OPERATIONS FOR ANEURISM OF THE ABDOMINAL AORTIC DEPARTMENT - RESECTION WITH THE FOLLOWING PROSTHETICS AND ENDOPROSTHETICS: A COMPARATIVE ANALYSIS OF COMPLICATIONS

2020 ◽  
pp. 43-49
Author(s):  
Андрей Анатольевич Иванов ◽  
Александр Иванович Жданов ◽  
Максим Сергеевич Шевелин ◽  
Александр Сергеевич Брежнев
Keyword(s):  
Comparative Analysis ◽  
Postoperative Complications ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Surgical Interventions ◽  
Vein Thrombosis ◽  
Scientific Hypothesis ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
High Level

В статье представлены данные оригинального исследования по улучшению хирургического лечения аневризм брюшного отдела аорты. С этой целью произведен сравнительный анализ двух альтернативных друг другу операций: 1) резекции аневризмы с последующим протезированием аорты; 2) эндопротезирования аорты. Сформулировано научное предположение о том, что замена «классических» операций резекции аневризмы на «альтернативные» операции эндопротезирования приведет к принципиальному снижению уровня послеоперационных осложнений. В независимых группах пациентов с использованием сравниваемых хирургических вмешательств произведена точная качественная и количественная оценка послеоперационных осложнений: нетромботических - кардиальных, пульмональных, ренальных и тромботических - тромбозов глубоких вен и тромбозов браншей протеза. После реализации исследования было установлено, что замена «классических» операций на «альтернативные» достоверно приводит к принципиальному снижению уровня наиболее жизнеопасных осложнений - кардиальных (острых форм ишемической болезни сердца, нарушений сердечного ритма), пульмональных (пневмоний, тромбоэмболии легочной артерии, респираторного дистресс-синдрома взрослых) и ренальных (острой почечной недостаточности). Некоторое исключение составили менее жизнеопасные тромботические осложнения. Полученные результаты имеют высокий уровень статистической значимости, что позволяет рекомендовать их к рассмотрению к использованию в практике сосудистой хирургии The article presents data from an original study to improve the surgical treatment of abdominal aortic aneurysms. For this purpose, a comparative analysis of two alternate operations was performed: 1) aneurysm resection followed by aortic prosthetics; 2) aortic endoprosthetics. The scientific hypothesis is formulated that the replacement of the «classical» operations of resection of the aneurysm with «alternative» operations of endoprosthetics will lead to a fundamental decrease in the level of postoperative complications. In independent groups of patients using the compared surgical interventions, an accurate qualitative and quantitative assessment of postoperative complications was made: non-thrombotic - cardiac, pulmonary, renal and thrombotic - deep vein thrombosis and prosthetic jaw thrombosis. After the study was completed, it was found that the fundamental replacement of «classical» operations with «alternative» reliably leads to a fundamental decrease in the level of the most life-threatening complications - cardiac (acute forms of coronary heart disease, cardiac arrhythmias), pulmonary (pneumonia, pulmonary thromboembolism, respiratory distress syndrome of adults) and renal (acute renal failure). Some exceptions were less life-threatening thrombotic complications. The results obtained have a high level of statistical significance, which allows us to recommend them for consideration in the practice of vascular surgery

IMPROVEMENT OF THROMBOTIC COMPLICATIONS PREVENTION AFTER OPERATIONS OF ENDOPROSTHETICS OF THE ABDOMINAL DEPARTMENT OF AORTA

2020 ◽  
pp. 64-70
Author(s):  
Александр Иванович Жданов ◽  
Андрей Анатольевич Иванов ◽  
Максим Сергеевич Шевелин ◽  
Александр Сергеевич Брежнев
Keyword(s):  
Traditional Approach ◽  
Statistical Significance ◽  
Oral Anticoagulants ◽  
Aortic Aneurysms ◽  
Antithrombotic Prophylaxis ◽  
Vein Thrombosis ◽  
Scientific Hypothesis ◽  
Increased Risk ◽  
Thrombotic Complications ◽  
High Level

