Diabetic foot (DF) continues to present a significant challenge to the vascular surgeon. Despite great advances in the treatment of DF, including open revascularization and endovascular techniques, significant numbers of amputations are still performed. The effect of aggressive revascularization on ultimate limb salvage rates continues to be debated. In the ...

Emergency endovascular aneurysm repair (eEVAR) for ruptured abdominal aortic aneurysms (rAAA) is still a relatively new treatment option. A pre-defined strategy of an eEVAR first approach for rAAA is associated with improved mortality rates. After establishing and implementing the Intention-to-treat eEVAR protocol for rAAAs the mortality and morbidity rates improved ...

Few publications address cardiac surgery in the presence of meningioma. Individual complications include transient visual loss from a suprasellar meningioma, hemiparesis after mitral valve replacement with recovery after resection, and non-fatal hemorrhage into a posterior fossa meningioma. The largest report of 16 patients with known meningiomas over 11 years suggested ...

PURPOSE: Retrograde ascending aortic dissection (rAAD) is a potential complication of thoracic endovascular aortic repair (TEVAR), yet little data exist regarding its occurrence. This study examines the incidence, etiology, and outcome of this event. METHODS: A prospective institutional database was used to identify cases of acute rAAD following TEVAR from ...

Benign colonic strictures and fistulas are a growing problem presenting most commonly after bowel resection. Standard treatment is with endoscopic bougies or, more usually, balloon dilation. When these approaches are not successful, other solutions are available and different endoscopic and surgical approaches have been used to treat fistulas. We present ...

BACKGROUND: Use of self-expanding metallic stents (SEMS) as a bridge to surgery has been suggested as an alternative management for acute malignant left-sided colonic obstruction, as emergency surgery has a high risk of morbidity and mortality. This meta-analysis evaluated high-quality evidence comparing preoperative SEMS with emergency surgery. METHODS: Relevant randomized ...

ABSTRACT: Esophageal strictures are common pediatric diseases and dilations are the most spread procedure, difficult to perform and with possible important complicationsAbout the stricture etiology the authors report a special series of peptic strictures, in patients coming from rural areas with possible delayed GERD diagnosis and treatment. About etiology, it ...

BACKGROUND AND IMPORTANCE: Carotid body tumors (CBT) represent a technically challenging surgical problem. One of the primary goals of surgery and often one of the most difficult aspects of management involves preservation of the ipsilateral internal carotid artery (ICA). We report a small case series with challenging aspects to ICA ...

PURPOSE OF REVIEW: There is an increasing interest and availability of micro-invasive glaucoma surgery (MIGS) procedures. It is important that this increase is supported by sound, peer-reviewed evidence. This article will define MIGS, review relevant publications in the period of annual review and discuss future directions. RECENT FINDINGS: The results ...

OBJECTIVE: Less invasive approaches to aortic valve surgery are increasingly used; however, few studies have investigated their impact on outcome. We sought to compare clinical outcomes after these approaches with full sternotomy using propensity-matching methods. METHODS: From January 1995 to January 2004, a total of 2689 patients underwent isolated aortic ...

The aim of this study was to evaluate vascular complications in a consecutive patient population undergoing transfemoral percutaneous aortic valve replacement (PAVR) applying current Valve Academic Research Consortium definitions. Vascular complications have been the major cause of mortality and morbidity associated with PAVR. Both open surgical and fully percutaneous access ...

Abstract Objective. Endoscopic sphincterotomy plus large-balloon dilatation (ESLBD) has an efficacy equal to or higher than that of endoscopic sphincterotomy alone for biliary lithiasis extractions. Our purpose was to evaluate the feasibility, efficacy and morbidity of large-balloon dilatation of the sphincter of Oddi after sphincterotomy or infundibulotomy for large or ...

Background We evaluated an open stented elephant trunk (sET) technique combined with cardiac operations for a one-stage treatment of patients with complicated Stanford type B aortic dissection (AoD) and cardiac diseases.Methods Between April 2007 and March 2010, 16 patients with Stanford B AoD and cardiac diseases (mean age 49.75 ± 13.42 years) ...

With the development of minimally invasive surgical techniques, endovascular stent-graft placement has become an accepted and widely used alternative to the traditional surgical repair of aortic disease and is gaining acceptance as the treatment of choice. Many studies show that endovascular stent-graft therapy is safe and effective, although complications related ...

PURPOSE OF REVIEW: This review will discuss the immediate- and long-term success, complications and overall benefits of self-expandable metal stents (SEMSs) in malignant or benign obstruction of the oesophagus, stomach and duodenum. Over recent years, indications such as benign disease have expanded, as has SEMS diversity with self-expandable plastic stents ...

OBJECTIVEFeasibility of mitral repair is a key factor in the decision to operate for mitral regurgitation. Repair feasibility is highly dependent on surgical experience and repair complexity. We sought an objective means of predicting complexity of repair using three-dimensional (3D) transoesophageal echocardiography.METHODSIn a cohort of 786 patients who underwent mitral ...

