bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ten-Year Outcomes after Endovascular Aneurysm Repair (Evar) and Magnitude of Additional Procedures
Authors: Väärämäki S. , Pimenoff G. , Heikkinen M. , Suominen V. , Saarinen J. , Zeitlin R. , Salenius J. 
Published: January 2017

Background and Aims: With any new technology complications are possible, and problems with first-generation aortic stentgrafts have been extensively reported. The long-term outcome of this patient population and the magnitude of additional secondary procedures are, however, less well covered. Materials and Methods: Between February 1997 and November 1999, 48 patients (44 men and 4 women; mean age 70 years; range 54–85) with AAA (average 57mm, range 40–90mm) were treated with a Vanguard® endoprosthesis. Stentgrafts were sized by CT and angiography-based measurements. Results were continuously assessed using contrast-enhanced CT before discharge, 1, 3, 6 and 12 months after the procedure and thereafter annually. Since 2001 plain abdominal X-rays have been performed annually. Results: The technical implant success rate was 100%. Median follow-up was 91 months (range 7.6–120 months). None of the patients was lost during this period. Hospital mortality was 0%. There were 25 subsequent deaths (52%), the most common cause being coronary artery disease. There were ten late conversions to open surgical repair, including three emergency operations: two due to rupture and one to thrombosis. EVAR-related complications were encountered in 43 patients (90%): 12 primary endoleaks (all type II), 36 late endoleaks (16 type I, 2 type II and 18 type III), 22 migrations, 25 row separations, 20 thromboses, one endotension and 3 ruptures of the AAA. Secondary procedures were required in 39 patients (81%): 1 re-endografting by aortoiliac bifurcated graft and 3 with a uni-iliac graft; 33 limb graft repairs were performed and 19 infrarenal cuffs were placed. There were 4 late embolizations and 4 attempts, and 6 thrombolyses, four of which were successful. Further, 9 femoro-femoral crossover by-pass and 2 axillo-femoral by-pass operations and 2 amputations were carried out during the follow-up. Only one patient was alive without complications. Conclusions: The impact of long-term follow-up of patients treated with the new technology was emphasized in this patient population. A careful surveillance protocol and active endovascular treatment of complications can yield acceptable results and low AAA rupture and aneurysm mortality rates, also with the first-generation endovascular graft. A new technology, however, may involve unpredictable problems which can magnify the workload and incur high costs over several years after the initial procedure.
Interplay between Coagulation and Inflammation in Open and Endovascular Abdominal Aortic Aneurysm Repair — Impact of Intra-Aneurysmal Thrombus
Authors: Aho P.-S. , Niemi T. , Piilonen A. , Lassila R. , Renkonen R. , Lepäntalo M. 
Published: January 2017

Aims: Our aim was to compare hemostatic and inflammatory mechanisms in abdominal aortic aneurysm (AAA) patients after open surgery (OPEN) and endovascular AAA repair (ENDO). Subjects and Methods: From the 32 consecutive AAA patients recruited, 17 represented ENDO and 15 OPEN. The intra-aneurysmal thrombus was removed during OPEN, but stayed intact after ENDO. The pre-operative volume of the intra-aneurysmal thrombus was calculated from computed tomography images. Markers of coagulation and inflammation were studied pre-operatively, at one, two, three, four and seven days and at three months postoperatively. Results: Preoperative upregulation of F 1 + 2, TAT and D-dimer was evident in both groups. The volume of intra-aneurysmal thrombus correlated with CRP (β=0.62, p=0.001), IL-6 (β=0.60, p=0.001) and PAI-1 ag (β=0.51, p=0.007). Surgery further enhanced inflammation, coagulation and fibrinolysis. IL-6 increased in both groups, but the increases of CRP and PIIINP were higher in the OPEN group. Postoperative CRP correlated with the intra-aneurysmal thrombus volume in the ENDO group. At three months D-dimer (p<0.05) was higher than pre-operatively in the ENDO, in contrast to the OPEN group. Conclusion: Preoperatively both prothrombotic and fibrinolytic mechanisms are activated in patients with AAA. Intraluminal thrombus induces prothrombotic and inflammatory interactions, which persist after endovascular aortic aneurysm repair.
Evolution of the Therapeutic Approach of Visceral Artery Aneurysms
Authors: Ruiz-Tovar J. , Martínez-Molina E. , Morales V. , Sanjuanbenito A. , Lobo E. 
Published: January 2017

