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Obstetrical & Gynecological Survey Apr 2021Postpartum hemorrhage (PPH) is an emergent obstetric complication and the leading cause of maternal mortality. Pelvic arterial embolization (PAE) is an effective... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Postpartum hemorrhage (PPH) is an emergent obstetric complication and the leading cause of maternal mortality. Pelvic arterial embolization (PAE) is an effective treatment for intractable PPH. However, a unique protocol has not been accepted in obstetrical practice.
OBJECTIVE
To evaluate its efficiency, safety, complications, and outcomes, we conducted a systematic review and meta-analysis of PAE for PPH in the literature.
EVIDENCE ACQUISITION
The Medline, the database of abstract of reviews, the index to allied health literature, and the Chinese database Sino-Med were searched on March 31, 2020, for studies on PAE for PPH. The data for PAE indication, agents, arteries, success rate, complications, and outcomes were extracted and syncretized for meta-analysis.
RESULTS
From 1075 identified articles, 113 abstracts or full articles were retrieved and 43 studies were finally identified as meeting the including criteria. The results demonstrated that the indications for PAE were as follows: uterine atony, placental abnormality, delivery tract injury, disseminated intravascular coagulation, arteriovenous malformation, and vaginal hematoma. The embolization agents mostly in order were gelatin sponge particles, polyvinyl alcohol particles, Gelfoam, -butyl cyanoacrylate, microcoil, and glue; for arteries, they were mostly uterine artery and internal iliac artery. The clinical success rate was 90.5%, whereas the technical success rate was 99.3%. The most common complications of PAE were postembolization syndrome and menstrual abnormality.
CONCLUSIONS AND RELEVANCE
The emergent PAE is a safe and effective method with high success rate in life-threatening PPH management. Gelatin sponge granules measuring 500 to 1000 μm in diameter have safe results. Pelvic arterial embolization may affect the recovery of menses and increase PPH in the subsequent pregnancy, but there was no noted correlation with fetal growth restriction.
Topics: Adult; Embolization, Therapeutic; Female; Humans; Iliac Artery; Pelvis; Postpartum Hemorrhage; Pregnancy; Treatment Outcome; Uterine Artery
PubMed: 33908615
DOI: 10.1097/OGX.0000000000000887 -
Morphologie : Bulletin de L'Association... Sep 2023The superior thyroid artery (STA) is one of the main arteries that provide blood supply to the thyroid gland. It has a plethora of anatomical variations, and knowledge...
BACKGROUND
The superior thyroid artery (STA) is one of the main arteries that provide blood supply to the thyroid gland. It has a plethora of anatomical variations, and knowledge of its anatomy is necessary in procedures in this area. The aim of this review is to summarize and describe human studies (cadaveric and angiographic) that investigate the anatomical variations related to the STA.
MATERIAL AND METHODS
A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A literature search in PubMed, and Embase databases was carried out. Original studies that investigated the origin of the STA and reported data on the variant arterial anatomy were considered, including only cadaveric and angiographic studies.
RESULTS
A total of 34 studies (4048 heminecks in total; heminecks in each study: min: 25-max: 1280) were finally included. All studies provide details about sex [men/women ratio median (IQR): 2(1-5)] but none about age and 10 (29%) about nationality. STA morphological characteristics described in the included studies are origin, length, number of branches, distance from the carotid bifurcation and the vessel's diameter.
CONCLUSIONS
The STA's anatomical features are subject to a non-negligible degree of variability. Our results should improve the awareness of anatomical variations of the STA, and eventually have an impact on the interventions regarding the visceral compartment of the neck in clinical practice.
Topics: Male; Humans; Female; Child; Thyroid Gland; Arteries; Neck; Cadaver
PubMed: 37061377
DOI: 10.1016/j.morpho.2023.03.002 -
Surgical and Radiologic Anatomy : SRA Aug 2021The splenic artery (SA) is the largest and most tortuous branch of the celiac trunk with a wide spectrum of variants, particularly in its terminal branches.
PURPOSE
The splenic artery (SA) is the largest and most tortuous branch of the celiac trunk with a wide spectrum of variants, particularly in its terminal branches.
METHODS
The current study presents a systematic review of the English literature on the SA variations, with emphasis on its terminal branching patterns.
