Update on the Diagnosis and Management of Popliteal Aneurysm and Literature Review

Vascular ◽  
2006 ◽  
Vol 14 (2) ◽  
pp. 103-108 ◽  
Author(s):  
Albeir Y. Mousa ◽  
Robert B. Beauford ◽  
Peter Henderson ◽  
Prem Patel ◽  
Peter L. Faries ◽  
...  
Keyword(s):  
Gold Standard ◽  
Open Surgery ◽  
Clinical Presentation ◽  
Survival Outcomes ◽  
Significant Morbidity ◽  
Endovascular Stents ◽  
Popliteal Aneurysm ◽  
Indications For Use

Popliteal artery aneurysms (PAAs) are the most frequent peripheral aneurysm with a significant morbidity if left untreated. Open surgical technique is still considered the gold standard; however the revolution in endovascular repair has proven to be a valid alternative option in selected patients. The role of endovascular treatment in PAA is still considered in its infancy. In addition, the indications for use of endovascular stents as compared to standard open surgery have not yet been fully defined and more studies are warranted to characterize the durability of this technique. This article describes the general principles of the natural history, clinical presentation, and long-term limb salvage and survival outcomes for patients with such aneurysms. It also details the features and results for the devices in current use and highlights the current consensus in the management of PAA.

Vascular malformations revisited

VASA ◽  
2015 ◽  
Vol 44 (1) ◽  
pp. 5-22 ◽  
Author(s):  
Robert K. Clemens ◽  
Thomas Pfammatter ◽  
Thomas O. Meier ◽  
Ahmad I. Alomari ◽  
Beatrice R. Amann-Vesti
Keyword(s):  
Gold Standard ◽  
Multidisciplinary Approach ◽  
Vascular Malformations ◽  
Treatment Options ◽  
Reduce Blood Loss ◽  
Significant Morbidity ◽  
Treatment Techniques ◽  
New Treatment ◽  
Common Understanding

Vascular malformations are congenital anomalies that can affect each part of the vasculature. Combined forms are common and they are often part of complex syndromes. Most malformations are diagnosed during infancy, but some get obvious only later in life. The field of vascular malformations is emerging with recently described new entities and treatments. Still, misdiagnosis is common in this field, leading to nosologic confusion and wrong treatment. Clinical evaluation and imaging are the gold standard for diagnostic confirmation. Sclerotherapy and embolization are the main treatment techniques but are also used preoperatively to reduce blood loss and shrink the lesion if surgery is planned. Despite new treatment options, especially if extensive in size or involving vulnerable structures, vascular malformations are still considered chronic diseases and cause significant morbidity. Common understanding and agreement on terminology and a multidisciplinary approach are the basis of successful treatment and long-term support for these patients. Continuing research in the field of vascular anomalies will improve knowledge and create further treatment options.

scholarly journals What is the optimal timing for Thoracic Endovascular Aortic Repair in uncomplicated Type B aortic dissection? Facts, fallacies and the future

2021 ◽  
Author(s):  
Matti Jubouri ◽  
Mohamad Bashir ◽  
Sven Zhen Cian Patrick Tan ◽  
Damian Bailey ◽  
Richard Anderson ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Gold Standard ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Therapeutic Window ◽  
Survival Outcomes ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Aortic Repair