Introduction: Visceral artery aneurysms are an infrequent entity. Most of them are asymptomatic, but when they present as a rupture, a high mortality is associated. Material and Methods: We review our experience of 18 cases between 1988 and 2006. Results: 9 males and 9 females with a mean age of 66,5 years are analyzed. Aneurysms were located in splenic artery (9), hepatic artery (2), superior mesenteric artery (2), celiac trunk (3), inferior mesenteric artery (1) and gastroduodenal artery (1). Three of them were associated with abdominal aorta aneurysms. Fourteen patients were asymptomatic, three presented abdominal pain and one case presented with rupture and intraperitoneal bleeding. Surgical treatment was performed in thirteen of the patients and endovascular in five. Two cases of endovascular treatment failed and surgery was necessary. Postsurgical mortality was 0 and complications appeared in 2 patients. Mean hospital stay after surgical treatment was 11 days and 3 days after endovascular one. None of the patients presented recurrences, and one has chronic mesenteric ischemia as sequelae of surgical treatment of a superior mesenteric artery aneurysm. Conclusion: Visceral artery aneurysms must be treated if it is feasible, due to the potential risk of rupture. Endovascular treatment associates lower morbimortality rates and shorter hospital stay than surgical one, but nowadays many aneurysms are not suitable for this management. Endovascular treatment is a technically difficult approach, that requires a specific training and the first cases represent a learning curve.
Retrospective Review of 234 Scaphoid Fractures and Nonunions Treated with Arthroscopy for Union and Complications
Authors: Slade J. F. , Gillon T. 
Published: January 2017

The purpose of this paper is to retrospectively review 234 consecutive cases of scaphoid fractures and nonunions treated using arthroscopy with the dorsal percutaneous implantation of a headless compression screw for healing and complications. Solid union of fracture is determined by CT scan. We identified 126 acute injuries, including 65 proximal pole fractures; 67 grossly displaced fractures; 12 trans-scaphoid perilunate dislocations including four trans-scaphoid trans-capitate fractures; and ten combined scaphoid and distal radius fractures. 108 scaphoid nonunions were identified. 98 were correctly aligned and ten had a humpback deformity which was correctable using arthroscopic assisted reduction techniques at the time of surgery. 82 presented with a fracture gap 2mm or greater requiring percutaneous bone grafting. 12 cases of avascular necrosis (AVN) were identified by MRI. 20 nonunions had surgery performed at other institutions. The mean time to surgery for the nonunions was 20 months. 99% union rate of acute scaphoid fractures was obtained by 12 weeks, as determined by CT scan. Two complications were identified (3%). One case of delayed healing was identified. This delayed union was treated with percutaneous bone grafting and continued on to heal uneventfully. The other complication was a case of volar trans-scaphoid peri-lunate dislocation. While the fracture healed, the patient developed a traumatic dislocation requiring a capitate-lunate arthrodesis. Treatment of scaphoid nonunions resulted in ten cases of delayed healing, which were treated with repeat percutaneous bone grafting. This represented a 9% complication rate. Of the ten cases of delayed unions that were re-bone grafted, four failed to heal by nine months. This resulted in a 96% union rate of our nonunion group by nine months. When acute fracture healing was compared to nonunions the average healing of acute fractures as determined by CT scanning measuring trabecular bridging was 12 weeks, while the average healing of nonunions was 22 weeks. We conclude that the dorsal percutaneous treatment of scaphoid fractures and nonunions using arthroscopy is safe and effective. CT scans to evaluate scaphoid healing by measuring trabecular bridging at the fracture site was determined to be an excellent modality to evaluate scaphoid healing. While not witnessed in this series, the potential for complications requires proper training.
Expertise and Skill in Minimally Invasive Surgery
Authors: Silvennoinen M. , Mecklin J.-P. , Saariluoma P. , Antikainen T. 
Published: January 2017

New attitudes to medical ethics and demands for efficiency have brought increased attention to surgical skills and training. It is important to characterize the expertise and skill involved in the multidimensional surgical profession. At a time of change, there is a need to discuss the nature of surgical expertise, and also the prospects for resident training, with special reference to new minimally invasive techniques (MIS). In this paper, we selectively review knowledge on surgical expertise and the specific demands placed on a skilled MIS surgeon. In addition, the review contains a selection of studies from those areas that have been seen as important for the future of training in surgery.
Effectiveness of Superficial Venous Surgery in Terms of Quality-Adjusted Life Years and Costs
Authors: Eskelinen E. , Räsänen P. , Albäck A. , Lepäntalo M. , Eskelinen A. , Peltonen M. , Roine R. P. 
Published: January 2017

