Xenopericardial self-made tube grafts in infectious vascular reconstructions: Preliminary results of an easy and ready to use surgical approach

Vascular ◽  
2016 ◽  
Vol 24 (6) ◽  
pp. 621-627 ◽  
Author(s):  
Alicja Zientara ◽  
Igor Schwegler ◽  
Omer Dzemali ◽  
Hans Bruijnen ◽  
Andreas Sebastian Peters ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Graft Patency ◽  
Vascular Reconstruction ◽  
Graft Material ◽  
Preliminary Results ◽  
Hospital Deaths ◽  
Vascular Infections ◽  
Considerable Morbidity ◽  
Free Rate

Purpose Infections are a major setback of vascular reconstruction and associated with considerable morbidity and mortality. We evaluated retrospectively our results with self-made bovine pericardial grafts in infected vessel revascularization versus standard graft material. Basic methods Retrospective analysis of 9 patients with bovine reconstruction and 10 patients with miscellaneous grafts (vein, homograft) for vascular infections. Principal findings Infection-free rate of the pericardial group was 100% in 17 months. For patients after reconstructions with miscellaneous grafts, the infection-free rate was 82% in 45 months. Overall in-hospital mortality was 10.5%. There were no in-hospital deaths in the pericardial group. Graft patency of the whole cohort was 100%. The median follow up was 11.74 months. Conclusion Self-made bovine pericardial tube grafts can be crafted to almost any size and adjusted to complex anatomic requirements. The use was feasible in various situations and was associated with good preliminary results concerning patency and reinfection.

Use of biosynthetic prosthesis (Omniflow II®) to replace infected infrainguinal prosthetic grafts - first results

VASA ◽  
2012 ◽  
Vol 41 (3) ◽  
pp. 215-220 ◽  
Author(s):  
Töpel ◽  
Betz ◽  
Uhl ◽  
Wiesner ◽  
Bröckner ◽  
...  
Keyword(s):  
Bacterial Resistance ◽  
Composite Graft ◽  
Vascular Reconstruction ◽  
Current Treatment ◽  
Autologous Reconstruction ◽  
Graft Material ◽  
External Compression ◽  
Treatment Standard ◽  
Omniflow Ii

Background: The current treatment standard of infected infrainguinal prosthetic vascular grafts includes total graft explantation and autologous vascular reconstruction. In the absence of appropriate autologous venous graft material prosthetic grafts with increased bacterial resistance can be used, whereas reinfection rates are still higher than after autologous reconstruction. Biosynthetic grafts have shown low postoperative infection rates when used as elective bypass material. Their higher resistance to bacterial infection could make them an alternative to replace infected prosthetic grafts in the absence of autologous material. Patients and methods: Between November 2009 and April 2011, 7 patients with infected infrainguinal prosthetic grafts (Szilagyi 3; 3 supragenicular and 4 infragenicular reconstructions) presented to our institution. There were 4 early (< 3 months after implantation) and 3 late infections (> 3 months after implantation. All grafts were explanted and replaced by biosynthetic grafts (Omniflow II®), because the patient had no suitable peripheral vein for complete autologous replacement. In 2 cases a composite graft with greater saphenous vein was done. In 6 cases microbiological cultures from intraoperatively obtained species were positive. The initial broad spectrum antibiotic therapy was continued according to the antibiogram for 6 to12 weeks. Results: There was no early or late reinfection during follow up (mean 9 months, range 4 - 20 months). During follow up we observed graft occlusions in 3 patients (1 due to kinking of the bypass, 1 due to progressive artheriosclerotic occlusion of the outflow vessels and 1 iatrogenic by external compression with a pressure cuff during arthroscopy). There were no early or late major amputations. One patient died with pneumonia 11 months postoperatively. Conclusions: In the absence of appropriate autologous material biosynthetic grafts seem to be a possible alternative to replace infected infrainguinal grafts. The different mechanical properties of biosynthetic grafts may be of certain disadvantage in infragenicular reconstructions.

scholarly journals Hybrid treatment of thoracoabdominal aortic aneurysm: Case series and review of the literature

2019 ◽  
Vol 76 (3) ◽  
pp. 331-340
Author(s):  
Petar Zlatanovic ◽  
Igor Koncar ◽  
Miroslav Markovic ◽  
Ranko Trailovic ◽  
Vladimir Cvetic ◽  
...  
Keyword(s):  
Overall Survival ◽  
Aortic Aneurysm ◽  
Literature Review ◽  
Hospital Mortality ◽  
Case Series ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Graft Patency ◽  
Technical Failure ◽  
Hybrid Treatment

