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World Journal of Emergency Surgery :... Aug 2021Multiple studies regarding the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in patients with non-compressible torso injuries and... (Meta-Analysis)
Meta-Analysis
Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis.
BACKGROUND
Multiple studies regarding the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in patients with non-compressible torso injuries and uncontrolled haemorrhagic shock were recently published. To date, the clinical evidence of the efficacy of REBOA is still debated. We aimed to conduct a systematic review assessing the clinical efficacy and safety of REBOA in patients with major trauma and uncontrolled haemorrhagic shock.
METHODS
We systematically searched MEDLINE (PubMed), EMBASE and CENTRAL up to June 2020. All randomized controlled trials and observational studies that investigated the use of REBOA compared to resuscitative thoracotomy (RT) with/without REBOA or no-REBOA were eligible. We followed the PRISMA and MOOSE guidelines. Two authors independently extracted data and appraised the risk of bias of included studies. Effect sizes were pooled in a meta-analysis using random-effects models. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Primary outcomes were mortality, volume of infused blood components, health-related quality of life, time to haemorrhage control and any adverse effects. Secondary outcomes were improvement in haemodynamic status and failure/success of REBOA technique.
RESULTS
We included 11 studies (5866 participants) ranging from fair to good quality. REBOA was associated with lower mortality when compared to RT (aOR 0.38; 95% CI 0.20-0.74), whereas no difference was observed when REBOA was compared to no-REBOA (aOR 1.40; 95% CI 0.79-2.46). No significant difference in health-related quality of life between REBOA and RT (p = 0.766). The most commonly reported complications were amputation, haematoma and pseudoaneurysm. Sparse data and heterogeneity of reporting for all other outcomes prevented any estimate.
CONCLUSIONS
Our findings on overall mortality suggest a positive effect of REBOA among non-compressible torso injuries when compared to RT but no differences compared to no-REBOA. Variability in indications and patient characteristics prevents any conclusion deserving further investigation. REBOA should be promoted in specific training programs in an experimental setting in order to test its effectiveness and a randomized trial should be planned.
Topics: Aorta; Balloon Occlusion; Endovascular Procedures; Humans; Injury Severity Score; Shock, Hemorrhagic
PubMed: 34384452
DOI: 10.1186/s13017-021-00386-9 -
Obesity Surgery Sep 2022This systematic review intends to evaluate incidence and symptoms of post-bariatric splenic complications as well as best available modalities establishing the diagnosis... (Review)
Review
This systematic review intends to evaluate incidence and symptoms of post-bariatric splenic complications as well as best available modalities establishing the diagnosis and management protocols. A systematic literature search was performed in electronic database until March 2022. A total of 41 articles were included on the subject of splenic complications following bariatric/metabolic surgery (BMS). Splenic abscess was the most common splenic complications (44.2%) after BMS and leak was the most common reported etiology of the splenic abscess. Fever and abdominal pain were the most common presenting symptom in all splenic complications and CT scan was the most common diagnostic modality. Splenic complications after BMS are relatively rare but may lead to dangerous consequences. Prompt diagnosis and treatment can prevent potentially life-threatening outcomes.
Topics: Abdominal Abscess; Abscess; Bariatric Surgery; Humans; Obesity, Morbid; Postoperative Complications; Splenic Diseases
PubMed: 35778627
DOI: 10.1007/s11695-022-06190-x -
Annals of Vascular Surgery Sep 2022To provide a contemporary review on endovascular false lumen (FL) embolization for thoracic aortic dissection (AD) and evaluate its early outcome. (Review)
Review
BACKGROUND
To provide a contemporary review on endovascular false lumen (FL) embolization for thoracic aortic dissection (AD) and evaluate its early outcome.
METHODS
A systematic literature review on FL embolization for thoracic AD from January 2003 to December 2020 was performed under the instruction of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Each article was analyzed using a standardized protocol including predefined demographic characteristics, perioperative mortality, and major complications.