В статье представлены данные оригинального исследования по оптимизации антитромботической профилактики после хирургического лечения аневризм брюшного отдела аорты методом эндопротезирования. С этой целью произведен сравнительный анализ двух альтернативных друг другу подходов к предупреждению развития тромботических осложнений: 1) «традиционный подход» на основе использования препаратов дезагрегантов; 2) разработанная программа на основе использования препарата класса новых пероральных антикоагулянтов. Выдвинута научная гипотеза о том, что радикальная замена «традиционного подхода» на разработанную программу приведет к принципиальному снижению количества развивающихся послеоперационных тромботических осложнений. В независимых группах пациентов с использованием сравниваемых подходов к антитромботической профилактике произведена точная качественная и количественная оценка послеоперационных тромботических осложнений - тромбозов глубоких вен и тромбозов браншей протеза, а также ключевых клинико-лабораторных показателей системы гемостаза. После выполнения исследования было установлено, что принципиальная замена «традиционного подхода» на разработанную программу действительно приводит к принципиальному снижению уровня тромботических осложнений. При этом не происходит критических «сдвигов» как в сосудисто-тромбоцитарном, так и в коагуляционном звене системы гемостаза, и тем самым не создаются повышенный риск кровотечений. Полученные результаты имеют высокий уровень статистической значимости, что позволяет рекомендовать их к широкому использованию в практике сосудистой хирургии The article presents data from an original study on optimizing antithrombotic prophylaxis after surgical treatment of abdominal aortic aneurysms by endoprosthetics. To this end, a comparative analysis of two alternative approaches to preventing thrombotic complications has been made: 1) the «traditional approach» based on the use of disaggregant preparations; 2) a developed program based on the use of a drug of the class of new oral anticoagulants. A scientific hypothesis is put forward that the radical replacement of the “traditional approach” with the developed program will lead to a fundamental reduction in the number of developing postoperative thrombotic complications. In independent groups of patients, using the compared approaches to antithrombotic prophylaxis, an accurate qualitative and quantitative assessment of postoperative thrombotic complications - deep vein thrombosis and prosthetic branches thrombosis, as well as key clinical and laboratory parameters of the hemostasis system was performed. After carrying out the study, it was found that a fundamental replacement of the «traditional approach» with the developed program does lead to a fundamental decrease in the level of thrombotic complications. In this case, there are no critical «shifts» both in the vascular-platelet and in the coagulation unit of the hemostatic system, and thus there is no increased risk of bleeding. The results obtained have a high level of statistical significance, which allows us to recommend them for widespread use in the practice of vascular surgery

THE THROMBOTIC COMPLICATIONS PREDICTION AFTER OPERATIONS AT THE ABDOMINAL DEPARTMENT ОF AORTA BY RISK FACTORS

2020 ◽  
pp. 139-146
Author(s):  
Максим Сергеевич Шевелин ◽  
Андрей Анатольевич Иванов ◽  
Александр Сергеевич Брежнев ◽  
Евгений Алексеевич Азаров
Keyword(s):  
Risk Factors ◽  
Statistical Significance ◽  
Abdominal Aortic Aneurysms ◽  
Risk Groups ◽  
Aortic Aneurysms ◽  
Specific Patient ◽  
Planning Stage ◽  
Abdominal Aortic ◽  
Thrombotic Complications ◽  
High Level

