994 to January 2014 at our institution were reviewed. Clinical, operative, pathological and follow up information were reported. Results Twenty patients (four males; median age was 36) with 21 CBT operations were recorded during the period. One patient undertook sequential operations for bilateral CBTs. Patients had 19 neck mass, 1 incidental finding and 1 facial nerve palsy. Six CBTs (28.6%) were Shamblin class I, ten (47.6%) were class II and five (23.8%) were class III. Nine CBTs had preoperative conjunctive embolization. Two operations required internal carotid artery resection and reconstruction. Four patients received subtotal resections, while 17 achieved complete resection. Complications included two major strokes, three hoarse voice and two Horner’s syndrome. Shamblin class was significant predictor of operative time, blood loss, and whether complete resection accomplished, but could not predict postoperative complication. With median follow up period of 94 months, there was no tumor recurrence found in those had complete resection. Conclusions This small cohort showed that Shamblin class was significant in predicting technical difficulties but could not predict occurrence of complications.

scholarly journals Surgical Management of Sporadic Peripheral Nerve Schwannomas in Adults: Indications and Outcome in a Single Center Cohort

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1017
Author(s):  
Julian Zipfel ◽  
Meizer Al-Hariri ◽  
Isabel Gugel ◽  
Alexander Grimm ◽  
Volker Steger ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Clinical Signs ◽  
Complete Resection ◽  
Adult Patients ◽  
Neurological Deficits ◽  
Primary Tumors ◽  
Surgical Interventions ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath

Most sporadic peripheral nerve sheath tumors in adults are schwannomas. These tumors usually present with significant pain but can also cause neurological deficits. Symptomatology is diverse, and successful surgical interventions demand interdisciplinarity. We retrospectively reviewed 414 patients treated between 2006 and 2017 for peripheral nerve sheath tumors. We analyzed clinical signs, symptoms, histology, and neurological function in the cohort of adult patients with schwannomas without a neurocutaneous syndrome. In 144 patients, 147 surgical interventions were performed. Mean follow-up was 3.1 years. The indication for surgery was pain (66.0%), neurological deficits (23.8%), significant tumor growth (8.8%), and suspected malignancy (1.4%). Complete tumor resection was achieved on 136/147 occasions (92.5%). The most common location of the tumors was intraspinal (49.0%), within the cervical neurovascular bundles (19.7%), and lower extremities (10.9%). Pain and neurological deficits improved significantly (p ≤ 0.003) after 131/147 interventions (89.1%). One patient had a persistent decrease in motor function after surgery. Complete resection was possible in 67% of recurrent tumors, compared to 94% of primary tumors. There was a significantly lower chance of complete resection for schwannomas of the cervical neurovascular bundle as compared to other locations. The surgical outcome of sporadic schwannoma surgery within the peripheral nervous system is very favorable in experienced peripheral nerve surgery centers. Surgery is safe and effective and needs a multidisciplinary setting. Early surgical resection in adult patients with peripheral nerve sheath tumors with significant growth, pain, neurological deficit, or suspected malignancy is thus recommended.

scholarly journals A survey of clinical opinions and preferences on the non-surgical management of intermittent exotropia in China

2021 ◽  
Author(s):  
Yidong Wu ◽  
Tingting Peng ◽  
Jinjing Zhou ◽  
Meiping Xu ◽  
Yi Gao ◽  
...  
Keyword(s):  
Surgical Management ◽  
Online Survey ◽  
Randomized Clinical Trials ◽  
Treatment Guidelines ◽  
Survey Study ◽  
Cross Sectional Survey ◽  
Intermittent Exotropia ◽  
Cross Sectional ◽  
Surgical Interventions ◽  
Surgical Options