Background: Uncomplicated Stanford Type B aortic dissection (un-TBAD) is characterised by a tear in the aorta distal to the left subclavian artery without ascending aorta and arch involvement. Optimised cardiovascular control (blood pressure and heart rate) is the current gold standard treatment according to current international guidelines. However, emerging evidence indicates that Thoracic Endovascular Aortic Repair (TEVAR) is both safe and effective in the treatment of un-TBAD with improved long-term survival outcomes in combination with optimal medical therapy (OMT) relative to OMT alone. However, the optimal timeframe for intervention is not entirely clarified. Aims: This review critically addresses current state-of-the-art comparing TEVAR with OMT and corresponding clinical outcomes for un-TBAD based on timing of intervention. Methods: We carried out a comprehensive literature search on multiple electronic databases including PUBMED and Scopus in order to collate all research evidence on timing of TEVAR in uncomplicated Type B aortic dissection. Results: TEVAR has proven to be a safe and effective treatment for un-TBAD in combination with OMT through comparable survival outcomes, improved aortic remodelling, and relatively low periprocedural added risks. Though the timing of intervention remains controversial, it is becoming clear that performing TEVAR during the subacute phase of un-TBAD yields better outcomes compared to earlier and delayed (>90 days) intervention. Conclusions: Further research is required into both short and long-term outcomes of TEVAR in addition to its optimal therapeutic window for un-TBAD. With stronger evidence, TEVAR is likely to be adopted as the gold-standard intervention for un-TBAD with definitive timeframe guidelines.

scholarly journals Laparoscopic Nephroureterectomy: Oncologic Outcomes and Management of Distal Ureter; Review of the Literature

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Andre Berger ◽  
Amr Fergany
Keyword(s):  
Open Surgery ◽  
Transitional Cell ◽  
Oncologic Outcomes ◽  
Perioperative Outcomes ◽  
Review Of The Literature ◽  
Distal Ureter ◽  
Upper Tract ◽  
Current Context

Introduction. Laparoscopic radical nephroureterectomy (LNU) is being increasingly performed at several centers across the world. We review oncologic outcomes after LNU procedure and the techniques for the management of distal ureter.Materials and Methods. A comprehensive review of the literature was performed on the oncological outcomes and management of distal ureter associated with LNU for upper tract transitional cell carcinoma (TCC).Results and Discussion. LNU for upper tract TCC is performed pure laparoscopically (LNU) or hand-assisted (HALNU). The management of the distal ureter is still debated. LNU appears to have superior perioperative outcomes when compared to open surgery. Intermediate term oncologic outcomes after LNU are comparable to open nephroureterectomy (ONU).Conclusions. Excision of the distal ureter and bladder cuff during nephroureterectomy remains controversial. Intermediate term oncologic outcomes for LNU compare well with ONU. Initial long-term oncologic outcomes are encouraging. Prospective randomized comparison between LNU and open surgery is needed to define the role of these modalities in the current context.

scholarly journals When the Diagnosis of Mesothelioma Challenges Textbooks and Guidelines

2021 ◽  
Vol 10 (11) ◽  
pp. 2434
Author(s):  
Giulio Rossi ◽  
Fabio Davoli ◽  
Venerino Poletti ◽  
Alberto Cavazza ◽  
Filippo Lococo
Keyword(s):  
Gold Standard ◽  
Clinical Presentation ◽  
Wide Spectrum ◽  
Routine Practice ◽  
Sampling Techniques ◽  
Immunohistochemical Expression ◽  
Difficult Diagnosis ◽  
Current Review ◽  
Common Clinical Presentation

The diagnosis of malignant mesothelioma (MPM) does not pose difficulties when presenting with usual clinico-radiologic features and morphology. Pathology textbooks and national/international guidelines generally describe the findings of classic MPM, underlining common clinical presentation, the gold standard of sampling techniques, usual morphologic variants, immunohistochemical results of several positive and negative primary antibodies in the differential diagnosis, and the role of novel molecular markers. Nevertheless, MPM often does not follow the golden rules in routine practice, while the literature generally does not sufficiently emphasize unusual features of its manifestation. This gap may potentially create problems for patients in sustaining a difficult diagnosis of MPM in clinical practice and during legal disputes. Indeed, the guidelines accidentally tend to favor the job of lawyers and pathologists defending asbestos-producing industries against patients suffering from MPM characterized by uncommon features. The current review is aimed at underlining the wide spectrum of clinical and radiological presentation of MPM, the possibility to consistently use cytology for diagnostic intent, the aberrant immunohistochemical expression using so-called specific negative and positive primary antibodies, and finally proposing some alternative and more unbiased approaches to the diagnosis of MPM.

