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World Neurosurgery Apr 2021Penetrating vertebral artery injuries (VAIs) are rare but devastating trauma for which the approach to treatment varies greatly. The literature on treatment modalities... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Penetrating vertebral artery injuries (VAIs) are rare but devastating trauma for which the approach to treatment varies greatly. The literature on treatment modalities is limited to case reports, case series, and 1 review, with the majority of cases being treated surgically. However, with the advent of digital subtraction angiography, treatment has shifted toward less invasive endovascular modalities that allows one to assess the flow and risks of sacrificing the vertebral artery (VA).
METHODS
In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses, a systematic review of VAI was performed. Two case reports were also detailed. Using a multidisciplinary team, a decision algorithm was proposed for approaching penetrating VAIs.
RESULTS
We identified 169 patients. Of the penetrating VAI, the majority were occlusions, most commonly managed conservatively. Other injuries including pseudoaneurysm, dissection, transection, and arterial-venous fistula were treated predominantly endovascularly and occasionally with the surgical exploration/ligation. Most endovascular treatments included embolization without significant stroke or complication from VA sacrifice. However, there are incidences in which VA sacrifice should be avoided and these scenarios can be better delineated with digital subtraction angiography to assess flow and anatomy.
CONCLUSIONS
This systematic review not only details the updated treatment options but also provides a decision algorithm for the treatment of penetrating VAI. It highlights the shifting treatment options of penetrating VAI to endovascular therapy, as well as details VAI variants that may suggest stenting over embolization.
Topics: Algorithms; Clinical Decision-Making; Head Injuries, Penetrating; Humans; Vertebral Artery
PubMed: 33460818
DOI: 10.1016/j.wneu.2021.01.021 -
Chinese Journal of Traumatology =... Sep 2022Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable... (Review)
Review
PURPOSE
Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable patients, with or without the adjunct of angioembolisation (AE). This systematic review assesses the incidence of complications in patients who sustained liver injuries and were treated with simple clinical observation. Given the differences in indications of treatment and severity of liver trauma and acknowledging the limitations of this study, an analysis of the results has been done in reference to the complications in patients who were treated with AE.
METHODS
A systematic literature review searched "liver trauma", "hepatic trauma", "conservative management", "non operative management" on MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials databases, EMBASE, and Google Scholar, to identify studies published on the conservative management of traumatic liver injuries between January 1990 and June 2020. Patients with traumatic liver injuries (blunt and penetrating) treated by NOM, described at least one outcome of interests and provided morbidity outcomes from NOM were included in this study. Studies reported the outcome of NOM without separating liver from other solid organs; studies reported NOM complications together with those post-intervention; case reports; studies including less than 5 cases; studies not written in English; and studies including patients who had NOM with AE as primary management were excluded. Efficacy of NOM and overall morbidity and mortality were assessed, the specific causes of morbidity were investigated, and the American Association for the Surgery of Trauma classification was used in all the studies analysed. Statistical significance has been calculated using the Chi-square test.
RESULTS
A total of 19 studies qualified for inclusion criteria were in this review. The NOM success rate ranged from 85% to 99%. The most commonly reported complications were hepatic collection (3.1%), followed by bile leak (1.5%), with variability between the studies. Other complications included hepatic haematoma, bleeding, fistula, pseudoaneurysm, compartment syndrome, peritonitis, and gallbladder ischemia, all with an incidence below 1%.
CONCLUSION
NOM with simple clinical observation showed an overall low incidence of complications, but higher for bile leak and collections. In patients with grade III and above injuries, the incidence of bile leak, collections and compartment syndrome did not show a statistically significant difference with the AE group. However, the latter result is limited by the small number of studies available and it requires further investigations.
Topics: Abdominal Injuries; Compartment Syndromes; Humans; Injury Severity Score; Liver; Retrospective Studies; Wounds, Nonpenetrating
PubMed: 35487854
DOI: 10.1016/j.cjtee.2022.04.004 -
Annals of Cardiothoracic Surgery May 2022Improvements in revascularisation, including pharmacological, catheter-based and surgical, have resulted in improved outcomes for patients with acute myocardial...
