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Journal of Vascular Surgery Nov 2020Type II endoleaks are the most common type of endoleak after endovascular aneurysm repair (EVAR) and may cause late sac expansion and rupture. To prevent this,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Type II endoleaks are the most common type of endoleak after endovascular aneurysm repair (EVAR) and may cause late sac expansion and rupture. To prevent this, prophylactic embolization of aortic side branches has been suggested. The aim of this review was to assess the current evidence for this prophylactic treatment and its association with sac size enlargement as well as rate of and reintervention for type II endoleak.
METHODS
This was a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The MEDLINE and Scopus databases were used to search for related articles until March 2019. After screening, original studies reporting outcome comparing patients having prophylactic embolization with those undergoing EVAR without prophylactic embolization were included. An assessment of the quality of the included studies as well as data extraction was performed by two independent observers. Statistical analysis was performed using Review Manager 5.3 (The Nordic Cochrane Center, Copenhagen, Denmark).
RESULTS
There were 3777 publications identified. After elimination of duplicate entries and review of titles and abstracts, 13 retrospective cohort studies including 1427 patients comparing prophylactic embolization with standard EVAR therapy were identified. No randomized trials were available. Five of these 13 studies reported sac growth, with a frequency of 7.4% (14/90) in the embolization group vs 13.4% in controls (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.29-1). The rate of type II endoleak was 18.5% (100/540) in the embolization group vs 38.6% in the control group (342/887; OR, 0.34; 95% CI, 0.26-0.44). Based on 10 studies, the rate of reintervention was 1.5% (7/468) in the embolization group vs 12.4% (80/646) in the control group (OR, 0.12; 95% CI, 0.06-0.24). Nine of these 13 studies showed that technical success of inferior mesenteric artery and lumbar artery embolization was 82.3% and 69.1%, respectively. Regarding complications, 10 of 108 patients (9.3%) in one study reported nonspecific abdominal pain after embolization, and all resolved with overnight rehydration. Only one patient, who previously had right hemicolectomy, died after inferior mesenteric artery embolization of ischemic colitis.
CONCLUSIONS
This systematic review and meta-analysis suggests that prophylactic aortic side branch embolization may be associated with lower rate of sac enlargement, incidence of type II endoleaks, and reinterventions. However, high-quality unbiased studies are lacking in this field, and this review and meta-analysis may be affected by selection bias and residual confounders remaining in the retrospective studies. To conclude whether prophylactic embolization should be routinely performed, a prospective, randomized trial is required.
Topics: Aortic Aneurysm, Abdominal; Embolization, Therapeutic; Endoleak; Endovascular Procedures; Humans
PubMed: 32442608
DOI: 10.1016/j.jvs.2020.05.020 -
Annals of Vascular Surgery Jan 2021Emerging evidence suggests that severe form of coronavirus disease 2019 (COVID-19) is mediated, in part, by a hypercoagulable state characterized by micro- and...
BACKGROUND
Emerging evidence suggests that severe form of coronavirus disease 2019 (COVID-19) is mediated, in part, by a hypercoagulable state characterized by micro- and macro-vascular thrombotic angiopathy. Although venous thrombotic events in COVID-19 patients have been well described, data on arterial thrombosis (AT) in these patients is still limited. We, therefore, conducted a rapid systematic review of current scientific literature to identify and consolidate evidence of AT in COVID-19 patients.
METHODS
A systematic search of literature was conducted between November 1, 2019, and June 9, 2020, on PubMed and China National Knowledge Infrastructure to identify potentially eligible studies.
RESULTS
A total of 27 studies (5 cohort, 5 case series, and 17 case reports) describing arterial thrombotic events in 90 COVID-19 patients were included. The pooled incidence of AT in severe/critically ill intensive care unit-admitted COVID-19 patients across the 5 cohort studies was 4.4% (95% confidence interval 2.8-6.4). Most of the patients were male, elderly, and had comorbidities. AT was symptomatic in >95% of these patients and involved multiple arteries in approximately 18% of patients. The anatomical distribution of arterial thrombotic events was wide, occurring in limb arteries (39%), cerebral arteries (24%), great vessels (aorta, common iliac, common carotid, and brachiocephalic trunk; 19%), coronary arteries (9%), and superior mesenteric artery (8%). The mortality rate in these patients is approximately 20%.
CONCLUSIONS
AT occurs in approximately 4% of critically ill COVID-19 patients. It often presents symptomatically and can affect multiple arteries. Further investigation of the underlying mechanism of AT in COVID-19 would be needed to clarify possible therapeutic targets.
Topics: Adult; Aged; Aged, 80 and over; Arterial Occlusive Diseases; Blood Coagulation; COVID-19; Host-Pathogen Interactions; Humans; Incidence; Male; Middle Aged; Prognosis; Risk Factors; SARS-CoV-2; Thrombosis
PubMed: 32866574
DOI: 10.1016/j.avsg.2020.08.087 -
Annals of Vascular Surgery. Brief... Sep 2022Venous thrombosis has been widely described in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; however, arterial thrombosis has...
