bluuebunny/crossref_metadata_2025_split huggingface dataset:
Open Repair for Juxta-Renal Aortic Occlusion in High-Risk Patients
Authors: Pandey Ashutosh Kumar , Manchikanti Sriram , Sun Neelamjingbha , Rajeev Akash , Gupta Aditya , Ramachandran C Sreekumar , Unnikrishnan Madathipat , Pitchai Shivanesan 
Published: June 2022

Background:
Juxtarenal aortic occlusion (JRAO) is an infrequent form of aortic occlusion, resulting from a proximal progression of a distal aortic thrombus. The occlusion at or above the level of renal arteries may present with features of renal failure or intestinal ischemia along with increased severity of pelvic and limb ischemia. Surgical treatment of JRAO is complex and usually involves suprarenal clamping and poses a significant morbidity and mortality risk. Nevertheless, the current literature supports superiority of surgical bypass with excellent long-term outcomes and remains the preferred modality in JRAO. We reviewed the results of open surgical bypass in JRAOs, done at our center over a 5-year period.

Materials and Methods:
A retrospective analysis of 35 patients who underwent JRAO over the past 5 years was performed. Demographic data, comorbidities, clinical presentation, and surgical results were analyzed.

Results:
Of the 35 patients who underwent open surgical bypass, 34 were male, and one was female. The median age of the cohort was 56 years. All the patients had either disabling claudication, rest pain or tissue loss at presentation. The notable comorbid conditions were hypertension (91%), diabetes (51%), coronary artery disease (71%), and chronic obstructive pulmonary disease (37%). Direct aortic reconstruction was done in all cases, seven patients with critical limb ischemia underwent sequential infra-inguinal bypass, additional mesenteric bypass was done in one patient, renal artery revascularisation was done in three patients in the form of endarterectomy for two patients and aortorenal bypass in one patient. There was no perioperative mortality, and a 93% cumulative graft patency rate was noted.

Conclusion:
Open surgical reconstruction is a safe method for JRAO even in patients with comorbidities and offers excellent perioperative and long-term results.
Retrograde Percutaneous Tibial Approach for Complex Infrainguinal Occlusions in Chronic Limb-Threatening Ischemia After Failed Antegrade Transfemoral Approach
Authors: Bharath N R , Narasimhan Sunder , Kumar K N , Aggarwal Ankur 
Published: June 2022

Introduction:
A significant proportion (20%) of patients with complex infrainguinal arterial occlusions cannot be recanalized using a conventional antegrade endovascular approach. Most of these patients will be poor candidates for open surgical reconstruction owing to the concomitant cardiovascular and pulmonary comorbidities or poor venous conduit. We present our experience using the percutaneous retrograde pedal approach for revascularization of infrainguinal arterial occlusions after failed conventional endovascular options.

Materials and Methods:
This is a retrospective observational study of all the patients admitted in our center from May 2019 to May 2021 for chronic limb-threatening ischemia with infrainguinal occlusive disease and attempted retrograde tibial approach after failed antegrade transfemoral approach. Procedural success was defined as residual stenosis of <30% after balloon angioplasty or stenting. Limb salvage was defined as freedom from major amputation during the follow-up period.

Results:
In a total of 20 patients managed with retrograde tibial approach, procedural success was achieved in 18 patients (90%). Limb salvage was achieved in 17 of the 18 patients who had procedural success during the follow-up period. One patient underwent below-knee amputation due to spreading infection.

Conclusion:
Retrograde tibial approach to recanalize infrainguinal arterial occlusions after failed traditional endovascular methods is safe and effective and should be advocated to avoid more invasive, time-consuming, and high-risk procedures as it offers high technical and procedural success rates with minimal complications.
Antegrade Access for Peripheral Vascular Disease Intervention of the Lower Limb – Our Experience at a Tertiary Center
Authors: Basavanthappa Rajendra Prasad , Mitta Nivedita , Ramswamy Chandrashekar Anagavalli , Desai Sanjay C , Chowdary R Hemanth Kumar , Kunapareddy Harikamal , Vishnumolakala Vijay Kumar 
Published: June 2022

Purpose:
Antegrade superficial femoral artery (SFA) access for peripheral artery disease reduces the time, radiation, and contrast required as compared with contralateral common femoral access (CFA). However, this technique remains underutilized and understudied in the treatment of SFA, popliteal and tibial disease, and there remains limited data on the safety and efficacy of antegrade SFA access.

