Open Surgical versus Minimally Invasive in Situ Femorodistal Bypass: Long-term Results

2003 ◽  
Vol 10 (1) ◽  
pp. 117-120 ◽  
Author(s):  
Nomdo S. Renken ◽  
Cees H.A. Wittens ◽  
Peter M.T. Pattynama ◽  
Nico A.J.J. Du Bois ◽  
Lukas C. van Dijk
Keyword(s):  
Minimally Invasive ◽  
Limb Salvage ◽  
Long Term Results ◽  
Open Technique ◽  
Treatment Groups ◽  
Closed Technique ◽  
Open Versus

Purpose: To compare long-term patency and limb survival rates for the classical in situ surgical bypass procedure versus a minimally invasive technique for femorodistal revascularization. Methods: From May 1992 to June 1994, a prospective multicenter study was undertaken at 4 centers to evaluate the open versus closed technique for femorodistal bypass grafting. Of 97 patients enrolled in the trial, 73 patients (49 men; mean age 71 years) were assigned to the long-term follow-up protocol and prospectively randomized to the open (n = 38) or closed (n = 35) procedure. The classical open technique is characterized by a long incision over the length of the bypass graft, while the minimally invasive procedure involves only two short incisions over each anastomosis site (the side branches are closed with a coaxial embolization catheter system). Graft patency was evaluated with duplex imaging periodically throughout the 4-year observation period. Results: There was no statistically significant difference between the treatment groups with respect to age, sex, hypertension, ischemic heart disease, or smoking. However, the open group had a significantly greater incidence of diabetes (p = 0.037). Over a median 4.7-year follow-up (range 0.3–6.4), 9 (12%) patients (3 open and 6 closed) were lost to follow-up: 2 died and 7 refused the duplex examination. No significant differences in 4-year patency, limb salvage, or survival was demonstrated between the open versus closed treatment groups; 4-year secondary patency was 62% versus 64%, respectively, and limb salvage was 72% versus 86%. Conclusions: The closed technique for femorodistal in situ bypass procedures yields favorable long-term outcomes compared to the traditional open technique.

Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 474-481 ◽  
Author(s):  
Radak ◽  
Babic ◽  
Ilijevski ◽  
Jocic ◽  
Aleksic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Limb Salvage ◽  
Iliac Artery ◽  
Graft Patency ◽  
Long Term Results ◽  
Surgical Reconstruction ◽  
Safe Procedure ◽  
Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

scholarly journals Minimally invasive video-assisted thyroidectomy: a critical analysis of long-term cosmetic results using a validated tool

2019 ◽  
Vol 101 (3) ◽  
pp. 180-185 ◽  
Author(s):  
M Sahm ◽  
R Otto ◽  
M Pross ◽  
R Mantke
Keyword(s):  
Minimally Invasive ◽  
Conventional Group ◽  
Long Term Results ◽  
Cosmetic Results ◽  
Assessment Score ◽  
Conventional Thyroidectomy ◽  
Video Assisted ◽  
Scar Assessment

Introduction Since its first publication in 1997, minimally invasive video-assisted thyroidectomy (MIVAT) has developed into the predominant minimally invasive surgery of the thyroid. A major advantage over conventional thyroid surgery is the superior cosmetic result. However, there are still few data comparing the long-term cosmetic results of the two methods. This paper compares the long-term cosmetic results of the two methods, based on follow-up assessments. Methods Between 2004 and 2011, 143 preselected patients underwent a MIVAT in our department. Additionally, 134 patients underwent a conventional thyroidectomy in our hospital in 2011. A total of 117 patients from the MIVAT group and 102 patients from the conventional thyroidectomy group received follow-up assessments after 23.1 and 23.6 months, respectively, using the patient and observer scar assessment scale. Results The measurable cervical scar length averaged 1.9 cm in the MIVAT group and 3.9 cm in the conventional group (P < 0.001). Some 11.1% of the patients in the MIVAT group and 7.1% of the patients in the conventional group had developed keloid (P = 0.391). The patient scar assessment score was 10.4 for the MIVAT group compared with 9.9 for the conventional thyroidectomy group (P = 0.691) and the observer scare assessment score was 8.6 for MIVAT compared with 9.9 for conventional thyroidectomy (P = 0.011). Conclusion In the patient assessment instrument, conventional thyroidectomy had a small advantage over MIVAT in the cosmetic long-term results. This difference between the two groups was, however, not significant. Our result contradicts short-term cosmetic results of published randomized studies with improvement for MIVAT. The Observer Score demonstrates a significant advantage of the MIVAT.