В статье представлены данные оригинального исследования по прогнозированию риска развития тромботических осложнений после хирургического лечения аневризм брюшного отдела аорты. С этой целью создана и реализована соответствующая программа исследования. В предоперационном периоде произведено обследование репрезентативной выборки тематических пациентов. Выделен комплекс факторов риска по развитию послеоперационных тромботических осложнений - тромбозов глубоких вен и тромбозов браншей протеза. В послеоперационном периоде определена фактическая вероятность их развития, выявлена диагностическая информативность (прогностическая значимость) оцениваемых периоперационных факторов риска. На основе наиболее значимых факторов разработана прогностическая математическая модель, позволяющая определять по их наличию и сочетанию высокий или низкий уровень риска развития осложнений. Работоспособность модели была проверена путем сравнения полученных клинических данных с результатами численного прогнозирования. Выявлен высокий уровень работоспособности. Верификация показала высокий уровень адекватности модели. Ее использование позволяет дифференцировать тематических пациентов на группы высокого, среднего и низкого риска по развитию послеоперационных тромботических осложнений. В соответствии с этим появилась возможность выбора рекомендации по использованию «стандартных» или «усиленных» программ антитромботической профилактики для каждого конкретного пациента. Полученные результаты имеют высокий уровень статистической значимости, что, в свою очередь, позволяет рекомендовать их к рассмотрению для использования в практике сосудистой хирургии на этапе планирования операций по поводу аневризм брюшного отдела аорты и составления программ профилактики послеоперационных тромботических осложнений The article presents data from an original study of predicting the risk of thrombotic complications after surgical treatment of abdominal aortic aneurysms. For this purpose, an appropriate research program has been created and implemented. In the preoperative period, a representative sample of thematic patients was examined. A complex of risk factors was identified for the development of postoperative thrombotic complications - deep vein thrombosis and thrombosis of prosthetics branches. In the postoperative period, the actual probability of their development was determined, diagnostic informativeness (prognostic value) of the estimated perioperative risk factors was revealed. Based on the most significant factors, a predictive mathematical model has been appearance that allows one to determine by their presence and combination a high, middle or low level of risk of complications. The performance of the model was tested by comparing the obtained clinical data with the results of numerical forecasting. A high level of performance has been identified. Verification showed a high level of model adequacy. Its use allows us to differentiate thematic patients into high and low risk groups according to the development of postoperative thrombotic complications. In accordance with this, it became possible to choose recommendations on the use of «standard» or «enhanced» antithrombotic prophylaxis programs for each specific patient. The results obtained have a high level of statistical significance, which, in turn, allows us to recommend them for consideration in the practice of vascular surgery at the planning stage of operations for abdominal aortic aneurysms and the development of programs for the prevention of postoperative thrombotic complications

Inferior Vena Cava Compression Caused by Ruptured Abdominal Aortic Aneurysms: Report of Two Cases

1997 ◽  
Vol 12 (3) ◽  
pp. 112-114
Author(s):  
J. I. Martínez-León ◽  
J. C. Bohórquez-Sierra ◽  
A. R. Sánchez-Guzmán ◽  
F. N. Arribas-Aguilar ◽  
F. Ceijas-Lloreda ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Abdominal Aortic Aneurysms ◽  
Iliac Vein ◽  
Aortic Aneurysms ◽  
Vein Thrombosis ◽  
Abdominal Aortic ◽  
Ruptured Abdominal Aortic Aneurysms ◽  
Iliac Vein Thrombosis

Objective: To report two cases of inferior vena cava (IVC) and iliac vein thrombosis secondary to expansive and ruptured abdominal aortic aneurysms. Design: Case report. Setting: Angiology and Vascular Surgery Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain. Patients: Patients with clinical and radiological evidence of IVC and iliac vein thrombosis secondary to a sealed rupture from expanding aortic aneurysms. Interventions: Surgical repair in one case and conservative management in the second case. Conclusions: Venous compression was relieved, avoiding the risk associated with anticoagulant therapy in the presence of an aortic aneurysm. Ultrasound scanning is useful in assessing deep venous thrombosis and detecting compressive masses such as aortic and iliac aneurysms. Inappropriate management of patients with venous obstruction from undiagnosed arterial aneurysms may cause serious complications.

scholarly journals Abdominal aortic aneurysms part two: Surgical management, postoperative complications and surveillance