OBJECTIVES
Venous thrombosis has been widely described in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; however, arterial thrombosis has rarely been reported. This study aims to assess the incidence, risk factors, interventions, and outcomes of acute aortoiliac arterial thrombosis in patients with active SARS-CoV-2 infections.
METHODS
We present seven SARS-CoV-2-positive patients from our institution who acutely developed thrombi in the aortoiliac arterial system (7/2020-1/2021). A systematic review of the literature on aortoiliac arterial thrombosis in patients with SARS-CoV-2 infections in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was also performed. The available data from all reported cases in the literature and at our institution were analyzed.
RESULTS
Thirty published articles and journal correspondences, including 52 patients, were reviewed and analyzed in addition to our institution's 7 cases. In total, 59 SARS-CoV-2-positive patients were found to have acute aortoiliac thrombosis. The abdominal aorta was the most frequent location for the development of a thrombus. Baseline demographics and medical comorbidities were not significantly different between the symptomatic and asymptomatic cohorts. Seventy-one percent of patients were symptomatic (lower limb ischemia: 75.0%, renal infarction: 20.0%, stroke: 12.5%, mesenteric ischemia: 10.0%). All patients with thrombus involving the ascending aorta, aortic bifurcation, or iliac artery developed thromboembolic or ischemic complications. All patients received systemic anticoagulation. Fifty-three percent of all patients were managed medically. Ninety-four percent of the asymptomatic patients were managed medically. One asymptomatic patient underwent endovascular aspiration of a mobile thrombus. Three (23.1%) deaths occurred in the asymptomatic cohort from hypoxic respiratory failure. Fourteen (36.8%) deaths occurred in the symptomatic cohort. The in-hospital mortality rate was 33.3% overall and 43.8% for patients with thrombi involving more than one aortoiliac segment.
CONCLUSIONS
The presence of thrombi in the aortoiliac arterial system appears to be a poor prognostic indicator for patients with active SARS-CoV-2 infections. Medical management of patients with asymptomatic aortoiliac thrombi may be considered. The presence of thrombi involving the ascending aorta, aortic bifurcation, or iliac artery may warrant consideration for operative intervention due to the risk for thromboembolic or ischemic complications. Further study is needed to fully delineate the risk factors, optimal treatment, and outcomes of arterial thrombosis in the setting of SARS-CoV-2 infection.
PubMed: 35821740
DOI: 10.1016/j.avsurg.2022.100105 -
Frontiers in Medicine 2021This review was designed to compile the evidence on the prognosis of patients with colorectal cancer and apical lymph node (APN) metastasis and the long-term benefit of...
BACKGROUND
This review was designed to compile the evidence on the prognosis of patients with colorectal cancer and apical lymph node (APN) metastasis and the long-term benefit of inferior mesenteric artery lymph node (IMA-LN) resection.
METHODS
We searched the PubMed Central, Cochrane library, EMBASE, and MEDLINE databases from inception until May 2021 for relevant publications. We assess the quality of the studies using the Newcastle Ottawa scale. We conducted a random-effects model meta-analysis and report pooled hazard ratios (HRs) with 95% confidence intervals (CIs).
RESULTS
We analyzed data from 13 studies conducted in Japan, China, and Korea with 6,193 participants. Most studies were retrospective in nature and of low quality. We found that patients with APN metastasis had shorter OSs (pooled HR, 2.41; 95% CI, 1.92-3.02) and PFSs (pooled HR, 2.42; 95% CI, 1.90-3.09) than the patients without the metastasis. We identified significant heterogeneity without publication bias for both outcomes. Moreover, our sensitivity analysis revealed robust estimates were robust for the individual effects.
CONCLUSION
Our findings suggest that patients with colorectal cancer and APN metastases have significantly worse OS and DFS than those without the metastasis. However, inclusion of low-quality retrospective studies with high heterogeneity limits the generalizability of study findings.
PubMed: 35111781
DOI: 10.3389/fmed.2021.800717 -
European Journal of Surgical Oncology :... Nov 2020Leakage of the esophago-gastrostomy after esophagectomy with gastric tube reconstruction is a serious complication. Anastomotic leakage occurs in up to 20% of patients... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Leakage of the esophago-gastrostomy after esophagectomy with gastric tube reconstruction is a serious complication. Anastomotic leakage occurs in up to 20% of patients and a compromised perfusion of the gastric tube is thought to play an important role. This meta-analysis aimed to investigate whether arterial calcification is a risk factor for anastomotic leakage in esophageal surgery.
