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Annals of Vascular Surgery Oct 2017Extra-anatomic bypass (EAB) remains a viable alternative for lower limb revascularization if aorto-bifemoral bypass and endovascular therapy are contraindicated. Among... (Review)
Review
BACKGROUND
Extra-anatomic bypass (EAB) remains a viable alternative for lower limb revascularization if aorto-bifemoral bypass and endovascular therapy are contraindicated. Among EAB, perigraft seroma (PS) occurs in about 4% of cases. Diagnostic and therapeutic management, as well as standardized treatment paradigm, are still not well defined. The aim of this study is to report 5 PS cases in EAB and to review the literature about similar cases.
METHODS
We retrospectively reviewed EAB performed during the period 2002-2015. Among these, PS cases were analyzed. A similar description for all cases found in the literature through research on the major international databases (PubMed, Scopus, EMBASE) was conducted.
RESULTS
During the study period, 797 bypasses-528 (66.3%) anatomical and 269 (33.7%) extra-anatomical-were performed. Among the latter, 169 femoro-femoral (FF), 20 axillo-femoral (AXF), 22 axillo-bifemoral (AxBF), and 58 aortouni-iliac endoprosthesis (AUI) + FF bypasses were performed. Five cases (1.86%) of PS in EAB population were detected: 3 after AxBF and 2 after AUI + FF. Although we initially preferred percutaneous drainage, a surgical choice with graft explant and replacement were imposed by the high recurrence rate. Literature analysis identified 20 additional cases (11 after AxBF, 7 after AXF and one after AUI + FF).
CONCLUSIONS
Our case series and the literature confirm that the most widely used therapy is the surgical drainage with primary or secondary replacement of the graft of a different material. Percutaneous drainage has proved to be ineffective because not conclusive and potential to increase risk of graft infection. Careful follow-up, even years after surgery, remains necessary for PS diagnosis and management, to prevent complications and potential infection.
Topics: Aged; Aged, 80 and over; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Device Removal; Drainage; Female; Humans; Male; Recurrence; Retrospective Studies; Risk Factors; Seroma; Treatment Outcome
PubMed: 28483618
DOI: 10.1016/j.avsg.2017.03.201 -
Journal of Vascular Surgery Apr 2021Thoracic endovascular aortic repair (TEVAR) has become the most common surgical procedure for treatment of descending thoracic aortic pathology. Cervical debranching in... (Comparative Study)
Comparative Study
OBJECTIVE
Thoracic endovascular aortic repair (TEVAR) has become the most common surgical procedure for treatment of descending thoracic aortic pathology. Cervical debranching in the form of carotid-subclavian bypass or transposition (CSBT) and carotid-carotid bypass (CCB) has enabled the use of TEVAR for the treatment of more complex anatomy involving the arch. The present study examined the effects of concomitant cervical bypass on the perioperative outcomes of TEVAR.
METHODS
The American College of Surgeons National Surgical Quality Improvement Program files (2005-2017) were reviewed. Using the Current Procedural Terminology codes, all patients who had undergone TEVAR were identified and were divided into three groups: TEVAR, TEVAR with one bypass (CSBT or CCB), and TEVAR with two bypasses (CSBT and CCB). The patient characteristics and perioperative outcomes of the three groups were compared. Multivariable analysis was performed to determine the factors associated with mortality.
RESULTS
A total of 3281 patients had undergone TEVAR and 10% had also undergone one or more debranching procedure (one bypass, 9%; two bypasses, 1%). The frequency of debranching had increased from 3.4% to 10.9% (P = .01) during the study period. Significant differences were found among the three groups in age, sex, smoking history, urgency of surgery, and anesthesia technique. The patients who had undergone TEVAR with cervical debranching had had significantly greater morbidity, longer operating times, and longer hospital stays compared with those who had undergone TEVAR alone. The mortality of TEVAR with two bypasses (22.6%) was significantly greater than that of TEVAR alone (7.5%) and TEVAR with one bypass (6.8%; P < .01). The total morbidity (30.9% vs 35.1% vs 67.7%; P < .001) and stroke rate (3% vs 7.5% vs 12.9%; P < .0001) increased with the increasing number of bypasses. A subgroup analysis of patients who had undergone TEVAR with one bypass showed no significant differences in mortality between TEVAR plus CSBT (6.6%) vs TEVAR plus CCB (8.8%; P = .63). Multivariable analysis showed that TEVAR with two bypasses was associated with significantly increased mortality compared with TEVAR alone (odds ratio [OR], 4.33; 95% confidence interval [CI], 1.75-10.73) and TEVAR with one bypass (OR, 3.44; 95% CI, 1.24-9.51). Older age (OR, 1.74; 95% CI, 1.42-2.13), dependent functional status (OR, 1.48; 1.00-2.19), dialysis (OR, 2.61; 95% CI, 1.57-4.33), and emergent status (OR, 3.66; 95% CI, 2.73-4.90) were also associated with mortality.
CONCLUSIONS
TEVAR with concomitant cervical debranching has been increasingly used to treat complex aortic pathology but is associated with significantly worse outcomes than TEVAR alone. As advanced endovascular technology to treat the aortic arch emerges, the outcomes of open surgical debranching in the present study constitute an important benchmark for comparison.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aorta, Thoracic; Aortic Diseases; Blood Vessel Prosthesis Implantation; Carotid Arteries; