scholarly journals Incidence of major complication following embolo-sclerotherapy for upper and lower extremity vascular malformations

Vascular ◽  
2020 ◽  
pp. 170853812093761
Author(s):  
Chung Sim Lim ◽  
Nicholas Evans ◽  
Ishapreet Kaur ◽  
Anthie Papadopoulou ◽  
Mohamed Khalifa ◽  
...  
Keyword(s):  
Informed Consent ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Vascular Malformation ◽  
Vascular Malformations ◽  
Direct Injection ◽  
Major Complication ◽  
Complication Rates ◽  
Major Complications ◽  
Skin Ulcerations

Objective The current literature on the major complications of embolo-sclerotherapy of upper and lower extremity vascular malformations is scarce. Evaluating and understanding the rates and types of potential major complications of embolo-sclerotherapy of vascular malformations help treatment planning and informed consent. Therefore, this study reviewed major complications following embolo-sclerotherapy of all upper and lower extremity vascular malformations in a single specialized multidisciplinary vascular malformation center over a 5-year period. Methods All patients with vascular malformations underwent multidisciplinary directed intervention. Demographic, procedural, follow-up, and complication data were collected prospectively in a dedicated database, and reviewed retrospectively. Major complications for upper and lower extremity vascular malformations from 1 January 2013 to 31 December 2017 were analyzed. All embolo-sclerotherapies of high-flow vascular malformations (HFVMs) were performed under selective catheter angiography and direct injection, but low-flow vascular malformations (LFVM) with direct injection only. Major complications were defined as any tissue or functional damage caused by direct injection, distal embolization, or tissue reaction. Results Seventy patients (median age of 25 years; 44 males and 26 females) had 150 embolo-sclerotherapy procedures for upper extremity vascular malformation. Of these, 28 patients had embolo-sclerotherapy for HFVM and 42 patients for LFVM; total 78 and 72 procedures, respectively. A total of 107 patients (median age of 26 years; 42 males and 65 females) had 160 embolo-sclerotherapy interventions for lower extremity vascular malformations. Of these, 18 patients had embolo-sclerotherapy for HFVM and 89 patients for LFVM; total of 30 and 130 procedures, respectively. The overall major complication rates following embolo-sclerotherapy of upper and lower extremity vascular malformations were 14.3% and 4.7%, respectively ( P = 0.030). In the upper extremity HFVM group, major complications from embolo-sclerotherapy occurred in five patients; three ischemic fingers requiring amputation and two skin ulcerations. Meanwhile, in the upper extremity LFVM group, major complications occurred in five patients; one median nerve injury requiring nerve grafting and hand therapy, one hand contracture requiring tendon release, and three skin ulcerations. There was only one major complication, which was cellulitis in the lower extremity HFVM group. In the lower extremity LFVM group, major complications occurred in four patients; two skin ulcerations, one cellulitis, and one deep vein thrombosis. Conclusions Embolo-sclerotherapy is relatively safe for upper and lower extremity vascular malformations in a high-volume experienced center where our major complication rates were 14.3% and 4.7%, respectively, which compare favorably or similar to those reported in most recent literature. These outcomes will direct treatment strategies to avoid local and systemic toxic complications in the upper and lower extremity, for both HFVM and LFVM, and to improve informed consent.

scholarly journals Incidence of major complications from embolo-sclerotherapy of head and neck vascular malformations in a single specialist centre

Vascular ◽  
2021 ◽  
pp. 170853812110352
Author(s):  
Helena Smith ◽  
Chung Sim Lim ◽  
Nicholas Evans ◽  
Anthie Papadopoulou ◽  
Mohamed Khalifa ◽  
...  
Keyword(s):  
Informed Consent ◽  
Head And Neck ◽  
Treatment Planning ◽  
Multidisciplinary Team ◽  
Vascular Malformations ◽  
Direct Injection ◽  
Major Complication ◽  
Airway Compromise ◽  
Improve Treatment ◽  
Major Complications