Materials and Methods:
An observational review of lower extremity peripheral arterial interventions was conducted from January 2014 to July 2021. Interventions necessitating CFA access such as iliac, common femoral, or deep femoral artery revascularization were excluded. In addition, interventions potentially requiring large sheaths were excluded. Relevant demographic and treatment variables including postoperative complications were abstracted.

Results:
We identified 482 patients, who underwent revascularization of the SFA, popliteal and tibial arteries. Antegrade SFA access was chosen in all these patients. Access was attained either through ultrasound or fluoroscopy guidance in 94.6% of patients. The overall rate of complications was low (access site complications, hematoma, pseudoaneurysm, etc.).

Conclusions:
Percutaneous antegrade SFA access can be performed safely and remains an effective alternative to retrograde CFA access with significantly less complications and is also associated with lesser utilization of fluoroscopy and contrast.
Quantification of Hemodynamic Parameters in Primary Great Saphenous Reflux using Colour Doppler in Clinical Settings and Effect of GSV Ablation on the Venous Arterial Flow Index
Authors: Jha Manvendu , Mukherji Ruchira , Mopagar Vishwajeet , Kumari Kirti 
Published: June 2022

Purpose:
The aim of our study was to quantify venous reflux in outpatient settings using color Doppler and document objective improvement in hemodynamic parameters post ablation.

Methods:
Venous reflux was measured using color Doppler using venous-arterial flow index (VAFI), recirculation index (RCI), and percentage diameter change (PDC) (n = 30) and compared with healthy volunteers (n = 30), adjusted for age, sex, and body mass index (BMI). Patients with concomitant peripheral arterial disease (PAD), past history of deep venous thrombosis, chronic venous insufficiency, and venous ulcers were excluded from the study. Patients with reflux underwent RFA and VAFI was measured 6 months after treatment. Data were analyzed using IBM SPSS statistics software version 25. Tests of normality were applied before choosing statistical tests. Box-and-whisker plots with outliers were used to illustrate the difference between case and control groups. VAFI scores were compared pre- and postoperatively and Wilcoxon signed-rank test was applied for the comparison. P < 0.05 defined statistical significance.

Results:
Thirty patients with primary GSV reflux along with 30 healthy volunteers were adjusted for age, sex, and BMI. Clinical part of CEAP classification was C0 = 2, C1 = 6, C2 = 16, and C3 = 6 in reflux group and C0 = 26 and C1 = 4 in (n = 30) in healthy volunteers. There was a statistical difference in RCI, PDC, and VAFI across both groups (P < 0.5). In addition, VAFI decreased significantly after treatment at 6 months (1.38 preoperative to 0.95 postoperative, SD P < 0.5). Of the 30 patients, 21 had pain as the primary presenting symptom; 81% (17) reported a significant decrease in pain scores associated with hemodynamic improvement.

Conclusion:
RCI, PDC, and VAFI are accurate quantitative measurements of reflux in outpatient settings. VAFI is useful in objectifying the results of treatment. Symptomatic improvement in terms of pain score can be used to supplement the hemodynamic improvement though further substantiation of the above would be required in a larger cohort.
Contemporary Portrait of Aortic Bifurcated Bypass Procedures for Occlusive Disease in Indian Population
Authors: Kota Prajna B , Kota Albert Abhinay , Samuel Vimalin , Premkumar Prabhu , Selvaraj Dheepak , Stephen Edwin , Agarwal Sunil 
Published: June 2022

Purpose:
We sought to scrutinize the current clinical profiles and postoperative outcomes, following aortic bifurcated bypass (ABB) for occlusive arterial disease, over the past ten years and compare them with our formerly published dataset.

Methods:
From January 2011 to December 2020, a prospective single hospital database was maintained for ABB procedures in patients with occlusive disease. Clinico-demographic profile and postoperative outcomes were surveyed and assessed for associations. Graft patency, amputation-free survival, and mortality were the primary end points. In addition, we did a comparison analysis with our historical cohort to appraise the shift in trends.

