Endovascular Instead of Open Surgical Repair of Axillosubclavian Artery Injuries: An Evolving Paradigm Shift

Axillosubclavian injuries (ASI) comprise a small proportion of vascular injuries, yet their morbidity and mortality is high. This is often attributable to non-compressible bleeding in the apical thorax, hemodynamic instability, and the anatomically challenging location of these vessels making them difficult to access and control quickly. While the traditional management of ASI was with open surgical repair (OSR), recent years have seen an evolution towards less invasive endovascular repair (EVR). In patients with these injuries, EVR may be a safer alternative that achieves similar immediate results with significantly lower complication and mortality rates than the highly morbid open surgical option. In this article, we review and compare the two approaches, providing an overview of patient selection, anatomic considerations, techniques, postoperative management, and outcomes. With the advent of EVTM and more trauma team members capable of endovascular management of vascular trauma, a paradigm shift towards EVR for ASI is taking place.

Negative-pressure wound therapy is effective for peritoneal dialysis catheter exit-site management in the early postoperative period

Peritoneal dialysis (PD) catheter exit-site care is critically important for the prevention of catheter-related infections (CRIs) and subsequent peritonitis. The postoperative management of the site is particularly essential because it has an open wound that is always adjacent to a PD catheter tube. This study aimed to examine the effectiveness of negative-pressure wound therapy (NPWT) for postoperative PD catheter exit sites. Thirty patients with end-stage renal disease who underwent simultaneous PD catheter insertion and exit-site formation were randomly assigned to receive NPWT (NPWT group) or conventional dressing (non-NPWT group) for the first seven postoperative days. The exit-site scores on the seventh postoperative day was lower in the NPWT group than in the non-NPWT group (p = 0.0049). Analysis of variance F statistic for the effect of NPWT over 180 days was highly significant (11.482595, p = 0.007). There were no statistically significant differences between the time to first CRI and PD-related peritonitis between the two groups. There was one case of CRI with relapsing peritonitis and catheter loss in the non-NPWT group. These findings demonstrate the association between NPWT and low exit-site score. NPWT can be recommended for the management of PD catheter exit sites in the early postoperative period.

Trabeculectomy versus Xen gel implant for the treatment of open-angle glaucoma: a 3-year retrospective analysis

ObjectiveTo compare the two surgical techniques in terms of efficacy, safety, and postoperative management over 36 months of follow-up.MethodsThis retrospective clinical cohort study compared the outcome of trabeculectomy surgery and Xen gel implant in patients having uncontrolled glaucoma. Patients were recruited using the following inclusion criteria: uncontrolled intraocular pressure (IOP) on maximally tolerated medical therapy, healthy conjunctiva freely mobile in the superior sector, open-angle, glaucomatous visual field damage, full follow upfollow-up of at least 36 months. Thirty-four patients were submitted to trabeculectomy and 34 to Xen gel implant. We set the lower limit at 6mmHg mm Hg and the upper limit ≤12 mm Hg for criteria A, upper limit to ≤15 mm Hg for criteria B and upper limit ≤18 mm Hg for criteria C. Criteria for success have been characterizedcharacterised according to whether or not this has been achieved without (complete success) or with IOP -lowering medications (qualified success).ResultsFor all survival curves, trabeculectomy was superior to Xen gel implant. When considering complete success, the log-rank test for criteria A was statistically significant (pp=0.006), marginally significant for criteria B (pp=0.065) and not significant for criteria C (pp=0.23). When qualified success was considered, trabeculectomy was superior to Xen gel for criteria A, B, and C (pp=0.012, pp=0.033 and pp=0.025, respectively). Higher number of post-operative flat chamber and bleb leakage was observed in the trabeculectomy group.ConclusionXen gel implant techniques offer a better safety profile but a lower IOP reduction compared to compared with the gold -standard technique.

Indications, postoperative management, and long-term prognosis of Crohn’s disease after ileocecal resection: a multicentre study comparing the East and West

Background Crohn’s disease (CD) phenotype differs between Asian and Western countries and may affect disease management, including decisions on surgery. This study aimed to compare the indications, postoperative management, and long-term prognosis after ileocecal resection (ICR) in Hong Kong (HK) and The Netherlands (NL). Methods CD patients with primary ICR between 2000 and 2019 were included. The endpoints were endoscopic (Rutgeerts’ score ≥i2b and/or radiologic recurrence), clinical (start or switch of IBD medication) and surgical recurrences. Cumulative incidences of recurrence were estimated with a Bayesian multivariable proportional hazards model. Results Eighty HK and 822 NL patients were included. The most common indication for ICR was penetrating disease (HK 32.5%, NL 22.5%) in HK versus stricturing disease (HK 32.5%, NL 48.8%) in NL (P<0.001). Postoperative prophylaxis was prescribed to 65 (81.3%) HK (28 [35.0%] amino salicylates [5-ASA]; 30 [37.5%] immunomodulators [IM]; 0 biologicals) versus 388 (47.1%) NL patients (67 [8.2%] 5-ASA; 187 [22.8%] IM; 69 [8.4%] biologicals; 50 [6.1%] combination therapy, P<0.001). Endoscopic or radiologic evaluation within 18 months was performed in 36.3% HK versus 64.1% NL (P< 0.001) patients. No differences between both populations were observed for endoscopic (hazard ratio [HR]: 0.53 (95% confidence interval [CI]: 0.24–1.21), clinical (HR: 0.91 (95% CI: 0.62–1.32), or surgical (HR: 0.61 (95% CI: 0.31–1.13)) recurrence risks. Conclusion The main indication for ICR in CD patients is penetrating disease in HK patients and stricturing disease in NL patients. Although considerable pre- and post-operative management differences were observed between the two geographical areas, the long-term prognosis after ICR is similar.