Laparoscopic and Open Abdominal Staging for Early-Stage Ovarian Cancer: Our Experience, Systematic Review, and Meta-analysis of Comparative Studies

2014 ◽  
Vol 24 (7) ◽  
pp. 1241-1249 ◽  
Author(s):  
Giorgio Bogani ◽  
Antonella Cromi ◽  
Maurizio Serati ◽  
Edoardo Di Naro ◽  
Jvan Casarin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ovarian Cancer ◽  
Open Surgery ◽  
Early Stage ◽  
Meta Analysis ◽  
Rank Test ◽  
Survival Outcomes ◽  
Log Rank Test ◽  
Early Stage Ovarian Cancer

ObjectivesThe aim of this study was to analyze perioperative and long-term survival outcomes after either laparoscopic or open abdominal staging for apparent early-stage ovarian cancer.MethodsData of consecutive women with early-stage ovarian cancer undergoing comprehensive laparoscopic staging between 2003 and 2010 were matched with a historical cohort of patients undergoing open surgery. Five-year survival outcomes were analyzed using the Kaplan-Meier method. In addition, a systematic review of the literature and meta-analysis of comparative studies was performedResultsA total of 35 women undergoing staging via laparoscopy were compared with a cohort of 32 patients undergoing open surgery. Baseline characteristics were similar between groups. Spillage occurred in 6 and 4 patients in laparoscopic and open group, respectively (P = 0.59). Patients undergoing laparoscopy experienced longer operative time (P < 0.001), shorter hospital stay (P = 0.03), and lower postoperative complication rate (3% vs 28%; P = 0.005) than patients undergoing staging via open surgery. The median (range) follow-up period was 64 (37–106) and 100 (61–278) months for case and control, respectively (P < 0.001). Five-year disease-free survival (P = 0.12, log-rank test) and overall survival (P = 0.26, log-rank test) were not influenced by surgical approach. Pooled analyses of the literature results corroborate our results suggesting an improvement of perioperative results in the laparoscopic group in comparison with the open abdominal one. In comparison with open surgery, laparoscopy did not influenced spillage (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.35–1.73) and upstaging rate (OR, 0.7; 95% CI, 0.38–1.27). No between-group differences in survival were observed (OR, 0.5; 95% CI, 0.21–1.21).ConclusionsLaparoscopy upholds open surgery in long-term oncologic control, reducing morbidity.

scholarly journals Rhinovirus Infection in Children with Acute Bronchiolitis and Its Impact on Recurrent Wheezing and Asthma Development

2020 ◽  
Vol 8 (10) ◽  
pp. 1620
Author(s):  
Carlotta Biagi ◽  
Alessandro Rocca ◽  
Giulia Poletti ◽  
Marianna Fabi ◽  
Marcello Lanari
Keyword(s):  
Clinical Presentation ◽  
Clinical Course ◽  
Pediatric Population ◽  
Acute Bronchiolitis ◽  
Virus Infections ◽  
Recurrent Wheezing ◽  
Multiple Virus ◽  
Syncytial Virus

Acute bronchiolitis represents the leading cause of hospitalization in infants. Together with a respiratory syncytial virus, rhinovirus (RV) is one of the most common pathogens associated with bronchiolitis, and its genetic diversity (>150 types) makes the recurrence of RV infections each year quite typical. The frequency of RV infection and co-infection with other viruses and its impact on the clinical course of bronchiolitis have been studied by several authors with controversial results. Some studies demonstrate that multiple virus infections result in more severe clinical presentation and a higher risk of complications, whereas other studies suggest no influence on clinical course. Moreover, RV bronchiolitis has been reported to potentially contribute to the development of long-term sequelae, such as recurrent wheezing and asthma, in the pediatric population. In the present review, we summarize the most recent findings of the role of RV infection in children with acute bronchiolitis, its impact on subsequent asthma development, and the implication in clinical practice.

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