Aims: To assess the impact of superficial venous surgery (SVS) on health-related quality of life (HRQoL) and to explore the cost-utility of venous surgery. Material and Methods: 143 patients (110 female and 33 male) enrolled for SVS between 2003 and 2005 in Helsinki University Central Hospital filled in the 15D survey before and six months after operation. Direct hospital costs were obtained from a patient administration database and were examined from the perspective of secondary care provider. Results: After SVS, the HRQoL score improved in 71% of the patients, and the mean score increased from 0.919 (on a0–1 scale) preoperatively to 0.933 postoperatively at 6 months (p < 0.001). Patients with a clinically important result from SVS (≥ 0.03 increase in the HRQoL score) had significantly worse HRQoL at baseline. At 6 months postoperatively, the mean (SD) hospital costs were 1637€ (693) and the mean quality-adjusted life year (QALY) gain 0.504 (1.674), respectively. Thus, the mean cost per QALY gained during a 6-month period was 3248€ for SVS. Conclusions: Superficial venous surgery improves HRQoL, and is a cost-effective treatment of symptomatic superficial venous insufficiency.
Transfer versus Transition: Success in Pediatric Transplantation Brings the Welcome Challenge of Transition
Authors: Stabile Laura , Rosser Lynette , Porterfield Karen M. , McCauley Sonia , Levenson Cecile , Haglund Jeneva , Christman Karen 
Published: January 2017

Context Increasing success with solid organ transplantation in children has increased the numbers of adolescents and young adults who are at an age to transfer to adult healthcare. Objective To determine the nature of transfer/transition of adolescents and young adults to adult healthcare. Design Using a qualitative approach, 24 young adults provided answers to 12 questions about their transfer to adult healthcare. Responses were compared to identify themes. Setting Subjects had been pediatric patients at Children's Hospital of Pittsburgh. Most were transferred to the University of Pittsburgh Medical Center. Patients The subjects had received, or were on the list to receive, solid organ transplants and had been transferred within 18 months of the study. Results Twenty-four of 37 potential subjects completed interviews. Those who participated were enthusiastic about making a contribution to the transfer process. Most subjects cited difficulty leaving the pediatric system. Challenges included abrupt transfers, insufficient communication between pediatric and adult specialty providers, and becoming “lost to follow-up.” However, there was a consistent, clear statement that subjects preferred being treated as adults. They liked healthcare staff addressing them instead of their parents, being spoken to in an adult manner, and being responsible for their own care. Suggestions for improvement included early introduction of the concept of transition to adult care, providing written material about the transition process, and use of pediatric/adult social work collaboration to provide support for young adults in transition.
Subcapsular Hematoma Evacuation as a Method of Evaluating Injured Kidneys for Transplant
Authors: Yushkov Yuriy , Hoffman Allison , Giudice Anthony 
Published: January 2017

Background Approximately one-third of organ donors in the United States are trauma victims. In general, kidneys with large subcapsular hematomas are not used for transplant because of the possibility of significant parenchymal injury. A large subcapsular renal hematoma may cause scarring resulting in renal parenchymal compression and development of the Page syndrome. Objective To elucidate a successful method of evaluating kidneys subject to trauma, while also possibly preventing further damage and improving their function. Design Data were collected from the donor kidney pool of the New York Organ Donor Network from January 2006 through July 2007. Four kidneys during that period were determined to have significant subcapsular hematomas. Surgical intervention was undertaken and outcomes after transplantation were reviewed. Main Outcome Measures Four of the kidneys underwent a surgical procedure to drain the subcapsular hematoma allowing assessment of the underlying renal parenchyma. All 4 of these kidneys were deemed transplantable. After transplantation, 3 of the 4 kidneys had immediate function and did not require dialysis. The remaining kidney was removed as a result of primary nonfunction. Conclusion The described surgical intervention allows the transplant surgeon to accurately assess the extent of damage to a traumatized kidney while possibly preventing further damage to the kidney.
Short-Term Impact of an Educational Program Promoting Live Donor Kidney Transplantation in Dialysis Centers
Authors: Pradel Françoise G. , Suwannaprom Puckwipa , Mullins C. Daniel , Sadler John , Bartlett Stephen T. 
Published: January 2017