RESULTS
Thirty cadaveric studies (3132 specimens) were included in the analysis. The SA originated from the celiac trunk in 97.2%, from the abdominal aorta in 2.1% and from the superior mesenteric or the common hepatic artery in 0.7% of cases. A suprapancreatic course was observed in 77.4%, retropancreatic course in 17.8%, anteropancreatic course in 3.4% and intrapancreatic course in 1.3%. In the majority of cases, the SA bifurcated into superior and inferior lobar arteries (83.4%), with trifurcation and quadrifurcation in 11.3% and 2.7%, respectively. Five or more lobar branches (1.4%) and a single lobar artery (1.2%) were rarely identified. The distributed branching pattern was found in 72.7%, whereas the magistral pattern in 26.9%. The inferior and superior polar arteries (IPA and SPA) were found in 47.7% and 41.7% of cases, respectively, while polar artery agenesis was recorded in 28.2%. The SPA usually originated from the SA main trunk (53.6%) or from the superior lobar artery (33.1%). The IPA emanated mainly from the left gastroepiploic artery (53%), from the SA (23.5%) or the inferior lobar artery (21.9%). Intersegmental anastomoses between adjacent arterial segments were identified in 14.2%.
CONCLUSION
Knowledge of the SA aberrations is important for surgeons and radiologists involved in angiographic interventions.
Topics: Anatomic Variation; Cadaver; Humans; Splenic Artery
PubMed: 33481130
DOI: 10.1007/s00276-020-02675-5 -
Ultrasound in Obstetrics & Gynecology :... Mar 2018Doppler ultrasonographic assessment of the cerebroplacental ratio (CPR) and middle cerebral artery (MCA) is widely used as an adjunct to umbilical artery (UA) Doppler to... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Doppler ultrasonographic assessment of the cerebroplacental ratio (CPR) and middle cerebral artery (MCA) is widely used as an adjunct to umbilical artery (UA) Doppler to identify fetuses at risk of adverse perinatal outcome. However, reported estimates of its accuracy vary considerably. The aim of this study was to review systematically the prognostic accuracies of CPR and MCA Doppler in predicting adverse perinatal outcome, and to compare these with UA Doppler, in order to identify whether CPR and MCA Doppler evaluation are of added value to UA Doppler.
METHODS
PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov were searched, from inception to June 2016, for studies on the prognostic accuracy of UA Doppler compared with CPR and/or MCA Doppler in the prediction of adverse perinatal outcome in women with a singleton pregnancy of any risk profile. Risk of bias and concerns about applicability were assessed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool. Meta-analysis was performed for multiple adverse perinatal outcomes. Using hierarchal summary receiver-operating characteristics meta-regression models, the prognostic accuracy of CPR vs MCA Doppler was compared indirectly, and CPR and MCA Doppler vs UA Doppler compared directly.
RESULTS
The search identified 4693 articles, of which 128 studies (involving 47 748 women) were included. Risk of bias or suboptimal reporting was detected in 120/128 studies (94%) and substantial heterogeneity was found, which limited subgroup analyses for fetal growth and gestational age. A large variation was observed in reported sensitivities and specificities, and in thresholds used. CPR outperformed UA Doppler in the prediction of composite adverse outcome (as defined in the included studies) (P < 0.001) and emergency delivery for fetal distress (P = 0.003), but was comparable to UA Doppler for the other outcomes. MCA Doppler performed significantly worse than did UA Doppler in the prediction of low Apgar score (P = 0.017) and emergency delivery for fetal distress (P = 0.034). CPR outperformed MCA Doppler in the prediction of composite adverse outcome (P < 0.001) and emergency delivery for fetal distress (P = 0.013).
CONCLUSION
Calculating the CPR with MCA Doppler can add value to UA Doppler assessment in the prediction of adverse perinatal outcome in women with a singleton pregnancy. However, it is unclear to which subgroup of pregnant women this applies. The effectiveness of the CPR in guiding clinical management needs to be evaluated in clinical trials. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Female; Fetal Distress; Fetal Growth Retardation; Fetus; Humans; Middle Cerebral Artery; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Prognosis; Pulsatile Flow; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Umbilical Arteries
PubMed: 28708272
DOI: 10.1002/uog.18809 -
Scandinavian Journal of Surgery : SJS :... Jun 2021There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac...
BACKGROUND AND AIMS
There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case-control studies are now available, while randomized controlled trials are awaited.
MATERIAL AND METHODS
The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis.