2020 ◽  
pp. 175045892094735
Author(s):  
Harry Kyriacou ◽  
Ahmed M H A M Mostafa ◽  
Anoop S Sumal ◽  
Holly N Hellawell ◽  
Jonathan R Boyle
Keyword(s):  
Postoperative Complications ◽  
Literature Review ◽  
Surgical Management ◽  
Surgical Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Open Surgical Repair ◽  
Abdominal Aortic ◽  
Ruptured Abdominal Aortic Aneurysms

Large, symptomatic and ruptured abdominal aortic aneurysms are usually treated surgically if patients are deemed fit enough. This may be achieved through endovascular or open surgical repair. The type of treatment that a patient receives is dependant on many factors, such as the rupture status of the aneurysm. Each approach is also associated with different risks and postoperative complications. Multiple guidelines exist to inform the surgical management of abdominal aortic aneurysms. This literature review combines these recommendations and explores the evidence upon which they are based. In addition, it highlights the key perioperative considerations that need to be considered in cases of unruptured and ruptured abdominal aortic aneurysms.

scholarly journals Vasculo-Behcet's Disease: Profile and Management - Single Center Experience

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4955-4955
Author(s):  
Mohammed Abdullah Alsheef ◽  
Kamal Gazal ◽  
Nahar Alenizi ◽  
Khalid Qushmaq ◽  
Mukhtar Alomar ◽  
...  
Keyword(s):  
Behçet’S Disease ◽  
Anticoagulant Therapy ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
Aortic Aneurysms ◽  
Vascular Involvement ◽  
Behcet's Disease ◽  
Vein Thrombosis ◽  
Abdominal Aortic ◽  
Peripheral Arterial

Background Behçet's disease (BD) is a multisystem vasculitis characterized by exacerbations and remissions with unknown etiology. Males are more affected than females with the usual onset in the third decade. Vascular involvement can occur in up to 40% of cases of BD. BD is unique among the vasculitides that it may involve all sizes and types of vessels. Objectives 1. To study the pattern of vascular involvement of Behçet's disease (BD) in the Saudi population; use of anticoagulation and its duration, thromboembolic, and major bleeding complications during anticoagulant therapy. 2. The effect of combined immunosuppression and anticoagulation treatment approach in reducing the risk of venous and arterial thromboembolism. 3. The role of vascular surgery for peripheral arterial and abdominal aortic aneurysms (AAA), and the role of immunosuppression in the treatment of pulmonary artery aneurysm (PAA) without the need for surgical intervention. Methods Twenty-three patients with confirmed vasculo-BD attending the thrombosis clinics at our tertiary care center between 2010 and 2015 were studied retrospectively and analyzed through descriptive statistics SPSS version 22. Results Demographics and pattern of vascular involvement are shown in tables 1 and 2. HLA-typing was performed for 13 patients, and HLA- B51 was positive in 7 (54%) patients tested. The acute phase reactants (ESR and CRP) were high in all 23 (100%). Hereditary and acquired thrombophilia workup was performed for all patients and only 1 (4.3%) was positive for antiphospholipid antibodies. Oral ulcers were present in all the patients, genital ulcers in 12 (52%), ocular involvement in 8 (35%), skin manifestations in 3 (13%), and arthritis in 1 (4.3%). Lower extremity vein thrombosis is the most frequent manifestation of Vasculo-BD in Saudi Arabia, followed by CVT, PAI, SVT/Budd-Chiari syndrome, IVC thrombosis, peripheral artery aneurysms, and AAA. Peripheral arterial and abdominal aortic aneurysms in 3 (13.6%), all of whom had successful vascular surgery for aneurysm repair. Inferior vena cava filter was inserted in 3 (13.6%). One patient was admitted to the intensive care unit with fulminant hepatic failure due to bilateral hepatic vein thrombosis and subsequently died. The vascular thrombosis recurrence was in 11 patients (48%, all venous) despite adherence to the prescribed anticoagulant therapy and lack of any provocation. These patients were initially treated with anticoagulant monotherapy. After combining immunosuppressive therapy to the pre-existing anticoagulant therapy, none had thrombosis recurrence. There was a complete resolution of the two patients with PAA with mono-immunosuppressant therapy and no surgical intervention. The most commonly prescribed initiation anticoagulant therapy was low molecular weight heparin (87%). Conclusion BD with vascular involvement continues to pose a major diagnostic and therapeutic challenge to physicians due to the heterogeneity of the clinical presentation and lack of the diagnostic laboratory test. Therefore, we must have a low threshold for BD in any patient with vascular thrombosis or aneurysm. Combined immunosuppressive therapy is essential in suppressing and preventing the venous and arterial recurrence attacks. Disclosures No relevant conflicts of interest to declare.