Context Given the shortage of kidneys available for transplantation, a community-based intervention trial was implemented to assess the impact of an educational program on patients' access to live donor kidney transplantation (LDKT). Objective To compare the short-term impact of a basic intervention and an enhanced intervention on patients' readiness to pursue LDKT. Design Baseline data and data from 1 week after interventions were analyzed. Participants 214 transplant-eligible hemodialysis patients attending 14 dialysis facilities in Maryland, Virginia, and Pennsylvania. Interventions In the basic intervention, 107 patients watched a 10-minute videotape on the experience of recipients and live donors of a kidney. In the enhanced intervention, 107 patients watched the same videotape and had a discussion with a health educator on the risks and benefits of LDKT, who could be a donor, and how to address the barriers they were encountering when seeking a live kidney donor. Main outcome measure Patient reported whether they were considering LDKT, had talked with family or friends about LDKT, and had asked someone for a kidney. Results Over half of transplant-eligible patients were not pursuing LDKT at baseline (64% in the basic intervention group, 61% in the enhanced intervention group). One week after the intervention, the odds of considering LDKT were higher among African Americans (odds ratio [OR], 2.28; confidence interval [CI], 1.22–4.25), younger patients (OR, 0.94; CI, 0.91–0.97), and patients who spent less time on dialysis (OR, 0.90; CI, 0.83–0.97). The odds of asking for a kidney were higher among African Americans (OR, 4.94; CI, 2.54–9.60) and patients who perceived they were in poor to fair health (OR, 3.30; CI, 1.12–9.67). Conclusions Although both interventions helped patients consider LDKT and ask for a kidney, more time and expanded educational content might be needed to facilitate patients' discussion about LDKT with their loved ones.
Role of Multimodality Intraoperative Neurophysiological Monitoring during Embolisation of a Spinal Cord Arteriovenous Malformation
Authors: Sala F. , Niimi Y. , Berenstein A. , Deletis V. 
Published: January 2017

The decision whether or not to embolise during endovascular procedures for arteriovenous malformations (AVMs) of the spinal cord under general anesthesia, relies primarily on neurophysiological results of provocative tests with Lidocaine and short-acting barbiturates. Because of the complex haemodynamics of spinal AVMs, when either sensory (CSEPs) or muscle motor evoked potentials (mMEPs) are used independently, they can mislead the interpretation of provocative tests. This report illustrates the specific but complementary role played by provocative tests using CSEPs and mMEPs during embolisation of a low thoracic spinal cord AVM. We present the case of a 46 year old male with six year history of right lower extremity weakness. At that time, Magnetic Resonance (MR) imaging of the spine disclosed an intramedullary AVM at T11. He remained neurologically stable up to seven months before admission, when he developed sudden onset of low back pain, followed by progressive paraparesis, numbness in lower extremities, urinary retention and fecal incontinence. A new MR imaging study indicated venous thrombosis of the AVM. A two-stage embolisation was performed. During the first procedure, after provocative tests did not affect either CSEPs or mMEPs, an embolisation was performed through a sulco-commisure feeder from the anterior spinal artery (ASA) at T9. Conversely, provocative tests with Lidocaine performed from a right posterior spinal artery (PSA) feeder to the AVM nidus resulted in a significant (>50%) decrease of CSEPs, while mMEPs remained unchanged. The repeatedly positive tests warranted further investigation of the vascular anatomy which disclosed a normal right PSA distal to the nidus; the distal normal PSA was protected with coils. A repeated Lidocaine test was negative and the posterior feeder was embolised with no subsequent changes in CSEPs or mMEPs. After the procedure, the patient experienced only a mild transitory increase in right leg numbness, but no additional motor deficits. Five days later, the embolisation through the ASA feeder at T9 was completed on the basis of negative provocative tests. No additional neurological deficits were observed. Favoring either CSEPs or MEPs during endovascular procedures in the spinal cord is not justified by a solid scientific background. This case report illustrates that monitoring both CSEPs and mMEPs combined with provocative tests allows the safest and most effective embolisation of spinal cord AVMs under general anesthesia.
Diagnosis and Endovascular Treatment of Vertebral Arteriovenous Fistulas in Neurofibromatosis Type 1
Authors: Hori Y. , Goto K. , Ogata N. , Uda K. 
Published: January 2017