Purpose: Intermittent exotropia (IXT) is the most common form of childhood exotropia. Currently, controversies exist regarding its management and non-surgical options in particular. This study reports clinical opinions and preferences on the non-surgical management among practitioners in China. The opinions within and between ophthalmologists and optometrists were also compared. Design: Cross-sectional survey study. Methods: An online survey was developed and distributed through professional bodies. The study was conducted from July 25th to August 3rd, 2019. A total of 300 ophthalmologists and 188 optometrists responded. Results: Of 488 participants, 257 (53%) considered fusion defects as the main cause of IXT, and 299 (61%) took IXT as a progressive disorder. Two hundred and seventy-one (56%) participants considered orthoptic exercises as the most effective non-surgical intervention for IXT. Likewise, 245 (50%) participants reported that orthoptic exercises was their most frequent non-surgical option, followed by observation (178, 37%). There are discrepancies between ophthalmologists and optometrists. A greater proportion of ophthalmologists (201, 67%) shared the view that IXT worsens over time compared with optometrists (98, 52%) (p = 0.001). Additionally, ophthalmologists (121, 40%) tended to prefer observation compared with optometrists (57, 30%) (p = 0.021). Conclusions: This study shows that there is no general consensus on the non-surgical management of IXT in China. Given the lack of robust evidence, the findings from this study not only show the current clinical opinions but also highlight the need for future randomized clinical trials to validate the effectiveness of non-surgical interventions, orthoptic exercises in particular, and to establish treatment guidelines accordingly.

Back to the Future: How Biology and Technology Could Change the Role of PTFE Grafts in Vascular Access Management

2012 ◽  
Vol 25 (5) ◽  
pp. 495-504 ◽  
Author(s):  
Prabir Roy-Chaudhury ◽  
Mahmoud El-Khatib ◽  
Begona Campos-Naciff ◽  
Davinder Wadehra ◽  
Karthik Ramani ◽  
...  
Keyword(s):  
Vascular Access ◽  
Access Management ◽  
The Future

scholarly journals Surgical management of traumatic pancreatic injuries and their consequences.

2020 ◽  
Vol 7 (11) ◽  
pp. 3555
Author(s):  
Ashraf Mohammad El-badry ◽  
Mohamed Mahmoud Ali
Keyword(s):  
Surgical Management ◽  
Damage Control ◽  
Pancreatic Injury ◽  
Hemodynamic Instability ◽  
University Hospital ◽  
Pancreatic Trauma ◽  
Surgical Interventions ◽  
Pancreatic Injuries ◽  
Group A ◽  
Group B

Background: Management of pancreatic trauma remains challenging due to difficulty in diagnosis and complexity of surgical interventions. In Egypt, reports on pancreatic trauma are scarce.Methods: Medical records of adult patients with pancreatic trauma who were admitted at Sohag University Hospital (2012-2019) were retrospectively studied. Patients were categorized into group A of non-operative management (NOM), group B which required upfront exploratory laparotomy due to hemodynamic instability and group C in which surgical management was implemented after thorough preoperative assessment. Pancreatic injuries were ranked by the pancreas injury scale (PIS).Results: Thirty-two patients (25 males and 7 females) were enrolled, and median age of 36 (range: 23-68) years. Twenty-eight patients (87.5%) had blunt trauma whereas penetrating injury occurred in 4 (12.5%). There were 9 patients in group A, 7 in group B and 16 in group C. High grades of pancreatic injury ≥3 occurred in 4 patients from group B and 5 from group C. Distal pancreatectomy was performed in 7 patients while central resection and panceatico-gastrostomy in one. Grade IV injury occurred only in one patient who received damage-control laparotomy. Post-operative complication were significantly increased in group B compared with C, in correlation worse hemodynamic status and increased severity of PIS. Post-operative mortality occurred in 2 patients (6%), both from group B. Late consequences included pancreatic pseudocyst (4 cases) and walled off pancreatic necrosis (2 cases).Conclusions: High grades of pancreatic injury and hemodynamic instability correlate with worse outcome after surgery for pancreatic trauma.

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