Cement within Cement Revision Hip Arthroplasty a Minimum 5 Year Follow-Up Study

1998 ◽  
Vol 8 (3) ◽  
pp. 129-137 ◽  
Author(s):  
J.P. Holland ◽  
F.A. Weber
Keyword(s):  
Femoral Stem ◽  
Femoral Shaft ◽  
Complete Removal ◽  
Senior Author ◽  
Long Term Results ◽  
Cemented Stem ◽  
Revision Hip Surgery

Complete removal of femoral shaft cement during revision hip surgery is a difficult task prone to complications. If the cement bone interface is intact however, is there a place for its preservation and re-use with a new cemented stem? The results are reported of 51 cement within cement femoral stem revisions carried out between 1984 and 1991 with a minimum of 5 years’ follow-up, and a mean of 7.8 years. Excluding patients lost or deceased, 39 hips in 38 patients were reviewed clinically and radiologically. Eighty-two percent of these were still functioning in situ, 72% were excellent or good using the HSS scoring system and 97% had no radiological evidence of loosening. Femoral stem failure due to aseptic loosening occurred in 4 cases (10%) between 4 and 12 years after revision. Comparing this series to a previous revision hip series by the senior author, there appears to be no deterioration in long term results using this technique, and a better long term radiological outcome.

Early clinical results of minimally invasive coracoclavicular ligament reconstruction can be maintained at a minimum of five years’ follow-up

2020 ◽  
Vol 102-B (7) ◽  
pp. 918-924
Author(s):  
Steffen B. Rosslenbroich ◽  
Katharina Heimann ◽  
Jan Christoph Katthagen ◽  
Clemens Koesters ◽  
Oliver Riesenbeck ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Constant Score ◽  
Clinical Results ◽  
Long Term Results ◽  
Short Term ◽  
Ac Joint ◽  
Ac Joint Dislocation ◽  
Significant Difference

Aims There is a lack of long-term data for minimally invasive acromioclavicular (AC) joint repair. Furthermore, it is not clear if good early clinical results can be maintained over time. The purpose of this study was to report long-term results of minimally invasive AC joint reconstruction (MINAR) and compare it to corresponding short-term data. Methods We assessed patients with a follow-up of at least five years after minimally invasive flip-button repair for high-grade AC joint dislocation. The clinical outcome was evaluated using the Constant score and a questionnaire. Ultrasound determined the coracoclavicular (CC) distance. Results of the current follow-up were compared to the short-term results of the same cohort. Results A total of 50 patients (three females, 47 males) were successfully followed up for a minimum of five years. The mean follow-up was 7.7 years (63 months to 132 months). The overall Constant score was 94.4 points (54 to 100) versus 97.7 points (83 to 100) for the contralateral side showing a significant difference for the operated shoulder (p = 0.013) The mean difference in the CC distance between the operated and the contralateral shoulder was 3.7 mm (0.2 to 7.8; p = 0.010). In total, 16% (n = 8) of patients showed recurrent instability. All these cases were performed within the first 16 months after introduction of this technique. A total of 84% (n = 42) of the patients were able to return to their previous occupations and sport activities. Comparison of short-term and long-term results revealed no significant difference for the Constant Score (p = 0.348) and the CC distance (p = 0.974). Conclusion The clinical outcome of MINAR is good to excellent after long-term follow-up and no significant differences were found compared to short-term results. We therefore suggest this is a reliable technique for surgical treatment of high-grade AC joint dislocation. Cite this article: Bone Joint J 2020;102-B(7):918–924.

scholarly journals Long-Term Results of Universal 2 Total Wrist Arthroplasty

2019 ◽  
Vol 08 (04) ◽  
pp. 317-320 ◽  
Author(s):  
H. J. A. Zijlker ◽  
M. J. P. F. Ritt ◽  
C. B. IJsselstein
Keyword(s):  
Patient Satisfaction ◽  
Long Term Results ◽  
Fourth Generation ◽  
X Rays ◽  
Implant Survival ◽  
Total Wrist Arthroplasty ◽  
Component Loosening