Objective Current data on the nature and rate of major complications for embolo-sclerotherapy (EST) of vascular malformations are scarce. However, even fewer studies focus on vascular malformations specific to the head and neck, which confer an increased specific risk of airway compromise, neurologic and ophthalmologic injury. More understanding is required surrounding the type and incidence of complications to improve treatment planning and informed consent. Therefore, this study aimed to review major complications secondary to EST of head and neck vascular malformations over a 5-year period in a single specialized multidisciplinary centre for vascular anomalies. Methods All interventions were decided by the multidisciplinary team. Demographic, procedural and complication data between 1st January 2013 and 31st December 2017 were prospectively documented in a dedicated database and analysed. EST of high-flow vascular malformations (HFVMs) was performed by selective catheter angiography or direct injection, and by direct injection only for low-flow vascular malformations (LFVMs). Major complications were defined as any tissue or functional damage caused by direct injection, distal embolization or tissue reaction and were decided by the multidisciplinary team. Results Forty-eight patients (median age of 35 years; range of 14–70 years; 18 men and 30 women) had 100 EST procedures for head and neck vascular malformation. Of these, 14 patients had EST for HFVM and 34 patients for LFVM, total 43 and 57 procedures, respectively. Overall, five patients with HFVM developed major complications from EST when compared with two patients with LFVM ( p = 0.0167). Two patients required pre-emptive tracheostomy due to risk of post-operative airway compromise. Overall, seven (14.6%) patients experienced major complication from EST. In the HFVM group, major complications from EST occurred in five patients; four cases of tissue ulceration and necrosis (two needed debridement, one healed with resultant fibrosis that impeded speech and one resolved spontaneously) and one post-procedural airway compromise requiring tracheostomy. Meanwhile, in the LFVM group, major complications occurred in two patients; one case of severe necrosis involving the alar cartilage, lip and cheek requiring debridement and reconstruction under plastics and one simple cellulitis. No patients sustained stroke or vision impairment. Conclusions EST is relatively safe for head and neck vascular malformations in a high-volume experienced centre. Our major complication rate of 14.6% per patient (35.7% for HFVM; 5.9% for LFVM) or 7% per procedure (11.6% for HFVM; 3.5% LFVM) compares favourably with published data from other centres. These data will improve treatment planning and informed consent for EST for both HFVM and LFVM of the head and neck.

scholarly journals Surgical Treatment of Olfactory Neuroblastoma: Major Complication Rates, Progression Free and Overall Survival

2017 ◽  
Vol 79 (02) ◽  
pp. 151-155 ◽  
Author(s):  
Aileen Wertz ◽  
Todd Hollon ◽  
Lawrence Marentette ◽  
Stephen Sullivan ◽  
Jonathan McHugh ◽  
...  
Keyword(s):  
Overall Survival ◽  
Major Complication ◽  
Olfactory Neuroblastoma ◽  
Csf Leak ◽  
Complication Rates ◽  
Care Hospital ◽  
Open Approach ◽  
Major Complications ◽  
Grading Systems ◽  
Significant Difference

Objective We aimed to compare major complication rates in patients undergoing open versus endoscopic resection of olfactory neuroblastoma (ONB) and to determine the prognostic utility of the Kadish staging and Hyams grading systems with respect to progression-free survival (PFS) and overall survival (OS). Methods It is a retrospective review of experience in treating ONB at a single tertiary care hospital from 1987 through 2015. Major complications were defined as cerebrospinal fluid (CSF) leak, meningitis, osteomyelitis, tracheostomy, and severe neurologic injury. Results Forty-one patients were included. An open approach was used in 34 (83%), endoscopic in 6 (15%), and combined in 1 (2%) case. Rates of major complications by surgical approach were 17% after endoscopic versus 31% after open (p = 0.65). There was no significant difference in PFS or OS based on Kadish B versus C (PFS, p = 0.28; OS, p = 0.11) or Hyams grade 1 and 2 versus Hyams grade 3 and 4 (PFS, p = 0.53; OS, p = 0.38). Conclusions There was no significant difference in major complications between open and endoscopic approaches for the treatment of ONB. Patient stratification using the Kadish staging and Hyams grading systems did not show significant differences in PFS or OS. Further research is needed to determine if a different staging system would better predict patient outcomes.