RESULTS AND CONCLUSIONS
Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery dissection, while the frequency of diabetes mellitus is reported to be low. Large aortomesenteric angle has also been considered to be a factor for superior mesenteric artery dissection. The overwhelming majority of patients can be conservatively treated without the need of endovascular or open operations. Conservative therapy consists of blood pressure lowering therapy, analgesics, and initial bowel rest, whereas there is no support for antithrombotic agents. Complete remodeling of the dissection after conservative therapy was found in 43% at mid-term follow-up. One absolute indication for surgery and endovascular stenting of the superior mesenteric artery is development of peritonitis due to bowel infarction, which occurs in 2.1% of superior mesenteric artery dissections and none in celiac artery dissections. The most documented end-organ infarction in celiac artery dissections is splenic infarctions, which occurs in 11.2%, and is a condition that should be treated conservatively. The frequency of ruptured pseudoaneurysm in the superior mesenteric artery and celiac artery dissection is very rare, 0.4%, and none of these patients were in shock at presentation. Endovascular therapy with covered stents should be considered in these patients.
Topics: Dissection; Humans; Male; Mesenteric Arteries; Retrospective Studies; Time Factors; Treatment Outcome; Vascular Surgical Procedures
PubMed: 33724090
DOI: 10.1177/14574969211000546 -
Annals of Vascular Surgery Jul 2018This study aimed to perform a systematic review and meta-analysis of current evidence comparing the drug-eluting stent (DES) with the bare-metal stent (BMS) in the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This study aimed to perform a systematic review and meta-analysis of current evidence comparing the drug-eluting stent (DES) with the bare-metal stent (BMS) in the treatment of femoropopliteal artery disease (FPAD).
METHODS
All relevant articles reporting the results of DES versus BMS implantation in FPAD were systematically searched in MEDLINE, EMBASE, and Cochrane database. Randomized controlled trial (RCT), cohort, and retrospective study were all included. The efficacy end points included late lumen loss (LLL), binary restenosis, primary patency rate, freedom from target lesion revascularization (TLR), and stent fracture. Related data of the follow-up outcomes were extracted and pooled. For each end point, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
RESULTS
A total of 9 studies with 776 patients were included in this meta-analysis. There was no statistically significant difference between the DES and BMS groups in terms of LLL at 6 months (standard mean difference = -0.37, P = 0.07); binary restenosis at 6, 12, and 24 months (OR = 0.44, P = 0.20; OR = 0.75, P = 0.74; and OR = 0.62, P = 0.36; respectively); primary patency rate at 6, 12, and 24 months (OR = 1.18, P = 0.73; OR = 1.43, P = 0.70; OR = 1.25, P = 0.68, respectively); freedom from TLR at 12 months (OR = 1.13, P = 0.79); and stent fracture at 6 months (OR = 1.67, P = 0.38). A sensitivity analysis demonstrated that there was a significant benefit in the DES group over the BMS group in binary restenosis at 6 months (OR = 0.22, P = 0.008) after excluding a retrospective study, whereas no significant difference was observed when eliminating any other study. A subgroup analysis did not reveal any significant difference between a subgroup (sirolimus-eluting stent or paclitaxel-eluting stent) and the BMS group in FPAD.
CONCLUSIONS
According to current evidence, DES was not superior to BMS in the treatment of FPAD. Further larger RCTs are needed to provide more evidence in the comparison between DES and BMS for FPAD.
Topics: Chi-Square Distribution; Constriction, Pathologic; Drug-Eluting Stents; Endovascular Procedures; Femoral Artery; Humans; Metals; Odds Ratio; Peripheral Arterial Disease; Popliteal Artery; Prosthesis Design; Randomized Controlled Trials as Topic; Recurrence; Risk Factors; Stents; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 29514049
DOI: 10.1016/j.avsg.2017.12.003 -
The Journal of Cardiovascular Surgery Feb 2018The effect of the insertion of guidewires and catheters on fusion accuracy of the three-dimensional (3D) image fusion technique during iliac percutaneous transluminal... (Review)
Review
The use of 3D image fusion for percutaneous transluminal angioplasty and stenting of iliac artery obstructions: validation of the technique and systematic review of literature.
INTRODUCTION
The effect of the insertion of guidewires and catheters on fusion accuracy of the three-dimensional (3D) image fusion technique during iliac percutaneous transluminal angioplasty (PTA) procedures has not yet been investigated.