Background The Universal 2 is a widely used total wrist implant that aims to maintain function of the wrist. Purpose Promising mid-term results of the Universal 2 total wrist implant are described in the literature. This study evaluates the long-term results in terms of implant survival and patient satisfaction. Patients and Methods Patients who received a Universal 2 implant between 2004 and 2009 were retrospectively identified through a database search. Clinical outcome and complications of the implant were assessed by examination of the patient's medical records, X-rays, and a questionnaire, consisting of the Patient-Rated Wrist and Hand Evaluation questionnaire (PRWHE) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires and additional questions. Results Twenty-five patients (26 wrists) were included in this study. Twenty-one (81%) Universal 2 implants remained in situ after a mean follow-up of 11 years. Moderate PRWHE (44) and QuickDASH (41) scores were found in these cases. Five Universal 2 implants failed and were converted to a total wrist arthrodesis after a mean period of 9.2 years due to distal component loosening (n = 3), recurrent luxation (n = 1), or recurrent synovitis (n = 1). Twenty-three (92%) patients were (very) satisfied with the Universal 2 implant. Conclusion The Universal 2 demonstrates a high (81%) implant survival with a high patient satisfaction after a mean follow-up of 11 years. Prospective studies of the Universal 2 implant are necessary to objectify improvement in wrist function and to provide a better comparison to other fourth generation wrist implants.

Long-Term Results of the Surgical Treatment of Spinal Dermoid and Epidermoid Tumors.

Neurosurgery ◽  
1989 ◽  
Vol 25 (6) ◽  
pp. 860-864 ◽  
Author(s):  
Pierpaolo Lunardi ◽  
Paolo Missori ◽  
Franco M. Gagliardi ◽  
Aldo Fortuna
Keyword(s):  
Surgical Treatment ◽  
Nervous Tissue ◽  
Working Life ◽  
Clinical Findings ◽  
Long Term Results ◽  
Tumor Capsule ◽  
Follow Up Study

Abstract The clinical findings and the results of surgical treatment in 16 patients with spinal dermoid or epidermoid tumors are reported. In 9 patients the tumor capsule adhered so tightly to the nervous tissue that part of it was left in situ. In a follow-up study ranging from 5 to 30 years with a mean of 14.2 years only 1 patient had a recurrence of the tumor and 10 patients resumed a normal working life.

Excellent long-term results with minimally invasive edge-to-edge repair in myxomatous degenerative mitral valve regurgitation

2020 ◽  
Vol 31 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Igor Belluschi ◽  
Elisabetta Lapenna ◽  
Andrea Blasio ◽  
Benedetto Del Forno ◽  
Andrea Giacomini ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Cumulative Incidence ◽  
Cardiac Death ◽  
Competing Risk ◽  
Long Term Results ◽  
Left Ventricular Ejection ◽  
Myxomatous Degeneration

Abstract OBJECTIVES Previous series of minimally invasive mitral valve repairs showed excellent results at up to 10 years of follow-up. The goal of this study was to assess the long-term durability beyond 10 years of the edge-to-edge repair for myxomatous degeneration performed through a minimally invasive approach. METHODS Ninety-seven consecutive patients (mean age 35 ± 9 years; left ventricular ejection fraction 63 ± 6%) with severe myxomatous mitral regurgitation (MR) underwent mitral valve repair through a right minithoracotomy between 1999 and 2006. MR was due to lesions involving the posterior leaflet (7.2% of patients), anterior leaflet (12.4%) and both leaflets (80.4%). RESULTS No hospital deaths occurred. At hospital discharge all patients had no or trivial MR. Follow-up was 100% complete (median 15.5 years; interquartile range 13.6–17.0, max 19.3 years). The 16-year overall survival rate was 95.9 ± 2.02% [95% confidence interval (CI) 89.39–98.43]. At 16 years, the cumulative incidence function of cardiac death, with non-cardiac death as a competing risk, was 3.1 ± 1.75 (95% CI 0.83–8.02). Only 3 patients (4.1%) had redo operations for recurrent severe MR. At 16 years, the cumulative incidence functions of reoperation for and recurrence of MR ≥3+, with death as a competing risk, were 3.1 ± 1.76% (95% CI 0.83–8.02) and 5.6 ± 2.47% (95% CI 2.06–11.83), respectively. No predictors of recurrence of MR ≥3+ were identified. At the last follow-up, moderate MR (2+/4+) was detected in 17 patients (17.5%); most of the patients were in New York Heart Association functional class I–II (97%) and in sinus rhythm (90%). CONCLUSIONS Minimally invasive mitral valve edge-to-edge repair through a right minithoracotomy for myxomatous degeneration appears to be an effective and durable approach even in the long-term follow-up (up to 19 years).

scholarly journals Long-term Results after Total Thyroidectomy in Patients with Graves' Disease in Uzbekistan: Retrospective Study