Determining the optimal timing for radical cystectomy after neoadjuvant chemotherapy.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 339-339
Author(s):  
Chinedu O. Mmeje ◽  
Cooper Benson ◽  
Graciela M. Nogueras-Gonzalez ◽  
Isuru Sampath Jayaratna ◽  
Neema Navai ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Major Complication ◽  
Complication Rates ◽  
Surgical Time ◽  
Node Metastasis ◽  
Major Complications

339 Background: We present the largest series reviewing complications and pathologic outcomes following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC), to determine whether the interval between chemotherapy and surgery (ICS) affects 90-day post-operative morbidity and lymph node metastasis. Methods: We analyzed 338 patients treated with NAC followed by RC from January 1995 through December 2013. The association of ICS with 90-day surgical morbidity, incidence of major complication, 90-day readmission, and lymph node metastasis was determined. Generalized linear models were used to determine potential predictors of each endpoint. Patients were stratified into four groups by ICS days (18 – 42; 43 – 64; 64 – 85; > 85). Complications were classified using the Clavien system. Results: The overall morbidity of the cohort was 59%, with 66% being minor, and 34% being major complications. The median ICS was 46 days (18 – 199 days). There was no difference in the overall morbidity, readmission, or major complication rates among the four groups. Patients with an ICT > 85 days had the highest incidence of lymph node metastasis (40%), though this was not found to be significant (p = 0.1). On multivariate analysis including predictors of perioperative morbidity, extravesical (pT3 – 4) disease (OR = 1.97; p = 0.01) was an independent predictor of overall morbidity, while age at cystectomy (OR = 1.05; p = 0.004), and surgical time ≥ 7 hrs (OR = 2.87; p = 0.001) were independent predictors of major complications. Only surgical time ≥ 7 hrs (OR = 2.24; p = 0.006) was found to be a predictor of readmission. In a separate multivariate analysis that included risk factors for pathological node positivity, the predictors for lymph node metastasis included variant histology (OR = 2.06; p = 0.026) and extravesical disease (OR = 2.76; p = 0.002). Patients with an ICT > 85 days had a higher risk of node metastasis though this was not significant. Conclusions: Patients can undergo RC anytime between 2.5 – 12 weeks after NAC with no difference in risk of surgical complications or nodal metastasis.

External beam radiotherapy in the treatment of extensive vascular malformation of the lower extremity refractory to surgery and interventional embolisation therapy

2009 ◽  
Vol 8 (3) ◽  
pp. 157-162
Author(s):  
Mark Trombetta ◽  
Jonathan Potts ◽  
Vladimir Valakh ◽  
E. Day Werts ◽  
Elmer Nahum ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Vascular Malformation ◽  
Vascular Malformations ◽  
External Beam Radiotherapy ◽  
External Beam ◽  
Viable Option ◽  
Patient Case

AbstractThis patient case-study represents the introduction of radiotherapy in the management of extra-cranial vascular malformations, a topic with virtually no supported literature before our case study. In those patients refractory to established therapies and facing the inevitability of mutilating amputation, radiotherapy may be a viable option to preserve the limb.

scholarly journals Complication Rates of Percutaneous Brachial Artery Puncture: Effect of Live Ultrasound Guidance

2021 ◽  
Author(s):  
Konrad Appelt ◽  
Martin Takes ◽  
Christoph J Zech ◽  
Tilman Schubert
Keyword(s):  
Upper Extremity ◽  
Brachial Artery ◽  
Complication Rates ◽  
Puncture Site ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Us Guidance ◽  
Major Complications ◽  
The Impact

Abstract PurposeThe current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications.Materials and MethodsThis is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 hours, either achieved hemostasis.Results75 procedures in 71 patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (11/14.7%), upper extremity (36/48%), visceral (20/26.7%), and lower extremity (12/16%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred.ConclusionExclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.

scholarly journals Major Short-term Complications of Arterial Cannulation for Monitoring in Children

2020 ◽  
Vol 134 (1) ◽  
pp. 26-34
Author(s):  
Stephen J. Gleich ◽  
Ashley V. Wong ◽  
Kathryn S. Handlogten ◽  
Daniel E. Thum ◽  
Michael E. Nemergut
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Major Complication ◽  
Anatomical Site ◽  
Complication Rates ◽  
Arterial Cannulation ◽  
Short Term ◽  
Anesthetic Care ◽  
Major Complications ◽  
Cardiac Procedures