scholarly journals Bilateral internal iliac artery ligation: the procedure of choice in life threatening postpartum haemorrhage

2020 ◽  
Vol 9 (9) ◽  
pp. 3607
Author(s):  
Sameer P. Darawade ◽  
Arti A. Wagle ◽  
Sneha Trivedi ◽  
Saloni Manwani
Keyword(s):  
Postoperative Complications ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Iliac Vein ◽  
Artery Ligation ◽  
Vein Thrombosis ◽  
Internal Iliac Artery Ligation ◽  
Internal Iliac ◽  
Life Threatening ◽  
Vein Injury

Background: The present study was to assess the indication and study the intraoperative and postoperative complications of bilateral internal iliac artery ligation. Aim of this study was to evaluate the effectiveness of internal iliac artery ligation in arresting postpartum haemorrhage.Methods: This is a retrospective study carried out between January 2015 to December 2018 at Shrimati Kashibai Navale Medical College and General Hospital, Pune. This study included 48 patients with life-threatening PPH. Bilateral internal iliac artery ligation was done by anterior approach in 7 patients and by posterior approach in 41 patients.Results: Intraoperative and postoperative complications were noted in all patients. Of the total patients, 10 required massive blood transfusion and 12 underwent obstetrical hysterectomies (n=12; 25%). Internal iliac vein injury was seen in 1 patient (n=1; 2.08%) and external vein thrombosis was noted in 3 patients (n=3; 6.25%). Maternal mortality was observed in 1 patient due to DIC on day 9 (n=1; 2.08%). The uterine salvage rate was 75%.Conclusions: Internal iliac artery ligation (IIAL) safe, rapid, effective, time tested method of controlling bleeding from genital tract.

4. Analyzing Endoleaks and Predicting Outcomes after Aneurysm Repair

2016 ◽  
Author(s):  
Jillian Gauld
Keyword(s):  
Text Mining ◽  
Statistical Significance ◽  
National Laboratory ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Large Variability ◽  
Oak Ridge ◽  
Abdominal Aortic ◽  
Significant Difference ◽  
Aneurysm Repair

Abdominal aortic aneurysms (AAAs) occur when a large blood vessel, the aorta, which supplies blood to the abdomen, pelvis, and legs, becomes exceedingly large. This can become dangerous as the aneurysm may rupture, and cause internal bleeding. Treatments for AAAs have become increasingly effective, and with proper detection, grafts may be used to surgically fix the aneurysm. Surgeons at The University of Tennessee Medical Center have seen a large variability in the survival and effectiveness of such grafts, and are working with Oak Ridge National Laboratory to help predict the success or failure of an AAA repair. The goal of this research was to analyze and integrate the results of a follow-up study on patients who have had repairs on abdominal aortic aneurysms. The analysis utilized text mining and statistical software. Radiological reports were analyzed initially using a text mining software. Documents clustered based on common words and phrases, and those relating to the occurrence of an endovascular leak (endoleak) were identified. These trends in the text were then tested for statistical significance. A contingency analysis showed a significant difference in endoleak occurrence in the populations with sigmoid diverticulosis and gallstones. Time points for the occurrence for endoleak were also plotted, and trends were identified. The results of this study provide a useful analysis of the patient dataset, and identify significant trends among patients with endoleaks after AAA repair. This study will contribute to the development of multi-modal mathematical models to predict the outcome of an abdominal aortic aneurysm repair.