Systematic review and meta-analysis of the mechanical complications of ischemic heart disease: papillary muscle rupture, left ventricle rupture and post-infarct ventricular septal defect.
BACKGROUND
Improvements in revascularisation, including pharmacological, catheter-based and surgical, have resulted in improved outcomes for patients with acute myocardial infarction (AMI), leading to decreased frequency of mechanical complications. Improvements in both techniques and technology have permitted select patients to be managed with a purely percutaneous, transcatheter strategy. Through systematic review, this study aims to synthesise the collective experience of percutaneous treatment of the mechanical complications of ischaemic heart disease.
METHODS
The search strategy queried the electronic databases PubMed, Embase and the Cochrane Central Register of Controlled Trials, from 1 January 2000 to 31 December 2020. Studies highlighting the outcomes of patients receiving percutaneous treatment of post-myocardial infarction papillary muscle rupture (PMR), ventricular septal defect (VSD), left ventricular free wall rupture (FWR) and pseudoaneurysm (PA) were included. A qualitative review of studies was conducted for PMR, FWR and PA. A quantitative analysis was conducted for VSD.
RESULTS
Fifteen studies were included in the qualitative synthesis of the percutaneous management of PMR, 4 were included in the qualitative analysis of the percutaneous management of left ventricular FWR, 7 studies defined the outcomes of the percutaneous management of PA and 25 were included in the quantitative meta-analysis of the primary percutaneous management of post-MI VSD. For VSD, there were 43 failed procedures in 314 patients. The proportion of failed procedures was 15.9% and there were 174 deaths in 428 patients. 37.5% of patients experienced early mortality.
CONCLUSIONS
Although surgical techniques remain the gold standard, we have shown that percutaneous management may be a viable option in certain cases.
PubMed: 35733707
DOI: 10.21037/acs-2022-ami-24 -
The Journal of Vascular Access Jan 2024Data comparing MANTA device with Perclose device for large bore arterial access closure is limited. We performed meta-analysis to compare safety and efficacy of the two... (Review)
Review
Data comparing MANTA device with Perclose device for large bore arterial access closure is limited. We performed meta-analysis to compare safety and efficacy of the two devices in large (⩾14 Fr sheath) arteriotomy closure post-TAVR. Relevant studies were identified via PubMed, Cochrane, and EMBASE databases until June, 2022. Data was analyzed using random effect model to calculate relative odds of VARC-2 defined access-site complications and short-term (in-hospital or 30-day) mortality. A total of 12 studies (2 RCT and 10 observational studies) comprising 2339 patients were included. The odds of major vascular complications (OR 0.99, 95% CI 0.51-1.92; = 0.98); life threatening and major bleeding (OR 0.77, 95% CI 0.45-1.33; = 0.35); minor vascular complications (OR 1.37, 95% CI 0.63-2.99; = 0.43); minor bleeding (OR 0.94, 95% CI 0.57-1.56; = 0.82); device failure (OR 0.74, 95% CI 0.49-1.11; = 0.14); hematoma formation (OR 0.76, 95% CI 0.33-1.75; = 0.52); dissection, stenosis, occlusion, or pseudoaneurysm (OR 1.08, 95% CI 0.71-1.62; = 0.73) and short-term mortality (OR 1.01, 95% CI 0.55-1.84; = 0.98) between both devices were similar. MANTA device has a similar efficacy and safety profile compared to Perclose device.
PubMed: 38189215
DOI: 10.1177/11297298231222314 -
Malaysian Orthopaedic Journal Mar 2023Total knee arthroplasty (TKA) is a common operation and is becoming more common due to population aging and increasing BMI. TKA provides excellent improvement in quality...
INTRODUCTION
Total knee arthroplasty (TKA) is a common operation and is becoming more common due to population aging and increasing BMI. TKA provides excellent improvement in quality of life but carries risk of arterial complications in the perioperative period. This systematic review aims to provide a greater understanding of the incidence of such complications, and time taken to diagnose arterial injury.