Background/Aim. Open thoracoabdominal aortic aneurysm (ThAAAs) repair is a challenging mission. Total endovascular approach is performed at selected institutions in developing countries, however these are not generalizable. Hybrid procedures offer an alternative approach. The aim of this study was to present our results of the ThAAA hybrid treatment and a literature review. Methods. This is a retrospective study of all patients that underwent the hybrid ThAAA repair at our institution between January 2011 and January 2018. Hybrid ThAAA repair was done as a twostaged procedure ? open visceral debranching followed by stent-graft placement (TEVAR). The following data from eligible studies were extracted and analyzed: first author, publication year, patient sample, 30-day/in-hospital mortality, permanent paraplegia rate, presence of endoleaks and graft patency after the follow-up period, overall survival and mean follow-up period. Results. Seven patients underwent the hybrid ThAAA repair at our institution. Neither intraoperative death nor technical failure due to TEVAR was observed. Mean follow-up rate after discharge was 51.71 months [95% confidence interval (CI): 14.67?88.74 months]. At the time of the follow-up, all bypasses were patent and no prosthesis migration was documented. After one year, a case of type Ib endoleak was identified and treated successfully. Twenty-five studies were eligible for the literature review. Primary technical success was 91.69% (95% CI: 85.34?97.24%). Mean percentage of permanent paraplegia was 5.27% (95% CI: 3.55?7.01%). Visceral graft patency during the mean follow-up of 27.54 months (95% CI: 17.41?37.66 months) was 94.5% (95% CI: 92.5?96.5%). Mean pooled percentage rate of overall endoleaks during the follow-up period was 16.72% (95% CI: 11.15?22.29%). Analysis revealed 15.32% (95% CI: 11.04?19.61%) of 30- day/in-hospital mortality and 65.98% (95% CI: 58.15? 73.81%) of overall survival after the follow-up period. Conclusion. Although thought as less invasive, the hybrid ThAAA repair is still associated with a considerable morbidity and mortality.

scholarly journals Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections

Vascular ◽  
2016 ◽  
Vol 24 (6) ◽  
pp. 590-597 ◽  
Author(s):  
Elizabeth A Genovese ◽  
Efthymios D Avgerinos ◽  
Donald T Baril ◽  
Michel S Makaroun ◽  
Rabih A Chaer
Keyword(s):  
Limb Salvage ◽  
Vascular Graft ◽  
Graft Patency ◽  
Prosthetic Graft ◽  
Vascular Reconstruction ◽  
University Center ◽  
Graft Preservation ◽  
Successful Infection ◽  
Infection Eradication

Objective There is limited investigation into the use of bio-absorbable antibiotic beads for the treatment of prosthetic vascular graft infections. Our goal was to investigate the rates of infection eradication, graft preservation, and limb salvage in patients who are not candidates for graft explant or extensive reconstruction. Methods A retrospective review of patients implanted with antibiotic impregnated bio-absorbable calcium sulfate beads at a major university center was conducted. Results Six patients with prosthetic graft infections were treated with bio-absorbable antibiotics beads from 2012–2014. Grafts included an aortobifemoral, an aorto-hepatic/superior mesenteric artery, and four extra-anatomic bypasses. Pathogens included Gram-positive and Gram-negative bacteria. Half of the patients underwent graft explant with reconstruction and half debridement of the original graft, all with antibiotic bead placement around the graft. Mean follow-up was 7.3 ± 8.3 months; all patients had infection resolution, healed wounds, and 100% graft patency, limb salvage, and survival. Conclusion This report details the successful use of bio-absorbable antibiotic beads for the treatment prosthetic vascular graft infections in patients at high risk for graft explant or major vascular reconstruction. At early follow-up, we demonstrate successful infection suppression, graft preservation, and limb salvage with the use of these beads in a subset of vascular patients.

A Controlled Clinical Trial of Antithrombotic Therapy in Patients Undergoing Aortocoronary Artery Bypass Grafting

1975 ◽  
Author(s):  
M. T. McEnany ◽  
E. D. Mundth ◽  
R. M. Weintraub ◽  
R. W. DeSanctis ◽  
J. W. Harthorne ◽  
...  
Keyword(s):  
Placebo Group ◽  
Antithrombotic Therapy ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Patency ◽  
The United States ◽  
Controlled Clinical Trial ◽  
Preliminary Results ◽  
Vein Grafts