RESULTS
A total of 29 papers with 229 patients were included into the analysis. The methods of FL occlusion used were the candy-plug technique, the knickerbocker technique, the "cork in the bottleneck" technique, and direct FL embolization with a combination of stent-grafts, coils, onyx, plugs, and glue. FL embolization procedure was performed in 79 patients (34.5%) with type A AD and 150 (65.5%) with type B AD. FL direct embolization was the most frequently used technique and it was applied in 198 (86.5%) patients. Candy-plug, knickerbocker, and "cork in the bottleneck" techniques were used in 26 (11.4%), 3 (1.3%), and 2 (0.9%) patients, respectively. Technical success was achieved in all patients except one (228/229, 99.6%) in which implantation of a stent to celiac trunk was not possible. There were 4 hospital deaths (1.7%). Neurological complications occurred in 6 patients (2.6%), including 4 (1.7%) spinal cord ischemia and 2 (0.9%) ischemic stroke. There were 1 (0.4%) iatrogenic retrograde dissection and 2 (0.9%) renal failure reported. The mean duration of follow-up was 16.5 months. There were 21 deaths (9.3%) during follow-up and 8 (3.6%) were aorta-related. Thirty three (14.7%) secondary interventions were performed. Five patients (2.2%) required an open completion thoracoabdominal procedure incorporating the stent-graft into the repair. Complete FL thrombosis was observed in 181 (80.4%) patients, 34 (15.1%) had partial thrombosis, and 10 (4.4%) had FL progression.
CONCLUSIONS
FL embolization of the distal thoracic aorta is a promising technique in a group of patients to promote FL thrombosis and aortic remodeling in thoracic aorta.
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Retrospective Studies; Stents; Thrombosis; Time Factors; Treatment Outcome
PubMed: 35339592
DOI: 10.1016/j.avsg.2022.03.020 -
European Journal of Vascular and... May 2022Kidney autotransplantation (ATx) is a treatment option for distal renal artery aneurysm (RAA). This systematic review evaluated the indications, treatment strategy, and... (Review)
Review
OBJECTIVE
Kidney autotransplantation (ATx) is a treatment option for distal renal artery aneurysm (RAA). This systematic review evaluated the indications, treatment strategy, and outcome of kidney ATx to verify the value of this procedure in treating RAA.
DATA SOURCES
PubMed, Embase, and Web of Science.
REVIEW METHODS
All study types were included, except study protocols and animal studies, without time or language restrictions. Data sources were reviewed until April 2021 to identify relevant articles evaluating operating time, cold and warm ischaemia time, total complications, length of hospital stay, and mortality rate in patients with RAA receiving kidney ATx.
RESULTS
The literature search retrieved 644 articles. Of these, 55 clinical studies (including 37 case reports and 18 case series) investigating 199 patients were eligible for inclusion. Endovascular treatment had failed in 17% of 70 patients with RAA. Heterotopic kidney ATx was performed in 81% of patients, and 19% received orthotopic kidney ATx. Unplanned nephrectomy was reported in only one patient (0.1%). Post-operative complications were reported in 6.9% of patients, including urinary tract infection (2.0%), wound infection (1.3%), acute renal insufficiency (0.6%), graft thrombosis (0.6%), kidney hypoperfusion (0.6%), haematoma (0.6%), lymphocoele (0.6%), pseudoaneurysm (0.6%), and arterial occlusion (0.6%). None of the patients died peri-operatively, and organ loss was reported in only one patient (0.05%). No further organ loss or death was reported during follow up (median follow up duration 12 months).
CONCLUSION
In patients with distal perihilar RAA, surgical repair with kidney ATx appears to be a suitable alternative when endovascular approaches are not appropriate. In these cases, kidney ATx saves the kidney and provides good clinical outcomes. However, these findings should be interpreted with caution, considering the lack of data regarding the adverse events, potential for favourable publication bias among included studies, and the absence of consecutive series and prospective trials.
Topics: Aneurysm; Humans; Kidney; Kidney Diseases; Prospective Studies; Renal Artery; Retrospective Studies; Transplantation, Autologous; Treatment Outcome
PubMed: 35283006
DOI: 10.1016/j.ejvs.2022.01.015 -
Pseudoaneurysms and Orthognathic Surgery: A Systematic Review and a Proposed Algorithm of Treatment.The Journal of Craniofacial Surgery May 2023This study aimed to gather existing evidence regarding the incidence, clinical presentation, and management of pseudoaneurysms (PA) after orthognathic surgery, identify...
This study aimed to gather existing evidence regarding the incidence, clinical presentation, and management of pseudoaneurysms (PA) after orthognathic surgery, identify the common blood vessels involved in PA, and propose a treatment algorithm based on current evidence. The protocol for this study was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols and was registered at the International Prospective Register of Systematic Reviews under the registration number CRD42020205479. Although these are rare, oral and maxillofacial surgeons should consider PA as a possible diagnosis, specifically in the maxillary artery of patients with epistaxis, severe facial edema, and swelling following LeFort I osteotomy.