MATERIALS AND METHODS
PubMed, Medline, Ovid SP and EMBASE databases were searched with the following MeSH keywords: 'complication', 'vascular injury', 'ischaemia', 'spasm', 'thrombosis', 'pseudoaneurysm', 'transection', 'pulse', 'ABPI OR ABI', 'Doppler', 'amputation'. All arterial vascular events in the perioperative state of the total knee replacement were included. Records were independently screened by two reviewers, and data was extracted according to a pre-determined proforma. Overall incidence and time to diagnosis was calculated for complications. Systematic review registration PROSPERO: CRD42018086643. No funding was received.
RESULTS
Twelve studies were selected for inclusion. A total of 3325 cases of arterial complications were recorded across all studies, and were divided into three categories, pseudoaneurysms (0.06%); ischaemia and thrombosis (0.17%); haemorrhage and arterial transections (0.07%). Time taken to reach the diagnosis for each complication was longest in the ischaemia and thrombosis group (6.8 days), followed by pseudoaneurysm (3.5 days) and haemorrhage and transections (3.0 days).
CONCLUSION
TKA post-operative vascular complications are rare, but when they do occur they lead to limb and life threatening complications. This should be discussed with patients during the consent process. Current times to diagnosis represent missed opportunities to recognise arterial injury and facilitate rapid treatment of the complication. A very low threshold for seeking specialist input should be adopted, and any concern for vascular injury, such as unexplained perioperative bleeding, absent lower limb pulses in the post-operative period or unexplained severe pain should warrant immediate review by a vascular surgeon, and in centres where this is not possible, immediate blue-light transfer to the closest vascular centre.
PubMed: 37064631
DOI: 10.5704/MOJ.2303.010 -
Journal of Neurointerventional Surgery Mar 2023Subarachnoid hemorrhage from cerebral aneurysm rupture is a major cause of morbidity and mortality. Early aneurysm identification, aided by automated systems, may... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Subarachnoid hemorrhage from cerebral aneurysm rupture is a major cause of morbidity and mortality. Early aneurysm identification, aided by automated systems, may improve patient outcomes. Therefore, a systematic review and meta-analysis of the diagnostic accuracy of artificial intelligence (AI) algorithms in detecting cerebral aneurysms using CT, MRI or DSA was performed.
METHODS
MEDLINE, Embase, Cochrane Library and Web of Science were searched until August 2021. Eligibility criteria included studies using fully automated algorithms to detect cerebral aneurysms using MRI, CT or DSA. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Diagnostic Test Accuracy (PRISMA-DTA), articles were assessed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Meta-analysis included a bivariate random-effect model to determine pooled sensitivity, specificity, and area under the receiver operator characteristic curve (ROC-AUC).
PROSPERO
CRD42021278454.
RESULTS
43 studies were included, and 41/43 (95%) were retrospective. 34/43 (79%) used AI as a standalone tool, while 9/43 (21%) used AI assisting a reader. 23/43 (53%) used deep learning. Most studies had high bias risk and applicability concerns, limiting conclusions. Six studies in the standalone AI meta-analysis gave (pooled) 91.2% (95% CI 82.2% to 95.8%) sensitivity; 16.5% (95% CI 9.4% to 27.1%) false-positive rate (1-specificity); 0.936 ROC-AUC. Five reader-assistive AI studies gave (pooled) 90.3% (95% CI 88.0% - 92.2%) sensitivity; 7.9% (95% CI 3.5% to 16.8%) false-positive rate; 0.910 ROC-AUC.
CONCLUSION
AI has the potential to support clinicians in detecting cerebral aneurysms. Interpretation is limited due to high risk of bias and poor generalizability. Multicenter, prospective studies are required to assess AI in clinical practice.
Topics: Humans; Artificial Intelligence; Intracranial Aneurysm; Sensitivity and Specificity; Retrospective Studies; Algorithms; Multicenter Studies as Topic
PubMed: 36375834
DOI: 10.1136/jnis-2022-019456 -
Journal of Vascular Surgery May 2020Upper extremity access (UEA) is an important component of complex fenestrated and branched endovascular aneurysm repair (F/BEVAR). Open and percutaneous UEA approaches...