EVIDENCE ACQUISITION
Technical validation of the 3D fusion technique was evaluated in 11 patients with common and/or external iliac artery lesions. A preprocedural contrast-enhanced magnetic resonance angiogram (CE-MRA) was segmented and manually registered to a cone-beam computed tomography image created at the beginning of the procedure for each patient. The treating physician visually scored the fusion accuracy (i.e., accurate [<2 mm], mismatch [2-5 mm], or inaccurate [>5 mm]) of the entire vasculature of the overlay with respect to the digital subtraction angiography (DSA) directly after the first obtained DSA. Contours of the vasculature of the fusion images and DSAs were drawn after the procedure. The cranial-caudal, lateral-medial, and absolute displacement were calculated between the vessel centerlines. To determine the influence of the catheters, displacement of the catheterized iliac trajectories were compared with the noncatheterized trajectories. Electronic databases were systematically searched for available literature published between January 2010 till August 2017.
EVIDENCE SYNTHESIS
The mean registration error for all iliac trajectories (N.=20) was small (4.0±2.5 mm). No significant difference in fusion displacement was observed between catheterized (N.=11) and noncatheterized (N.=9) iliac arteries. The systematic literature search yielded 2 manuscripts with a total of 22 patients. The methodological quality of these studies was poor (≤11 MINORS Score), mainly due to a lack of a control group.
CONCLUSIONS
Accurate image fusion based on preprocedural CE-MRA is possible and could potentially be of help in iliac PTA procedures. The flexible guidewires and angiographic catheters, routinely used during endovascular procedures of iliac arteries, did not cause significant displacement that influenced the image fusion. Current literature on 3D image fusion in iliac PTA procedures is of limited methodological quality.
Topics: Angiography, Digital Subtraction; Angioplasty; Arterial Occlusive Diseases; Blood Vessel Prosthesis Implantation; Cone-Beam Computed Tomography; Contrast Media; Humans; Iliac Artery; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Angiography; Stents
PubMed: 28933523
DOI: 10.23736/S0021-9509.17.10224-7 -
Annals of Plastic Surgery Oct 2022The flaps in the trapezius region are routinely elevated as musculocutaneous flaps. The anatomy of trapezius perforators and their clinical application are unclear.
BACKGROUND
The flaps in the trapezius region are routinely elevated as musculocutaneous flaps. The anatomy of trapezius perforators and their clinical application are unclear.
METHODS
The number and distribution of superficial cervical artery perforators (SCAPs) and dorsal scapular artery perforators (DSAPs) were studied on 8 cadavers. The clinical usage of SCAP and DSAP flaps was investigated through a systematic literature review.
RESULTS
A total of 27 SCAPs and 28 DSAPs were found in the 16 hemibacks. The mean calibers of SCAP and DSAP were 0.9 ± 0.2 and 0.8 ± 0.2 mm, respectively. The vascular length to the takeoff of the source artery was 7.3 ± 2.0 cm (range, 4.7-9.7 cm) for SCAPs and was 8.1 ± 2.8 cm (range, 3.2-13.6 cm) for DSAPs. Contour and density heat maps showed that the SCAPs were clustered within approximately 3 to 5 cm above the horizontal line through the medial point of the scapular spine (x-axis) and 5 to 8 cm from the midline (y-axis, P = 0.001) and clustered DSAPs located in approximately 4 to 9 cm below the x-axis and 4 to 10 cm from the y-axis ( P = 0.002). Four SCAP and 19 DSAP flaps were found in literature. The mean sizes of SCAP flaps and DSAP flaps were 18.5 × 7.8 and 16.5 × 8.7 cm, respectively.
CONCLUSIONS
Both SCAP and DSAP flaps can be elevated with a relatively long pedicle. The anatomical knowledge of the location of major clusters of perforators contributes to the application of these flaps.
Topics: Arteries; Cadaver; Humans; Neck; Perforator Flap; Superficial Back Muscles
PubMed: 35502939
DOI: 10.1097/SAP.0000000000003192 -
Clinical Research in Cardiology :... Jul 2022Pulmonary arterial hypertension (PAH) can lead to left main coronary artery compression (LMCo), but data on the impact, screening and treatment are limited. A... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Pulmonary arterial hypertension (PAH) can lead to left main coronary artery compression (LMCo), but data on the impact, screening and treatment are limited. A meta-analysis of LMCo cases could fill the knowledge gaps in this topic.