Over 25,000 coronary artery bypass graft (CABG) procedures, involving more than 50,000 saphenous vein grafts, are performed yearly in the United States. The recognized one-year graft failure rate of 20-30% would imply thrombosis of at least 5,000 vein grafts per year. To improve graft patency rates, we have investigated the benefits of aspirin (ASA), warfarin (Coumadin®), or placebo in a randomized prospective study involving 216 patients undergoing CABG operations. A total of 412 vein grafts were performed. Clinical and angiographic follow-up at 1 to 2 years after operation is not yet completed, but preliminary results show 71% of grafts patent in ASA-treated patients, 64% in warfarin-treated patients, and 52% in the placebo group. 89% of warfarin-treated patients have at least one graft patent compared with 73% of placebo- and 75% of ASA-treated patients. The incidence of late myocardial infarctions has been lower in warfarin-treated (1.4%) and ASA-treated (4%) patients than in the placebo group (8%). Relief from angina is also markedly improved in treated groups, with 44% of ASA-treated and 56% of warfarin-treated patients angina free, compared to 27% of patients in the placebo group. There have been only 4 cardiac-related deaths, (3 in the placebo group and 1 in the ASA group). Eight patients were dropped from the study because of drugrelated problems. Four patients bled on warfarin therapy, one ASA patient bled, while two had ASA-allergic reactions and one developed gastritis. Follow-up is continuing.Preliminary results suggest that antithrombotic therapy is feasible in CABG patients and appears to promote graft patency, relieve angina pectoris and increase longevity.

1848: Revolix 70 Watt 2 Micron Continuous Wave Laser Vaporesection of the Prostate. Preliminary Results After a One Year Follow-Up

2007 ◽  
Vol 177 (4S) ◽  
pp. 614-614
Author(s):  
Thorsten Bach ◽  
Thomas R.W. Herrmann ◽  
Roman Ganzer ◽  
Andreas J. Gross
Keyword(s):  
Continuous Wave ◽  
Continuous Wave Laser ◽  
Preliminary Results ◽  
Wave Laser ◽  
One Year

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.

BLUNT ABDOMINAL TRAUMA WITH HAEMOPERITONEUM TREATED BY EXPLORATORY LAPAROTOMY VERSUS ONLY ABDOMINAL DRAINAGE: A PROSPECTIVE AND COMPARATIVE STUDY.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Dhawal Panchal ◽  
Firdaus Dekhaiya ◽  
Harin Tailor
Keyword(s):  
Hospital Stay ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Exploratory Laparotomy ◽  
Blunt Injury ◽  
Abdominal Drainage ◽  
Duration Of Hospital Stay ◽  
Considerable Morbidity ◽  
Injured Patients

In today’s mechanized world, Blunt Abdominal Trauma (BAT) is a common emergency which is associated with considerable morbidity and mortality. More than 75% of abdominal traumas are blunt in nature and liver and spleen are the commonest organs to be injured as a result of BAT. The aim is to analyse and compare two groups of patient of blunt abdominal trauma managed conservatively with drainage and one by exploratory laparotomy. 50 cases of blunt abdominal trauma were taken. The patient were studied  which includes age ,sex, mode of injury, initial vitals on presentation, Mortality in each group, duration of hospital stay, pre interventions and post interventions state and requirements, complications and follow up. It was observed 48% of patients were in between age group ranging from 10 to 30. Overall in terms of sex ratio, males dominated the no. of cases. RTA was most common mode of trauma. Liver and spleen was most common organ to be injured. Patients managed by laparotomy had higher mortality rate, duration of hospital stay was more, and complication were more. Early diagnosis and repeated clinical examination and use of appropriate investigation form the key in managing blunt injury abdomen patients. Keywords:  Blunt Abdominal Trauma, Haemoperitoneum , laparotomy , Abdominal Drainage.

Noninvasive Follow-Up of Coronary Artery Bypass Graft Patency Using Multi-Slice Computed Tomography

2006 ◽  
Vol 55 (5) ◽  
pp. 451
Author(s):  
Seung Ho Joo ◽  
Byoung Wook Choi ◽  
Jae Seung Seo ◽  
Young Jin Kim ◽  
Tae Hoon Kim ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Patency ◽  
Artery Bypass Graft

Coronary endarterectomy in coronary artery disease: Factors affecting graft patency and survival

2021 ◽  
pp. 021849232110068
Author(s):  
Simon CY Chow ◽  
Jacky YK Ho ◽  
Micky WT Kwok ◽  
Takuya Fujikawa ◽  
Kevin Lim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Graft Patency ◽  
Complete Revascularization ◽  
Coronary Endarterectomy ◽  
Factors Affecting ◽  
Early Results ◽  
Cerebrovascular Events ◽  
Obtuse Marginal ◽  
One Year