OBJECTIVE
Upper extremity access (UEA) is an important component of complex fenestrated and branched endovascular aneurysm repair (F/BEVAR). Open and percutaneous UEA approaches have been reported during these procedures. The aim of this review was to assess the outcomes of UEA done to facilitate F/BEVAR.
METHODS
A systematic review of studies focusing on upper extremity arterial access during F/BEVAR was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Three databases including PubMed MEDLINE, Embase, and Cochrane Library were queried. Outcomes of interest included UEA-related and other unrelated early and late morbidity and mortality, such as arterial occlusion, neurologic deficit, bleeding complications, and stroke, in patients undergoing UEA during F/BEVAR.
RESULTS
Five full-text manuscripts and one abstract met criteria to be included, accounting for a total of 495 patients. The median age of patients who underwent UEA during F/BEVAR was 73.4 years. Predominantly male patients (371 [74.9%]) were treated. Indications for F/BEVAR were thoracoabdominal aortic aneurysms in 325 (65.6%), pararenal aneurysms in 96 (19.4%), juxtarenal aneurysms in 44 (8.9%), and suprarenal aortic aneurysms in 30 (6.1%). Axillary conduits were created in 29 (5.8%) patients. A total of 41 (8.2%) UEA-related complications were reported. Of those 41 complications, 17 (41.5%) were access bleeding, 10 (24.4%) were ischemic strokes, 7 (17.1%) were arterial occlusions, 4 (9.7%) were upper extremity neurologic deficits, 2 (4.9%) were arterial stenoses, and 1 (2.4%) was pseudoaneurysm. UEA-related complications were reported in 15 of 56 (26.8%) patients undergoing percutaneous UEA and 26 of 439 (5.9%) undergoing open UEA (P < .001).
CONCLUSIONS
The overall complication rate associated with UEA during F/BEVAR is low, with 2% stroke rate reported. The percutaneous approach showed a higher UEA-related complication rate compared with open UEA. More studies on percutaneous UEA and randomized studies comparing open vs percutaneous UEA during F/BEVAR are warranted to determine the safest and most efficient UEA approach strategy during complex aortic procedures.
Topics: Aortic Aneurysm; Endovascular Procedures; Humans; Postoperative Complications; Upper Extremity
PubMed: 31740188
DOI: 10.1016/j.jvs.2019.09.028 -
Neurosurgical Review Jun 2020Extracranial internal carotid artery dissection (ICAD) is a potential source of morbidity and mortality in trauma patients and requires high degree of suspicion for...
Extracranial internal carotid artery dissection (ICAD) is a potential source of morbidity and mortality in trauma patients and requires high degree of suspicion for diagnosis after the initial presentation. Occasionally, if standard therapy is contraindicated, endovascular reconstruction is a treatment option. The aim of this systematic review was to report clinical and radiographic outcomes following endovascular repair of ICAD of traumatic and iatrogenic etiology. A comprehensive systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed and Cochrane Library databases were searched. Twenty-four studies comprising 191 patients (204 lesions) were included; 179 underwent traditional carotid artery stenting (CAS), whereas 12 patients underwent flow diversion with the pipeline embolization device (PED). In total, 75.7% of the CAS group and 66.6% of the PED group presented with ICAD-related symptomatology. Concomitant pseudoaneurysms were identified in 61.9% and 78.5% of lesions in the CAS and PED group, respectively. Adverse event rates among CAS-treated lesions after 30-day follow-up were below 2.2% for stroke, transient ischemic attack, and mortality. During follow-up in the CAS group, there was no incidence of ICAD-related stroke or death and 2.2% of patients underwent a repeat CAS procedure. In the PED group, no patient suffered stroke or death in the reported follow-up. In the PED cohort, there was an adequate occlusion rate and no patient had to be retreated. Endovascular reconstruction of traumatic or iatrogenic ICAD appears safe. This approach demonstrated acceptable short- and long-term clinical and radiographic outcomes in both groups.