Topics: Humans; Orthognathic Surgery; Aneurysm, False; Osteotomy; Epistaxis; Algorithms
PubMed: 36377043
DOI: 10.1097/SCS.0000000000009134 -
World Neurosurgery Nov 2022The goal of this study was to systematically review the management and outcomes of patients who developed pseudoaneurysm (PA) after carotid endarterectomy... (Review)
Review
BACKGROUND
The goal of this study was to systematically review the management and outcomes of patients who developed pseudoaneurysm (PA) after carotid endarterectomy (postendarterectomy PA [PEPA]).
METHODS
Following the PRISMA guidelines, a systematic literature review was performed using PubMed, Scopus, and Web of Science databases from date of inception to June 2022. Studies were selected based on predetermined inclusion and exclusion criteria. Simultaneously, a retrospective review was conducted of patients who underwent neurosurgical evaluation of suspected PEPA at our institution.
RESULTS
Of the 321 articles in the original literature search, 62 were selected. A total of 143 patients (93 men, 27 women; mean age, 70.7 years) diagnosed with PEPA were included. Mean time from carotid endarterectomy to PA diagnosis was 41.8 months. Primary repair data were available for 135 patients, including 19 with primary closures, 112 with patch or graft repairs, and 4 with eversion procedures. Fifty-five patients with PA (39%) presented with infection. Staphylococcal species were the most common causative organism. Of infected PAs, 89.1% were treated with open procedures. Overall complication rates of PAs treated via open, endovascular, and hybrid methods were 31%, 15.4%, and 0%, respectively. Open ligation (42.9%) and aneurysmectomy with grafting (36.4%) resulted in the highest rates of complications.
CONCLUSIONS
Despite higher complication rates after open repair strategies, use of these techniques remains a viable option in situations requiring removal of infected patches or evacuation of large extravascular collections. Endovascular treatment options are associated with low numbers of complications and can be considered for primary PEPA treatment when infection is not present.
Topics: Male; Humans; Female; Aged; Endarterectomy, Carotid; Aneurysm, False; Blood Vessel Prosthesis Implantation; Retrospective Studies; Treatment Outcome; Carotid Stenosis
PubMed: 36058488
DOI: 10.1016/j.wneu.2022.08.124 -
International Journal of Nursing Studies Jan 2023Hemostasis control after percutaneous endovascular procedures through the femoral approach remains challenging for catheterization laboratory nurses, given method... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hemostasis control after percutaneous endovascular procedures through the femoral approach remains challenging for catheterization laboratory nurses, given method variability.
OBJECTIVE
To summarize the available evidence on vascular devices efficacy dedicated to hemostasis control compared to the extrinsic compression after percutaneous procedures in the femoral vein or artery.
METHODS
A systematic review with meta-analysis of randomized clinical trials was conducted. We compared different hemostasis methods in adult patients who underwent diagnostic and/or therapeutic procedures through femoral access. The databases searched were PubMed, Embase, CINAHL and Cochrane CENTRAL, and updated on 03/2022. The outcomes included hematoma, pseudoaneurysm, bleeding, minor and major vascular complication, time to hemostasis, device failure, and manual compression repetition. The risk of bias was assessed using the Cochrane Risk of Bias Tool 1.0. Pooled effect sizes on continuous, categorical and proportion variables were estimated with the random effects model. The continuous variables were summarized as the difference between means weighted by the inverse of variance (WMD), and the categorical ones by the summary of relative risks (RR), estimated by the DerSimonian and Laird method. The Freeman-Tukey method was used to estimate the summary effect of proportions.
RESULTS
Fifty articles were included in the systematic review. When compared to extrinsic compression, vascular closure devices resulted in a relative risk reduction (RRR) for hematoma: RR 0.82 [95%CI 0.72 to 0.94] and in shorter time to hemostasis WMD -15.06 min [95%CI -17.56 to -12.56]; no association was observed between interventions with vascular closure devices and extrinsic compression for pseudoaneurysm, bleeding, minor and major vascular complications. Compared to extrinsic compression, sealant or gel type devices were compatible with a RRR for hematoma: RR 0.73 [95%CI 0.59 to 0.90]; and metal clip or staple type devices for pseudoaneurysm: RR 0.48 [95%CI 0.25 to 0.90]; and major vascular complication: RR 0.33 [95%CI 0.17 to 0.64]. For each 100 observations, the device failure rate for metal clip or staple was 3.28% [95%CI 1.69 to 6.27]; for suture 6.84% [95%CI 4.93 to 9.41]; for collagen 3.15% [95%CI 2.24 to 4.41]; and for sealant or gel 7.22% [95% CI 5.49 to 9.45].