Comparative Analysis of Immediate Postoperative Complications Following Total Gastrectomy

2017 ◽  
Vol 89 (3) ◽  
pp. 1-6
Author(s):  
S. M. Stancu ◽  
B. A. Popescu
Keyword(s):  
Postoperative Complications ◽  
Gastric Carcinoma ◽  
Total Gastrectomy ◽  
Statistical Significance ◽  
Hemodynamic Instability ◽  
Postoperative Risk ◽  
Complex Procedure ◽  
Life Threatening ◽  
Manual Anastomosis ◽  
Surgery Department

Introduction: Total gastrectomy (TG), despite disrupting the continuity of the alimentary tract and accounting for significant postoperative complications, is the procedure of choice for curative resection of gastric carcinoma. The objectives of this study were to report the rate of postoperative complications following TG, to analyze adverse postoperative outcomes, and to determine the safer technique between Roux –en-Y Esophagojejunostomy and Omega Braun TG. Materials and Methods: A retrospective, observational study was conducted among patients diagnosed with gastric carcinoma who underwent TG between January 1st, 2010 and December 31st, 2012 in the Surgery Department of the Bucharest Clinical Emergency Hospital. Descriptive and analytical statistical analysis with parametric and non-parametric tests was carried out using GraphPad, with statistical significance set at p <0.05. Results: Seventy-seven patients, aged 37-91 years (average age 64.1 ± 11.59 years), were enrolled in this study. A total of 84 immediate postoperative complications were encountered in 35 patients (47.5%), classified into local (n=21, 25%) and general complications (n=63, 75%). Reoperation was necessary in five cases (6.2%), all after Roux-en-Y end-side esophagojejunostomy. Two deaths (n=2, 2.5%), one after Roux-en-Y and one after Omega-Braun TG, were reported. Discussion: The Roux-en-Y technique had the higher number of complications, both local and general. Omega-Braun TG was associated with a lower number of local complications; however, it was associated with life-threatening complications including hemodynamic instability and multisystem organ failure. A statistically significant correlation between manual anastomosis and mortality was observed. Conclusion: The study deemed Roux-en-Y Esophagojejunostomy the overall safer procedure. A statistically significant correlation between manual anostomosis and mortality was observed. Total Gastrectomy is a complex procedure with numerous potential complications which calls for an improved surgical technique to reduce postoperative risk.

Mechanical Characterization and Simulation of Murine Thrombi

2011 ◽  
Author(s):  
Constance L. Slaboch ◽  
Timothy Ovaert
Keyword(s):  
Mechanical Properties ◽  
Aortic Rupture ◽  
Blood Clot ◽  
Significant Treatment ◽  
Flow Simulations ◽  
Vein Thrombosis ◽  
Abdominal Aortic ◽  
Optimal Drug ◽  
Life Threatening ◽  
Deep Vein

Deep vein thrombosis (DVT) is the formation of a thrombus, or blood clot, in one of the extremities, often in the vein of a leg. Approximately 2 million incidences of DVT occur annually. Roughly 300,000 people die due to the development of a pulmonary embolism (PE), which occurs when the thrombus from a DVT relocates to the pulmonary artery. Abdominal aortic aneurysm (AAA) is another life-threatening disease involving thrombi, resulting in 15,000 deaths annually. Together, these diseases impact over 2.5 million people each year. The effects of mechanical properties on thrombi dissociation and aortic rupture are not well characterized, and this lack of knowledge has hampered significant treatment and management of many blood-related diseases, as well as the development of optimal drug therapies. Determining these mechanical properties (i.e., elastic modulus and viscosity) is valuable information, as it can be used as inputs to simulations of thrombi disorders to more accurately determine thrombus dissociation or aortic rupture. The goal of this research is to determine the mechanical properties of murine (rat) thrombi under physiologic conditions via nanoindentation, for use as inputs data to numerical flow simulations.

Sign in / Sign up

Export Citation Format

Share Document