We present diagnostic problems, strategies, techniques and material selection for endovascular treatment of high flow arteriovenous fistula (AVF) of tortuous and fragile vertebral artery (VA) with neurofibromatosis type 1 (NF1). Diagnosis of NF1 was easy in four of our cases because of neurofibromatosis, skin pigmentation and various skeletal abnormalities. These stigmas of NF1 were lacking in one case, and the only clue to the diagnosis was ovoid bone defects of the skull vault. Diagnosis was made by performing biopsy of scalp neurofibromas incidentally found on CT. In two initial cases, venous varix were packed with coils by transvenous approach after the transarterial embolisation failed to completely cure the fistula. In three recent cases, blood flow through the fistula was markedly reduced as an initial step by placing detachable coils into the distal and proximal stumps of the afferent VA. Then a liquid adhesive was injected under systemic hypotension to completely occlude the fistula. Control angiography revealed that the AVFs were completely occluded in all cases. Long-term angiographical and clinical status have been stable in all cases. Trying to attain complete occlusion of fistulas using detachable balloons is not an appropriate treatment option for high flow fistulas situated on markedly dilated, tortuous and fragile VAs of patients with NF1. Also, trapping of fistulas is not justified because of the numerous potential feeding pedicles, and makes the following procedure difficult.
“Protected” Wallstenting of Atheromatous Stenoses at the Carotid Bifurcation
Authors: Théron J.G. , Guimaraens L.J. , Casasco A.E. , Courtheoux P.G. , Beaujeux R.L. , Rufenacht D.A. , Coskun O. , Sola M.T. , Constans J.-M. , Martin J.-B. 
Published: January 2017

Atheromatous stenoses at the carotid bifurcation were treated by angioplasty and Wallstenting with cerebral protection obtained in most cases by temporary occlusion of the internal carotid artery. 287 carotid stenoses were treated in 233 patients. The stenosis was symptomatic in 79% of cases. All patients presented either a stenosis of >70% with significant impairment of the cerebral circulation (281 cases) or a symptomatic ulcerated plaque (six cases). A self-mounted protection system was used in 177 cases, the Percusurge Guardwire protection device in 98 cases an EPI filter in 12 cases. There was a contralateral internal carotid occlusion in 13% of cases. A combined stenting (vertebral, siphon, subclavian) was performed in 14% of cases. A Rolling membrane Wallstent was used in 84 patients, a first generation Easy Wallstent in 38 cases, a “Carotid” Easy Wallstent 35 in 55 cases and monorail 14 in 110 cases. Full opening of the stenosis was obtained in 98% of patients with correction of the arterial curve and improvement of the cerebral vascular supply. There were 0.7% cases with transient symptomatic neurological complications and 2% with permanent sequelae mainly related to avoidable inadequacy in flushing or to the insufficient radial force of the first generation Easy Wallstent. There were no per and one post-procedural cardiac complication (0.6%) in the s165 cases performed with the “Carotid” Easy Wallstent. Follow-up angiograms showed O.7% of restenoses. Still in evolution, endovascular treatment of atheromatous stenoses at the carotid bifurcation with cerebral protection and stenting is a promising alternative technique to surgery. The association of Carotid Easy Wallstent 14 monorail and Percusurge Guardwire appears to be currently satisfactory.
Secondary Spontaneous Thrombosis of a Giant Aneurysm Located Distally on a Feeding Artery after Embolization of an Associated Arteriovenous Malformation
Authors: Poon W.L. , Alvarez H. , Lasjaunias P. 
Published: January 2017

Giant aneurysm located in the distal part of the feeding artery associated with a cerebral arteriovenous malformation is rare and the treatment is clinically challenging. We report the spontaneous and complete thrombosis of a flow-related giant aneurysm immediate up-stream to a cerebral arteriovenous malformation by embolization of that malformation alone in a patient presenting with complex partial seizure and no history of intracranial haemorrhage. We obviated the need to directly intervene on the giant aneurysm, thus reducing unnecessary procedure related risks to the patient. Follow up one year later confirms the thrombosis and show shrinkage of the mass. The patient is asymptomatic.