CONCLUSIONS
Vascular closure devices performed better in hemostasis control. The certainty of the evidence was rated as very low to moderate.
REGISTRATION
PROSPERO CRD42019140794.
Topics: Adult; Humans; Aneurysm, False; Femoral Artery; Vascular Closure Devices; Hemostasis; Hemorrhage; Hematoma; Treatment Outcome
PubMed: 36399944
DOI: 10.1016/j.ijnurstu.2022.104364 -
Journal of Maxillofacial and Oral... Sep 2021Pseudoaneurysms are one of the rare complications that can be encountered after the orthognathic surgery. We are presenting a new case of pseudoaneurysm of bilateral... (Review)
Review
PURPOSE
Pseudoaneurysms are one of the rare complications that can be encountered after the orthognathic surgery. We are presenting a new case of pseudoaneurysm of bilateral sphenopalatine artery after Bijaw Surgery in a young male and a systematic review of all the cases in the literature emphasizing on signs and symptoms, epistaxis or bleeding episodes and treatment outcomes.
METHODS
A systematic research strategy was planned according to the PRISMA guidelines, and articles were taken from 1986 to September, 2019. A total of 899 articles were selected for screening, out of which only 26 articles met our inclusion and exclusion criteria. These were included in the study for qualitative analysis.
RESULTS
Most PAs were associated with Lefort I osteotomy (69.7%), followed by sagittal split osteotomy (24.24%). Average intraoperative blood was 635 ml. Maximum number of episodes of epistaxis/swelling or bleeding occurred in second week. Mean bleeding episodes were 2.58 ± 0.996. The arteries commonly affected were internal maxillary artery (42%), sphenopalatine artery (27.27%), facial artery (15.15%), descending palatine artery (12.12%), internal carotid artery (9.09%) and infraorbital artery (3.03%). Embolization was treatment of choice in 81.81% cases.
CONCLUSION
If a patient has recurrent epistaxis or swelling after orthognathic surgery, it is advisable to go for diagnostic imaging like angiography without any delay. In recent times, advanced techniques and expertise are readily available for early diagnosis and management of pseudoaneurysm.
PubMed: 34408361
DOI: 10.1007/s12663-020-01476-y -
Cureus Dec 2022Percutaneous scalpel tenotomy is frequently performed as part of congenital talipes equinovarus (CTEV) to correct the equinus deformity. The use of a scalpel is... (Review)
Review
Percutaneous scalpel tenotomy is frequently performed as part of congenital talipes equinovarus (CTEV) to correct the equinus deformity. The use of a scalpel is associated with complications such as neurovascular bundle damage and pseudoaneurysms. In the literature, a percutaneous large-bore needle has been found to be a safer alternative to a scalpel for performing tenotomies. The goal of this study was to conduct a systematic review and report a single-center case series on the use of percutaneous needle tenotomy in the treatment of CTEV. A Preferred Reporting Items of Systematic Review and Meta-analysis (PRISMA)-compliant literature search was conducted to identify studies describing the use of a percutaneous needle tenotomy in the treatment of idiopathic CTEV. A retrospective case series of patients with idiopathic CTEV treated with percutaneous needle tenotomy over a seven-year period from a single center were also conducted. The patients' demographics, the location of the clubfoot, and the Pirani score were all recorded. An analysis of descriptive statistics was carried out. Continuous data were expressed as mean and SD, whereas categorical variables were expressed as absolute numbers and percentages (%). The systematic review included eight papers with a total of 1026 feet and a mean age of 10.4 weeks (SD 5.9). There were 47 (0.04%) complications across all studies, with a pooled success rate of 95%. Eleven patients (16 feet) were included in the single-center case study. The patients' initial Pirani score was 4.8 (SD 1.5), with a final score of 0. (SD 0). Four complications occurred in the patient's cohort - one minor bleeding and three recurrences as a result of poor compliance with the post-tenotomy foot abduction brace. In conclusion, the percutaneous Achilles tenotomy of a CTEV foot with a large bore needle is a safe and effective alternative.
PubMed: 36694491
DOI: 10.7759/cureus.32812