Background Perioperative arterial cannulation in children is routinely performed. Based on clinical observation of several complications related to femoral arterial lines, the authors performed a larger study to further examine complications. The authors aimed to (1) describe the use patterns and incidence of major short-term complications associated with arterial cannulation for perioperative monitoring in children, and (2) describe the rates of major complications by anatomical site and age category of the patient. Methods The authors examined a retrospective cohort of pediatric patients (age less than 18 yr) undergoing surgical procedures at a single academic medical center from January 1, 2006 to August 15, 2016. Institutional databases containing anesthetic care, arterial cannulation, and postoperative complications information were queried to identify vascular, neurologic, and infectious short term complications within 30 days of arterial cannulation. Results There were 5,142 arterial cannulations performed in 4,178 patients. The most common sites for arterial cannulation were the radial (N = 3,395 [66.0%]) and femoral arteries (N = 1,528 [29.7%]). There were 11 major complications: 8 vascular and 3 infections (overall incidence, 0.2%; rate, 2 per 1,000 lines; 95% CI, 1 to 4) and all of these complications were associated with femoral arterial lines in children younger than 5 yr old (0.7%; rate, 7 per 1,000 lines; 95% CI, 4 to 13). The majority of femoral lines were placed for cardiac procedures (91%). Infants and neonates had the greatest complication rates (16 and 11 per 1,000 lines, respectively; 95% CI, 7 to 34 and 3 to 39, respectively). Conclusions The overall major complication rate of arterial cannulation for monitoring purposes in children is low (0.2%). All complications occurred in femoral arterial lines in children younger than 5 yr of age, with the greatest complication rates in infants and neonates. There were no complications in distal arterial cannulation sites, including more than 3,000 radial cannulations. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

703 SARCOPENIA OBESITY AND MYOSTEATOSIS ARE RISK FACTORS FOR COMPLICATIONS FOLLOWING RESECTION OF OESOPHAGOGASTRIC CANCERS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Manjunath Siddaiah-subramanya ◽  
Sivesh Kamarajah ◽  
Jame Halle-Smith ◽  
Abdulrahman Ghoneim ◽  
Yashashwi Sinha
Keyword(s):  
Assessment Tool ◽  
Clinical Stage ◽  
Major Complication ◽  
Complication Rates ◽  
Mortality And Morbidity ◽  
Cancer Resection ◽  
Operative Outcomes ◽  
Major Complications ◽  
Operative Assessment ◽  
Oesophagogastric Cancer

Abstract   Oesophagogastric cancer resection carries a morbidity, as high as 60%. Better patient selection, not only with regards to clinical stage but also with fitness reduces morbidity and improves outcome. Assessment of sarcopenia (SMI) and incremental shuttle walk test (ISWT) are two such tools to evaluate patients’ fitness. We investigate the influence of these two tools in predicting post-operative outcomes following Oesophagogastric resection. Methods All patients who underwent Oesophagogastric cancer resection between 2017–2019 and consented to participate in ISWT were included and outcomes evaluated retrospectively. Patient demographics, comorbidity profile and distance walked in ISWT were collected from the hospital cancer database. SMI was calculated on the pre-operative staging CT at the level of L3. Outcomes assessed included overall complications, major complications (Clavien-Dindo III-V) and 30-day mortality. Results Sixty-seven patients (median age = 67) met the inclusion criteria with majority receiving neoadjuvant chemotherapy (79%). Overall complication rate was 69% including 34% major complications. There was no difference in overall and major complication between patients with ISWT distance of >350 and < 350 m. Sarcopenia was diagnosed in 58% of the patients. Adjusted analyses showed female patients (OR: 9.31, CI95%: 1.49–94.15, p = 0.030), myosteatosis (OR: 7.52, CI95%: 1.64–48.62, p = 0.017), and sarcopenic obesity (OR: 6.16, CI95%: 3.28–36.59, p = 0.021) to be independent predictors of overall complications. Correlation plot shows no interaction between SMI and ISWT scores. Conclusion: The study shows that ISWT does not predict post-operative mortality and morbidity following Oesophagogastric cancer resection. Sarcopenia is associated with higher overall complication rates. SMI and ISWT score do not correlate in predicting post-operative outcomes. We recommend that assessment of sarcopenia to be used routinely as a pre-operative assessment tool for prediction of outcomes in patients undergoing Oesophagogastric cancer resection.

scholarly journals Complication rates of percutaneous brachial artery puncture: effect of live ultrasound guidance

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
K. Appelt ◽  
M. Takes ◽  
C. J. Zech ◽  
KA Blackham ◽  
T. Schubert
Keyword(s):  
Upper Extremity ◽  
Brachial Artery ◽  
Complication Rates ◽  
Puncture Site ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Us Guidance ◽  
Major Complications ◽  
The Impact

Abstract Purpose The current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications. Materials and methods This is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 h, either achieved hemostasis. Results Seventy-five procedures in seventy-one patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (10/13.5%), upper extremity (32/43.2%), visceral (20/27.0%), and lower extremity (12/16.3%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred. Conclusion Exclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.