METHODS
Electronic databases were searched for all LMCo/PAH studies, abstracts and case reports including pulmonary artery (PA) size. Restricted maximum likelihood meta-analysis was used to evaluate LMCo-associated factors. Specificity, sensitivity and accuracy of PA size thresholds for diagnosis of LMCo were calculated. Treatment options and outcomes were summarized.
RESULTS
A total of five case-control cohorts and 64 case reports/series (196 LMCo and 438 controls) were included. LMCo cases had higher PA diameter (Hedge's g 1.46 [1.09; 1.82]), PA/aorta ratio (Hedge's g 1.1 [0.64; 1.55]) and probability of CHD (log odds-ratio 1.22 [0.54; 1.9]) compared to non-LMCo, but not PA pressure or vascular resistance. A 40 mm cut-off for the PA diameter had balanced sensitivity (80.5%), specificity (79%) and accuracy (79.7%) for LMCo diagnosis, while a value of 44 mm had higher accuracy (81.7%), higher specificity (91.5%) but lower sensitivity (71.9%). Pooled mortality after non-conservative treatment (n = 150, predominantly stenting) was 2.7% at up to 22 months of mean follow-up, with 83% survivors having no angina at follow-up.
CONCLUSION
PA diameter, PA/aorta ratio and CHD are associated with LMCo, while hemodynamic parameters are not. Data from this study support that a PA diameter cut-off between 40 and 44 mm can offer optimal accuracy for LMCo screening. Preferred treatment was coronary stenting, associated with low mid-term mortality and symptom relief. Diagnosis and management of left main coronary artery compression (LMCo) in patients with pulmonary arterial hypertension (PAH).
Topics: Angina Pectoris; Coronary Vessels; Humans; Hypertension, Pulmonary; Pulmonary Arterial Hypertension; Pulmonary Artery
PubMed: 35290496
DOI: 10.1007/s00392-022-01999-z -
The Journal of Surgical Research Nov 2023In pediatric and neonatal populations, the carotid artery is commonly cannulated for venoarterial (VA) extracorporeal membrane oxygenation (ECMO). The decision to ligate...
A Systematic Review of Clinical Outcomes After Carotid Artery Ligation Versus Carotid Artery Reconstruction Following Venoarterial Extracorporeal Membrane Oxygenation in Infants and Children.
INTRODUCTION
In pediatric and neonatal populations, the carotid artery is commonly cannulated for venoarterial (VA) extracorporeal membrane oxygenation (ECMO). The decision to ligate (carotid artery ligation [CAL]) versus reconstruct (carotid artery reconstruction [CAR]) the artery at decannulation remains controversial as long-term neurologic outcomes remain unknown. The objective of this study was to summarize current literature on clinical outcomes following CAL and CAR after Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO).
METHODS
PubMed (MEDLINE), Embase, Web of Science, and Cochrane databases were searched using keywords from January 1950 to October 2020. Studies examining clinical outcomes following CAL and CAR for VA-ECMO in patients <18 y of age were included. Prospective and retrospective cohort studies, case series, case-control studies, and case reports were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were performed independently by two reviewers. Assessment of risk of bias was performed.
RESULTS
Eighty studies were included and classified into four categories: noncomparative clinical outcomes after CAL (n = 23, 28.8%), noncomparative clinical outcomes after CAR (n = 12, 15.0%), comparative clinical outcomes after CAL and/or CAR (n = 28, 35.0%), and case reports of clinical outcomes after CAL and/or CAR (n = 17, 21.3%). Follow-up ranged from 0 to 11 y. CAR patency rates ranged from 44 to 100%. There was no substantial evidence supporting an association between CAL versus CAR and short-term neurologic outcomes.
CONCLUSIONS
Studies evaluating outcomes after CAL versus CAR for VA-ECMO are heterogeneous with limited generalizability. Further studies are needed to evaluate long-term consequences of CAL versus CAR, especially as the first survivors of pediatric/neonatal ECMO approach an age of increased risk of carotid stenosis and stroke.
Topics: Infant, Newborn; Humans; Infant; Child; Extracorporeal Membrane Oxygenation; Retrospective Studies; Prospective Studies; Carotid Arteries; Carotid Artery, Common
PubMed: 37517350
DOI: 10.1016/j.jss.2023.06.046