Results:
Over the past ten years, 140 patients (mean age of 54.5 years) underwent ABB procedures for aortoiliac occlusive disease (AIOD). Majority were males (94.3%) with chronic limb-threatening ischemia (88.6%). Atherosclerosis was the most common etiology (85.7%). There was a significant increase in smoking (P < 0.001), dyslipidemia (P < 0.001), coronary artery disease (P < 0.001), chronic kidney disease (P = 0.05), flow limiting infra-inguinal disease (P < 0.001), intermediate graft thrombosis and primary amputation rates in the contemporary cohort (P = 0.050). No significant changes were noted in the 30-day mortality rates. The contemporary primary patency rate is 76.9%, and secondary patency rate is 94.2%, compared to an overall patency of 84% in the historical cohort.

Conclusion:
Our study highlighted the epidemiological shift transpiring in patients affected by AIOD in India. Despite challenging clinical profiles, our outcomes remain unchanged and are comparable to western literature.
Clinical Profile and Outcomes in Surgically Treated COVID-19 Patients Presenting with Acute Limb Ischemia
Authors: Patel Jayesh , Rangwala Varin , Thakkar Zeel , Bhatt Ravi 
Published: June 2022

Background:
Acute limb ischemia (ALI) refers to a sudden decrease in blood flow to the limb which threatens its viability. Such a sudden event of decreased or absent arterial supply to the limb causes ischemia and poor perfusion outcomes. The most common causes of ALI include embolism and thrombosis. Others include acute on chronic peripheral arterial occlusive disease or major trauma. It is well known to us that COVID-19 is a hypercoagulable state. In this prothrombotic state, patients can also present with ALI, with clinical features of pain, paresthesia, pulselessness, pallor, poikilothermia, and paralysis of the affected limb. Such patients rapidly progress to severe stages of limb ischemia that need immediate treatment to save the limb. Thus, our study aims to revisit the clinical features and outcomes of procedures performed on such patients.

Materials and Methods:
This is a single-center, retrospective study. COVID patients with ALI who underwent any surgical procedure, from February 2021 to July 2021, were identified from the surgical operation theater's list of the hospital. Detailed information regarding these patients was obtained from the digital software of the hospital. Detailed computed tomography angiography findings were also obtained from the radiology department. A required statistical study was done.

Results:
Nineteen COVID patients presenting with ALI and requiring surgical treatment were identified during the study period of 6 months. A complete study of their clinical presentations, surgical procedures performed and the outcomes, is done. The study shows that the most common site affected was the lower limb (95%) with occlusion occurring mainly in the popliteal artery, i.e., the lower limb artery.

Conclusion:
Recognition of limb ischemia at an early stage, considering it as a symptom or complication of COVID-19, may allow for early and prompt diagnosis and treatment of this condition.
Posterior midline approach to odontoidectomy
Authors: Erdogan Koral , Solmaz Serdar , Abbasoglu Bilal , Caglar Yusuf Sukru , Dogan Ihsan 
Published: June 2022

ABSTRACT

Background:
Basilar invagination (BI) is a common malformation of the craniocervical region where the odontoid process protrudes into the foramen magnum. Surgery in this region is difficult because of the complex anatomy of the craniocervical junction. Serious life-threatening complications have been observed with previously described approaches. Therefore, we conceived a novel surgical approach that can be implemented by neurosurgeons with different skill levels to facilitate better outcomes.

Methods:
We describe a new surgical technique for the treatment of BI that we used in two patients in whom cervical myelopathy and direct ventral compression of the cervicomedullary junction were confirmed through clinical and radiological findings. We present the technique of posterior odontoidectomy in a step-by-step, didactic, and practical manner with surgical tips and tricks.

Results:
The resection was completed without intraoperative or postoperative complications in both cases. The patients experienced substantial neurological improvements, and full recovery was observed during the 9-month and 12-month follow-up visits after discharge. Compared with the transoral approach, our technique provides a larger decompression area.

Conclusions:
We describe a novel method for the treatment of BI that was applied in two patients and suggest that the posterior approach might be a safe and effective method for ventral decompression of the craniocervical junction. Posterior odontoidectomy followed by craniocervical fixation helped achieve complete cervicomedullary decompression.
Does change in focal lordosis after spinal fusion affect clinical outcomes in degenerative spondylolisthesis?
Authors: Karamian Brian A. , DiMaria Stephen , Lambrechts Mark J. , D’Antonio Nicholas D. , Sawires Andrew , Canseco Jose A. , Kaye I. David , Woods Barrett I. , Kurd Mark F. , Rihn Jeffery A. , Lee Joseph K. , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D. 
Published: June 2022

ABSTRACT

Study Design:
Retrospective cohort study.