Topics: Carotid Artery Injuries; Carotid Artery, Internal, Dissection; Endovascular Procedures; Humans; Patient Safety; Plastic Surgery Procedures; Stents; Treatment Outcome
PubMed: 30903316
DOI: 10.1007/s10143-019-01092-6 -
Archivos Espanoles de Urologia Aug 2022Minimally invasive techniques for the treatment and diagnosis of kidney disease seek to preserve the greatest amount of parenchyma. Bleeding after these practices is...
UNLABELLED
Minimally invasive techniques for the treatment and diagnosis of kidney disease seek to preserve the greatest amount of parenchyma. Bleeding after these practices is rare, but must be treated quickly given its severity. Iatrogenic renal vascular injuries (IRVI) resulting from these procedures include active bleeding, arterial pseudoaneurysms, and arteriovenous fistulas. Renal artery embolization (RAE) is the main pillar in the treatment of this type of complications.
OBJECTIVE
To assess the results of RAE for the treatment of IRVI and its impact on the renal function of patients.
METHOD
Retrospective analysis of all patients who presented vascular complications after renal procedures and who were referred for management by RAE, between August 2012 and December 2020.
RESULTS
18 patients were included. 4 patients presented with pseudoaneurysm, 10 patients with active bleeding, and 1 patient with arteriovenous fistula; 2 patients had a combination of different IRVI; 1 patient did not present any findings at the time of renal angiography in dissonance with her computed tomography angiography. Technical and clinical success was achieved in all patients. One renal artery dissection was the only complication. No differences were found in serum creatinine ( = 0.51), urea ( = 0.37), hemoglobin ( = 0.26) and hematocrit ( = 0.24) after embolization.
CONCLUSION
EAR is a safe and effective method for the treatment of IRVI, achieving a very high technical and clinical success rate with a low incidence of complications and without significant repercussions on the renal function of patients.
Topics: Aneurysm, False; Arteriovenous Fistula; Creatinine; Embolization, Therapeutic; Endovascular Procedures; Female; Hemorrhage; Humans; Iatrogenic Disease; Kidney Diseases; Retrospective Studies; Treatment Outcome; Urea; Vascular System Injuries
PubMed: 36138501
DOI: 10.37554/es-j.arch.esp.urol-20210515-3507-27 -
Heliyon Nov 2022Intracranial aneurysms presenting as third ventricular and adjoining part masses are rare and are always associated with obstructive hydrocephalus. It is vital to...
OBJECTIVE
Intracranial aneurysms presenting as third ventricular and adjoining part masses are rare and are always associated with obstructive hydrocephalus. It is vital to provide precise diagnostics and apt treatment for such patients since endovascular or microsurgical operations remain challenging. This study aimed to discuss differential diagnosis tactics based on the cases we followed and the current literature on intracranial aneurysms mimicking third ventricular masses.
METHODS
We followed a case series of intracranial aneurysms presenting as third ventricular masses. Literature reports related to aneurysms adjoining the third ventricle since 1979 were systematically reviewed and summarized.
RESULTS
Twenty-seven cases of this disease were collected. A total of 92.6% of cases developed hydrocephalus. Six cases were reported as third ventricular tumors in primary radiologic reports, and misdiagnosis hindered subsequent clinical decisions. We found a significant correlation between thrombosis and misdiagnosis, as well as between misdiagnosis and craniotomy rate. There are also false negative angiography reports for aneurysms from our cases and literature review. Strategies for the diagnosis and treatment of these aneurysms have changed over time. The uniqueness of our cases sheds light on the use of CT angiography, which has proven to be an appropriate test for diagnosis and reexamination but was not widely applied in previous reports. VW-MRI may be useful to assess rupture risk. Distinct treatment strategies show no significant difference in prognosis.
CONCLUSIONS
Thrombosed aneurysms should be considered as a differential diagnosis in patients with third ventricular masses. Application of CTA and VW-MRI can be beneficial. Aneurysm coil occlusion might be a favorable treatment for cases with mass effects. Further studies should be conducted to confirm our observations.
PubMed: 36458318
DOI: 10.1016/j.heliyon.2022.e11506