2011 ◽  
Vol 3 (2) ◽  
pp. 79-82
Author(s):  
Said I Ismailov ◽  
Nusrat A Alimjanov ◽  
Bakhodir Kh Babakhanov ◽  
Murod M Rashitov ◽  
Alisher M Akbutaev
Keyword(s):  
Postoperative Complications ◽  
Total Thyroidectomy ◽  
Thyroid Tissue ◽  
Long Term Results ◽  
Graves Disease ◽  
Nerve Paralysis ◽  
Treatment Groups ◽  
Institutional Experience

ABSTRACT Subtotal thyroidectomy has been advocated as the standard treatment for Graves' disease (GD) because of the assumed lower risk of complications compared with total thyroidectomy, and also it provides the chance to avoid thyroxin therapy. The present study aims to examine our institutional experience with total thyroidectomy for GD. Patients were divided into two surgical treatment groups: Total thyroidectomy (TT) (n = 97) and total thyroidectomy with intraoperative thyroid autotransplantation (TTITA) (n = 74). TTITA performed in 74 patients. 0.5 to 2 gm of thyroid tissue was cut into small pieces and autotransplanted into the forearm muscle of the patient. Postoperative complications included eight cases of RLN palsy, two patients had nerve paralysis, two patients underwent tracheostomy, transient hypoparathyroidism in 25 patients, permanent hypoparathyroidism in two cases, wound hemorrhage in two patients. TPOAb levels were increased in 9% of patients with TT whereas in patients with TTITA TPOAb concentrations were elevated in 65% of patients at 3 months follow-up. TRAb in patients with TT were not detected while 20% patients undergone TTITA had high TRAb levels and 13.3% had terminal concentrations at 3 months follow-up. Serum TPOAb and TRAb were detected in none of the patients who underwent TT and TTITA at 1, 3 and 5 years follow-up. Removal of all thyroid tissue offers the best chance of preventing recurrent hyperthyroidism and we saw no increase in postoperative complications in the TT group. We feel that TT is safe and superior for achieving the goal of treatment of Graves' disease.

Ten Years’ Follow-Up of Single-Surgeon Minimally Invasive Reparative Surgery for Degenerative Mitral Valve Disease

2012 ◽  
Vol 7 (4) ◽  
pp. 270-273 ◽  
Author(s):  
Alessandro D'Alfonso ◽  
Filippo Capestro ◽  
Carlo Zingaro ◽  
Sacha Matteucci ◽  
Giuseppe Rescigno ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Long Term Results ◽  
Perioperative Morbidity ◽  
Annular Dilatation ◽  
Surgeon Experience ◽  
Leaflet Prolapse ◽  
Repair Techniques

Objective Granted that minimally invasive mitral valve (MV) surgery short-term results were found to be equivalent to those achieved with traditional sternotomy with respect to perioperative morbidity and echocardiographic outcomes, little is known about the long-term efficacy of this approach. This report analyzes a 10-year single-surgeon experience with minimally invasive MV surgery through a right minithoracotomy with peripheral cannulation and external aortic cross-clamping and MV repair (MVR) by direct vision. Methods We studied 179 patients (48% female) who underwent MVR between December 1999 and December 2010. Mean age was 40.2 ± 10.1 years (range, 15–67 years). One hundred seventy patients (95.0%) had degenerative diseases, and nine patients (5.0%) had endocarditic diseases. Repair techniques for degenerative disease with posterior leaflet prolapse (74 patients, 43.5%) consisted of quadrangular resection (QR) and annuloplasty (AP) combined with sliding plasty (49 patients, 58.1%); for anterior leaflet prolapse (28 patients, 16.5%) and bileaflet prolapse (66 patients, 38.8%), edge-to-edge repair (EE) and AP; in 2 patients (1.2%), annular dilatation alone consisting of AP. Repair techniques for endocarditic disease consisted of EE in six patients (66.7%), perforation closure in two patients (22.2%), and QR combined with AP in one patient (11.1%). Results All patients survived the operation and were discharged with MV regurgitation (MR) less than 2+/4+. At 10 years’ follow-up, overall survival was 98.7% ± 1.2%, freedom from redo was 98.5% ± 1.1%, freedom from MR recurrence (>2+/4+) in QR and in EE repair were, respectively, 91.7% ± 2.2% and 90.0% ± 2.4% (P = not significant). The linearized rates of overall mortality, MR recurrence (>2+/4+), and redo at follow-up are 0.10% ± 0.10% per year, 0.63% ± 0.26% per year, and 0.21% ± 0.15% per year, respectively. Conclusions Minimally invasive MVR can be performed with very good perioperative and long-term results. Freedom from MR greater than 2+/4+ recurrence for patients with QR is equivalent to that with EE repair in our patient cohort.

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