Background Coronary endarterectomy aims to improve completeness of revascularization in patients with occluded coronary vessels. The benefits of coronary endarterectomy remain uncertain. The aim of this study was to evaluate short-term surgical outcomes and factors affecting graft patency post-coronary endarterectomy. Methods Between 2009 and 2019, 81 consecutive patients who had coronary endarterectomy done were evaluated for their perioperative and early results. A total of 36 patients with follow-up coronary studies were included in patency analysis. Mortality rates, major adverse cardiac and cerebrovascular events, and graft patency were outcomes of interest. Survival and risk factor analysis were performed with Kaplan–Meier and logistic regression analysis. Results The average age of the cohort was 61.9 ± 9.29 years. Complete revascularization rate was 95.4% post-coronary endarterectomy. The 30-day and 1-year mortality was 2.5 and 6.2%, respectively. One-year major adverse cardiac and cerebrovascular events rate was 11.1%. Periprocedural myocardial infarction rate was 7.4%. Three patients required repeat revascularization within a mean follow-up duration of 49.6 ± 36.5 months. Overall graft patency was 89.2% at 20.2 months and graft patency post-coronary endarterectomy was 85.4%. Arterial grafts showed 100% patency. Vein grafts to endarterectomized obtuse marginal branch had patency rates of 33.3%. Multiple endarterectomies were associated with worse one-year major adverse cardiac and cerebrovascular events (OR: 28.6 ± 1.16; P = 0.003). Conclusions Coronary endarterectomy facilitates completeness of revascularization and does not increase early mortality. Graft patency post-coronary endarterectomy on obtuse marginal artery was suboptimal. Judicious use of coronary endarterectomy should be practiced to balance the need of completeness of revascularization against the risk of myocardial infarction.

scholarly journals Parenteral artemisinins are associated with reduced mortality and neurologic deficits and improved long-term behavioral outcomes in children with severe malaria

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Andrea L. Conroy ◽  
Robert O. Opoka ◽  
Paul Bangirana ◽  
Ruth Namazzi ◽  
Allen E. Okullo ◽  
...  
Keyword(s):  
Executive Function ◽  
Hospital Mortality ◽  
Cerebral Malaria ◽  
Severe Malaria ◽  
Behavioral Outcomes ◽  
Artemisinin Derivatives ◽  
Neurologic Deficits ◽  
Adjusted Scores

Abstract Background In 2011, the World Health Organization recommended injectable artesunate as the first-line therapy for severe malaria (SM) due to its superiority in reducing mortality compared to quinine. There are limited data on long-term clinical and neurobehavioral outcomes after artemisinin use for treatment of SM. Methods From 2008 to 2013, 502 Ugandan children with two common forms of SM, cerebral malaria and severe malarial anemia, were enrolled in a prospective observational study assessing long-term neurobehavioral and cognitive outcomes following SM. Children were evaluated a week after hospital discharge, and 6, 12, and 24 months of follow-up, and returned to hospital for any illness. In this study, we evaluated the impact of artemisinin derivatives on survival, post-discharge hospital readmission or death, and neurocognitive and behavioral outcomes over 2 years of follow-up. Results 346 children received quinine and 156 received parenteral artemisinin therapy (artemether or artesunate). After adjustment for disease severity, artemisinin derivatives were associated with a 78% reduction in in-hospital mortality (adjusted odds ratio, 0.22; 95% CI, 0.07–0.67). Among cerebral malaria survivors, children treated with artemisinin derivatives also had reduced neurologic deficits at discharge (quinine, 41.7%; artemisinin derivatives, 23.7%, p=0.007). Over a 2-year follow-up, artemisinin derivatives as compared to quinine were associated with better adjusted scores (negative scores better) in internalizing behavior and executive function in children irrespective of the age at severe malaria episode. After adjusting for multiple comparisons, artemisinin derivatives were associated with better adjusted scores in behavior and executive function in children <6 years of age at severe malaria exposure following adjustment for child age, sex, socioeconomic status, enrichment in the home environment, and the incidence of hospitalizations over follow-up. Children receiving artesunate had the greatest reduction in mortality and benefit in behavioral outcomes and had reduced inflammation at 1-month follow-up compared to children treated with quinine. Conclusions Treatment of severe malaria with artemisinin derivatives, particularly artesunate, results in reduced in-hospital mortality and neurologic deficits in children of all ages, reduced inflammation following recovery, and better long-term behavioral outcomes. These findings suggest artesunate has long-term beneficial effects in children surviving severe malaria.

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