Objective:
The objective of this study is to determine the effect of focal lordosis and global alignment and proportion (GAP) scores on patient reported outcome measures (PROMs) after posterior lumbar fusion for patients with 1- or 2-level lumbar degenerative spondylolisthesis (DS).

Summary of Background Data:
In patients with DS, improvements in spinopelvic parameters are believed to improve clinical outcomes. However, the effect of changing focal lordosis in patients with 1-or 2-level degenerative lumbar spondylolisthesis is unclear.

Materials and Methods:
Postoperative spinopelvic parameters and perioperative focal lordosis changes were measured for 162 patients at a single academic center from January 2013 to December 2017. Patients were divided into three groups: >2° (lordotic group), between 2° and −2° (neutral group), and −2°° (kyphotic group). Patients were then reclassified based on GAP scores. Recovery ratios (RR) and the number of patients achieving the minimal clinically important difference (MCID) were calculated for PROMs. Standard descriptive statistics were reported for patient demographics and outcomes data. Multiple linear regression analysis controlled for confounders. Alpha was set at P < 0.05.

Results:
There was no significant association between change in focal lordosis and surgical complications including adjacent segment disease (P = 0.282), instrumentation failure (P = 0.196), pseudarthrosis (P = 0.623), or revision surgery (P = 0.424). In addition, the only PROM affected by change in focal lordosis was Mental Component Scores (ΔMCS-12) (lordotic = 2.5, neutral = 8.54, and kyphotic = 5.96, P = 0.017) and RR for MCS-12 (lordotic = 0.02, neutral = 0.14, kyphotic 0.10, P = 0.008). Linear regression analysis demonstrated focal lordosis was a predictor of decreased improvement in MCS-12 (β = −6.45 [−11.03- −1.83], P = 0.007). GAP scores suggested patients who were correctly proportioned had worse MCID compared to moderately disproportioned and severely disproportioned patients (P = 0.024).

Conclusions:
The change in focal lordosis not a significant predictor of change in PROMs for disability, pain, or physical function. Proportioned patients based on the GAP score had worse MCID for Oswestry Disability Index.

Level of Evidence:
III
Does cranial incidence angle have a role in the tendency toward cervical degenerative disc disease?
Authors: Er Uygur , Şimşek Serkan 
Published: June 2022

ABSTRACT

Purpose:
The purpose is to investigate if a correlation existed between the frequency of cervical degenerative disc disease occurrence and cranial incidence (CI) angle.

Materials and Methods:
A retrospective analysis of case series. Sagittal parameters of the case series were compared with the sagittal parameters of the same number of consecutive patients with neck pain only but no cervical degenerative disc disease (CDDD). Moreover, CI angle values were noted to be significantly different among groups on variable-based examination. Furthermore, the cervical lordosis (CL) values of men were observed to be significantly different. Therefore, the significant intergroup differences related to the CI angle and CL values support the study hypothesis.

Results:
No intergroup differences were noted regarding gender and age distribution (p = 0.565; p = 0,498). A significant intergroup difference was observed regarding CS values and the mean vector of CI angle and CL values for men and women (p = 0.002). CI angle values were noted to be significantly different among groups upon variable-based examination (p < 0.001). The CL values of men were observed to be significantly different, but not the CL values of women (p = 0.850). Therefore, the significant intergroup differences related to the CI angle and CL values support the study hypothesis.