METHOD
Embase, Medline, PubMed, Cochrane databases and Google scholar databases were systematically searched for studies that assessed arterial calcification of the thoracic aorta, celiac axis including its branches, or the superior mesenteric artery in patients that underwent esophagectomy with gastric tube reconstruction. The degree of calcification was classified as absent, minor or major. A "random-effects model" was used to calculate pooled Odds Ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using the Q-test and I-test.
RESULTS
From the 456 articles retrieved, seven studies were selected including 1.860 patients. The median (range) of anastomotic leakage was 17.2% (12.7-24.8). Meta-analysis showed a statistically significant association between increased calcium score and anastomotic leakage for the thoracic aorta (OR 2.18(CI 1.42-3.34)), celiac axis (OR 1.62(CI 1.15-2.29)) and right post-celiac axis (common hepatic, gastroduodenal and right gastroepiploic arteries) (OR 2.69(CI 1.27-5.72)). Heterogeneity was observed for analysis on calcification of the thoracic aorta and celiac axis (I = 71% and 59%, respectively) but not for the right branches of the celiac axis (I = 0%).
CONCLUSION
This meta-analysis, including good quality studies, showed a statistically significant association between arterial calcification and anastomotic leakage in patients who underwent esophagectomy with gastric tube reconstruction.
Topics: Anastomosis, Surgical; Anastomotic Leak; Aorta, Thoracic; Celiac Artery; Esophagectomy; Gastroepiploic Artery; Humans; Plastic Surgery Procedures; Stomach; Surgically-Created Structures; Tomography, X-Ray Computed; Vascular Calcification
PubMed: 32883552
DOI: 10.1016/j.ejso.2020.06.019 -
HPB : the Official Journal of the... Sep 2020Positive margins in pancreatoduodenectomy (PD) for pancreatic cancer, specifically the superior mesenteric artery (SMA) margin, are associated with worse outcomes. Local...
BACKGROUND
Positive margins in pancreatoduodenectomy (PD) for pancreatic cancer, specifically the superior mesenteric artery (SMA) margin, are associated with worse outcomes. Local therapies targeting these margins could impact on recurrence. This study analysed recurrence-patterns to identify whether strategies to control local disease could have a meaningful impact.
METHODS
(I) Systematic review to define recurrence patterns and resection margin status. (II) Additional retrospective study of PD performed at our centre.
RESULTS
In the systematic review, 23/617 evaluated studies were included (n = 3815). Local recurrence was observed in 7-69%. SMA margin (6 studies) was positive in 15-35%. In the retrospective study (n = 204), local recurrence was more frequently observed with a positive SMA margin (66 vs.45%; p = 0.005). Furthermore, in a multivariate cox-proportional hazard model, only a positive SMA margin was associated with disease recurrence (HR 1.615; 95%CI 1.127-2.315; p = 0.009). Interestingly, median overall survival was 20 months and similar for patients who developed local only, metastases only or simultaneous recurrence (p = 0.124).
CONCLUSION
Local recurrence of pancreatic cancer is common and associated with similar mortality rates as those who present with simultaneous or metastatic recurrence. Involvement of the SMA margin is an independent predictor for disease progression and should be the target of future adjuvant local therapies.
Topics: Humans; Margins of Excision; Neoplasm Recurrence, Local; Pancreatic Neoplasms; Pancreaticoduodenectomy; Retrospective Studies
PubMed: 32046922
DOI: 10.1016/j.hpb.2020.01.005 -
Medicine Jan 2024This study aims to investigate the safety and feasibility of preserving left colonic artery (LCA) in radical sigmoid and rectal cancer surgery. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study aims to investigate the safety and feasibility of preserving left colonic artery (LCA) in radical sigmoid and rectal cancer surgery.
METHODS
Relevant articles were systematically searched on the PubMed, Embase, and Cochrane Library. The quality of included studies was evaluated using the Cochrane Handbook. A meta-analysis was conducted to assess the surgical outcomes and oncological outcomes by RevMan 5.4 software.
RESULTS
Fifteen studies with a total of 5054 patients, including 2432 patients with LCA preservation and 2622 patients without LCA preservation, were included and analyzed in this study. The meta-analysis revealed that preserving LCA in radical surgery of sigmoid and rectal cancer has lower anastomotic leakage incidence (OR = 1.03, 95% confidence interval = 0.83-1.27, P < .0001). There were no significant differences in the operative time, intraoperative blood loss, number of dissected lymph nodes, postoperative complications as well as the oncological outcomes including systemic recurrence, local recurrence, 5-year overall survival rate, and 5-year disease-free survival rate.
CONCLUSION SUBSECTIONS
This pooled analysis showed that preserving the LCA is safe and feasible in radical sigmoid and rectal cancer surgery.
Topics: Humans; Arteries; Colon; Colon, Sigmoid; Laparoscopy; Mesenteric Artery, Inferior; Rectal Neoplasms
PubMed: 38277569
DOI: 10.1097/MD.0000000000037026