The internal anal sphincter is currently regarded as a significant contributor to continence function. Four physiological and morphological aspects of the internal anal sphincter are presented as part of the current evidence base for its preservation in anal surgery. 1) The incidence of continence disturbance following deliberate internal anal sphincterotomy ...

The objective of this study was to investigate the incidence of esophageal complications associated with balloon dilation and their management in patients with malignant esophageal strictures. Fluoroscopically guided esophageal balloon dilation was performed in 89 patients with malignant esophageal strictures during a period of 15 years. Inclusion criteria were patients ...

We describe a successful perioperative management of a case of 38-year-old male, presented with chronic jaundice with severe mitral stenosis and moderate tricuspid regurgitation; upon evaluation, he was found to have severe glucose-6-phosphate dehydrogenase (G6PD) deficiency. Usually, patients deficient in G6PD exhibit increased hemolysis andtherefore increased need for blood transfusion ...

The patient was a 65-year-old man. Preoperative computed tomography showed a ruptured thoracic aortic aneurysm that formed a submucosal hematoma in the thoracic esophagus with perforation near the esophageal-cardiac junction. A one-stage operation was performed. The aortic arch and proximal descending aorta were replaced with rifampicin-soaked synthetic grafts, followed by ...

We developed a method for ureteral stent removal in female patients that requires no cystoscopy or fluoroscopic guidance using a crochet hook. In addition, we also investigated the success rate, complications and pain associated with this procedure. A total of 40 female patients (56 stents) underwent the removal of ureteral ...

Background/Aims: It is important to prevent pancreatic leakage and maintain pancreatic duct patency after pancreaticoduodenectomy (PD). We used an implantation method and a pancreatic stent in pancreaticogastrostomy (PG) and achieved good results without pancreatic leakage; however, PG strictures were observed in some cases. Using a pancreatic stent, we evaluated the ...

: Canaliculitis is an uncommon condition presenting with epiphora, medial eyelid swelling, pouting punctum, and punctal discharge. Surgical treatment with canaliculotomy with incision of the punctum is the treatment of choice when medical management fails. The risk of epiphora and functioning of the healed canaliculus is unknown. We describe a ...

Placement of removable stents to close pharyngo-cutaneous and tracheo-pharyngeal fistulas after laryngectomy has not been reported before. This case presents the feasibility of removable esophageal stent in closing pharyngo-cutaneous and tracheo-pharyngeal fistulas after laryngectomy for laryngeal cancer. Consecutive patients who underwent placement of removable esophageal stent for closing pharyngo-cutaneous and ...

Several methods can be used to manage tracheal stenosis. For patients unfit for surgery, frequent dilatation with stent placement is the most common treatment. We here describe a simple and effective method using Bakes common bile duct dilators to dilate a tracheal stenosis in a patient with a tracheostomy.

OBJECTIVE: The use of fenestrated and branched stent graft technology for paravisceral abdominal aortic aneurysms (PAAA) is on the rise; however, its application is limited in the United States to only a few selected centers. Most PAAAs are currently repaired using an open approach. The objective of this study was ...

BACKGROUND: Aortic dissection is an evolving process that may require one or several reoperations after its initial repair. We conducted a study to evaluate risk factors and define the incidence and locations of reoperations after surgical correction of acute type A aortic dissection (AAD). METHODS: Between 1998 and 2008, 250 ...

What's known on the subject? and What does the study add? Withdrawal of dual antiplatelet therapy before the recommended, 12 months for drug-eluting stents and 1 month for bare-metal stents increases the rate of major adverse coronary events and mortality. However, in those undergoing surgery the risk of bleeding is increased substantially ...

Cardiovascular magnetic resonance (CMR) imaging can predict hemodynamically significant coarctation of the aorta (CoA) with a high degree of discrimination. However, the ability of CMR to predict important clinical outcomes in this patient population is unknown. Therefore, we sought to define the ability of CMR to predict the need for ...

AIM: The study's aim was to evaluate the feasibility of laparoscopic extraperitoneal para-aortic lymphadenectomy at a peripheral center for the staging of patients with locally advanced cervical cancer (LACC). METHODS: From March 2009 to January 2011, 30 patients with LACC underwent laparoscopic extraperitoneal para-aortic lymphadenectomy. All patients were treated with ...

Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke worldwide and represents a significant health problem. The pathogenesis and natural history of ICAD are poorly understood, and rigorous treatment paradigms do not exist as they do for extracranial atherosclerosis. Currently, the best treatment for ICAD remains aspirin therapy, ...

BACKGROUND: Among the possible complications of bariatric surgery, fistula and partial dehiscence of the gastric suture are well known. Reoperation often is required but results in significant morbidity. Endoscopic treatment of some bariatric complications is feasible and efficient. METHODS: A modified metallic stent was placed between the gastroaesophageal junction and ...

Background: The aim of the present study was to review the clinical profile and outcome of emergency surgery for complicated acute type B aortic dissection. Methods and Results: A total of 34 consecutive patients requiring surgical treatment for complicated acute type B aortic dissection between 2003 and 2010 were examined. ...