Conclusions:
A reverse correlation between CI angle and CDDD development is demonstrated. This correlation is valid between CL and CDDD development. Therefore, cervical sagittal profile and the CI angle and CL measurements should be performed to follow-up patients with cervical pain.
Translaminar screw of C1 for the reinforcement of subaxial cervical spine reconstruction
Authors: Carelli Luis E. , Girão Alderico , Cabrera Juan P. 
Published: June 2022

ABSTRACT
Translaminar screws in the cervical spine have been mostly employed at C2 level when conventional trajectories are challenging. However, reports in the literature of translaminar screw of C1 are remarkably anecdotal. We aimed to report a case using C1 translaminar in addition to C1 lateral mass screws for the reinforcement of subaxial cervical spine reconstruction. We present a 22-year-old female patient, who developed persistent cervical pain, and computed tomography scan demonstrated lytic lesions of the vertebral bodies and lateral masses from C3 to C6. Magnetic resonance imaging showed spinal cord compression without myelopathy. Surgical biopsy was inconclusive, and an oncological vertebral instability led to surgical stabilization. Laminectomy and bilateral facetectomy of levels involved was achieved, instrumentation from C1 to T3 and reconstruction with posterolateral fibula bilaterally, and without occipital fixation. A third satellite rod was placed using C1-2–7 translaminar screws. Translaminar screw of C1 is a feasible alternative for increasing the strength of the construct.
An experience with Goel-Harms C1-C2 fixation for type II odontoid fractures
Authors: Jain Amit Kumar , Tawari Manish , Rathore Lavlesh , Sahana Debabrata , Mishra Harshit , Kumar Sanjeev , Sahu Rajiv Kumar 
Published: June 2022

ABSTRACT

Objective:
Type II odontoid fractures need surgical stabilization for disabling neck pain and instability. Anterior odontoid screw fixation is a well-known technique. However, certain patients require posterior fixation. We present our surgical results and experiences with nine cases managed by the Goel-Harms technique.

Materials and Methods:
This is a retrospective review of nine patients operated on between January 2019 and December 2021 for Type II odontoid fractures with posterior fixation technique. Their clinical profile was collected from case files. The radiological data were retrieved from radiology archives. The indications for surgery were instability and refractory neck pain. The surgical decision for posterior fixation was guided by fracture morphology.

Results:
The mean age of presentation was 37.22 ± 9.85 years. Seven patients had Type II, and two had Type IIa odontoid fracture. All patients presented with unbearable neck pain. One patient had a quadriparesis. The fracture line was anterior-inferior sloping in six, posterior-inferior sloping in two, and transverse in one case. The anterior-posterior displacement of fracture ranged from 0 to 7 mm (mean 2.44 ± 2.18 mm). Partial transverse ligament tear without the Atlanto Axial Dislocation was present in three patients. The C1-C2 joint distraction was required in five cases. C1-C2 joint spacer was required in two cases. Following surgery, neck pain was relieved in all cases. Complete fracture alignment was achieved in eight patients. There were no postoperative complications. At the mean follow-up of 16.22 ± 9.61 months, there was no implant failure.

Conclusions:
Posterior C1-C2 fixation by the Goel-Harms technique is an excellent alternative to anterior fixation in selected cases.
Aspergillus spinal epidural abscess
Authors: Rashid Mohammad Humayun , Hossain Mohammad Nazrul , Ahmed Nazmin , Kazi Raad , Ferini Gianluca , Palmisciano Paolo , Scalia Gianluca , Umana Giuseppe Emmanuele , Hoz Samer S , Chaurasia Bipin 
Published: June 2022

ABSTRACT
Aspergillus spinal epidural abscess (ASEA) is a rare entity that may mimic Pott's paraplegia as it commonly affects immunocompromised patients. We present one institutional case of ASEA with concomitant review of the literature. A 58-year-old female presented with intermittent low back pain for 10 years recently aggravated and with concurrent spastic paraparesis, fever, and weight loss. Emergent magnetic resonance imaging (MRI) showed T11–T12 epidural abscess with discitis and osteomyelitis. After empirical treatment with antibiotics, computed tomography-guided, percutaneous biopsy with drainage was performed, showing granulomatous tubercular-like collection. Antitubercular therapy was initiated, but after 1 month, the patient's condition deteriorated. Repeat MRI showed growth of the spinal epidural abscess with significant cord compression and vertebral osteomyelitis. T11–T12 laminectomy and tissue removal were performed with a posterior midline approach. Tissue histopathology showed necrotic debris colonies of Aspergillus spp. Antifungal therapy was started, and the patient rapidly improved. ASEA may mimic Pott's disease at imaging, leading to immediate start of antitubercular treatment without prior biopsy, leading to severe worsening of patients’ clinical status. Cases of ASEA should be considered at pretreatment planning, opting for biopsy confirmation before treatment initiation so to prevent the occurrence of fatal infection-related complications.