scholarly journals Tissue Expansion for Severe Foot and Ankle Deformities: A 16-Year Review

2018 ◽  
Vol 26 (4) ◽  
pp. 244-249
Author(s):  
Kevin J. Nickel ◽  
Aaron C. Van Slyke ◽  
Aaron D. Knox ◽  
Kevin Wing ◽  
Neil Wells
Keyword(s):  
Lower Extremity ◽  
Pediatric Population ◽  
Case Series ◽  
Deformity Correction ◽  
Tissue Expansion ◽  
Retrospective Chart Review ◽  
Complication Rates ◽  
Foot And Ankle ◽  
Major Complications ◽  
To Receive

Background: Tissue expansion in the lower extremity is controversial, with studies reporting complication rates as high as 83%. Few studies have looked at tissue expansion prior to orthopaedic correction of severe foot and ankle deformities, and those available are restricted to clubfoot in the pediatric population. Here, we report the largest case series on the use of tissue expanders for the reconstruction of severe foot and ankle deformity and the only report in adults. Methods: This is a retrospective chart review of the senior author’s practice over a 16-year study period. All patients over 18 years of age who underwent tissue expansion prior to definitive orthopaedic correction of a severe foot and ankle deformity were included. Patient demographics, etiology of deformity, rate of expansion, and complications were recorded. Major complications were defined as those which required surgical intervention. Data were analyzed using descriptive statistics. Results: Nineteen cases were performed on 16 patients. Our overall complication rate was 31.6% (6/19), with major complications occurring in 21.1% (4/19) of cases, and minor complications occurring in 10.5% (2/19) of cases. Despite this, 94.7% (18/19) of cases went on to receive definitive orthopaedic correction after tissue expansion. No demographic parameters were associated with occurrence of complications. Conclusions: This represents the largest report on lower extremity tissue expansion for severe foot and ankle deformity correction. While we observed complications in 31.6% of patients, 94.7% of cases went on to receive definitive orthopaedic correction with successful primary closure.

Racial disparities in the morbidity of radical cystectomy in the United States.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 304-304
Author(s):  
Tudor Borza ◽  
Chen Chen Feng ◽  
Jeffrey Leow ◽  
Benjamin I. Chung ◽  
Steven L. Chang
Keyword(s):  
United States ◽  
Bladder Cancer ◽  
Racial Disparities ◽  
Radical Cystectomy ◽  
Major Complication ◽  
The United States ◽  
Study Cohort ◽  
Complication Rates ◽  
Major Complications ◽  
Hispanic Patients

304 Background: Racial disparities in the management of bladder cancer have been previously reported. However, limited data exists on inequalities in the morbidity of radical cystectomy. We performed a contemporary population-based analysis to examine the association between race and surgical complications among patients undergoing radical cystectomy. Methods: We analyzed the Prospective Rx Comparative Database (Premier, Inc., Charlotte, NC), which collects data from over 600 non-federal hospitals throughout the US. We identified patients who underwent radical cystectomy between 2003 and 2010 based on ICD-9 code (57.71). Primary outcome measure was 90-day major complication rates, defined as Clavien Classification System Grade 3-5, derived from ICD-9 codes. Multivariable logistic regression models were developed adjusting for clustering by hospitals and survey weighting to ensure nationally representative estimates to evaluate 90-day major complication for all patients (Model 1), patients ≥65 years (Model 2), and Medicare only patients (Model 3). Results: Our study cohort included 50,175 patients. The majority of patients were Caucasion (76%), men (83.5%), with Medicare (64.2%). Major complication rates were 16% for Caucasions, 17% for African American, 24% for Hispanics, and 16% for Other. Compared to Caucasians, the odds ratio (OR) of major complications for Hispanics was 1.9 (p=0.03) and 2.6 (p<0.0001) in Models 1 and 2, and 1.7 (p=0.1) for Model 3. None of the other racial groups had significantly different odds of major complications compared with Caucasians. Conclusions: In the United States, Hispanic patients are the least likely to undergo radical cystectomy but have the highest rate of major complication following surgery. Our analysis shows that this disparity is uniquely absent among Hispanic patients with Medicare suggesting that barriers to healthcare may underlie the observed phenomenon. Therefore, the worse outcomes for Hispanic patients with bladder cancer may be secondary to challenges in accessing medical treatment at earlier stages of disease arising from language differences and non-U.S. citizenship status.

Sign in / Sign up

Export Citation Format

Share Document