Cerebral hyperperfusion syndrome (CHS) after carotid surgery, although rare, is a well described phenomenon. Although originally described following carotid endarterectomy (CEA), it has now also been described following carotid artery stenting (CAS). It is classically described as an acute neurologic deficit occurring several days following a carotid procedure associated with ...

OBJECTIVES: The success of endovascular therapies for descending thoracic aortic disease has turned attention toward stent graft options for repair of aortic arch aneurysms. Defining the role of such techniques demands understanding of contemporary results of open surgery. METHODS: The outcomes of open arch procedures performed on a single surgical ...

PURPOSE: This is a case report involving a middle-aged Jehovah's Witness patient who underwent a redo aortic valve replacement, coronary artery bypass graft, and Maze procedure facilitated by cardiopulmonary bypass. The consent process included a discussion of the management of bleeding and hemostasis in the perioperative period in the context ...

OBJECTIVE: Owing to the complexity of the underlying lesions, Barlow disease remains a challenge for surgeons performing mitral valve repair. We aimed to assess whether our most recent results involving several surgeons were comparable with those of a previous experience in which mitral valve repair was performed by a more ...

Abstract Objective. Anastomotic bile duct complications after liver transplantation (LT) have been treated endoscopically by dilation and plastic tube stenting, with the stent therapy having moved toward using covered, self-expandable metallic stents (cSEMS) in recent years. The aim of this study was to analyze therapy outcome of post-LT anastomotic complications ...

BACKGROUND: Although self-expandable metal stent (SEMS) insertion has been shown to be an effective therapy for palliation of obstruction from colorectal malignancy, the clinical efficacy of SEMS insertion in the palliation of colorectal obstruction from an extracolonic malignancy (ECM) has not been extensively evaluated. OBJECTIVE: The aim of this study ...

Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery ...

Background/Aims: The aim of the study was to analyze in-hospital morbidity and mortality after pancreatoduodenectomy (PD) with a modified duct-to-mucosa pancreaticojejunostomy. Methodology: We retrospectively analyzed 101 consecutive patients who underwent PD at our center between January 2002 and December 2010. Two-layered duct-to-mucosa pancreaticojejunostomy was performed over an internal transanastomotic stent ...

Abstract  Objective: We reviewed our experience to assess potential advantages of minimally invasive surgery without aortic clamping over conventional median sternotomy and cardioplegic arrest during reoperative valve surgery. Methods: From August 2008 to August 2010, 22 reoperative valve procedures were performed through a minimally invasive approach without aortic cross-clamping [no-clamp ...

An 81-year-old woman with recurrent episodes of dizzy spells was found to have a mass in the right atrium on transthoracic echocardiography. The patient underwent successful surgery to excise the mass, which was arising from the anterior leaflet of the tricuspid valve. Histology showed a papillary fibroelastoma. Although management is ...

BackgroundLumboperitoneal shunt (LPS), ventriculoperitoneal shunt (VPS) and optic nerve sheath fenestration (ONSF) are accepted surgical therapies for medically refractory idiopathic intracranial hypertension (IIH). In the subset of patients with IIH and venous sinus stenosis, dural venous sinus stenting has emerged as an alternative surgical approach.MethodsAll cases of dural stents for ...

Esophageal stenting is increasingly being utilized to treat a variety of benign and malignant esophageal conditions. The aim of our study was to review our experience with self-expanding metal, plastic, and hybrid stents in the treatment of esophageal disease on a thoracic surgical service. The study population consisted of 126 ...

Patients with thoracoabdominal aneurysm that require concomitant cardiac surgery present a complex surgical challenge. A staged hybrid technique including combined cardiac surgery and visceral revascularization from the ascending aorta, followed by endovascular aneurysmal exclusion is reported in four patients. No perioperative death and no neurological complications were observed. The surgical ...

The purpose of the study was to evaluate the clinical effects of bicanalicular double silicone stents in endoscopic transnasal dacryocystorhinostomy with lacrimal trephinized canaliculoplasty for monocanalicular and common canalicular obstruction. Bicanalicular double silicone intubation in endoscopic transnasal dacryocystorhinostomy with lacrimal trephination was performed in 58 eyes of 54 patients (5 ...

Dr C. Lever is a pioneer in endovascular infrarenal aneurysmectomy, with some of the best results published in the literature. He attempted an endovascular stent in an octogenarian that required an acute open repair. The procedure was touch-and-go and the postoperative course a train wreck, with multiple organ dysfunction syndrome. ...

BACKGROUND:: Pancreatic stents (PSs) are commonly inserted at the time of endoscopic retrograde cholangiopancreatography to reduce the risk of pancreatitis. If left in situ for more than 2 weeks, they have been associated with pancreatic duct injury. The mechanism of this injury is not clear, but it may be related ...

Staphylococcus lugdunensis is an infrequent cause of native valve endocarditis. A case of triple-valve involvement of Staphylococcus lugdunensis with intracardiac fistula formation in a 47-year-old woman was managed successfully with surgery. The importance of early diagnosis and prompt referral for surgical treatment is highlighted.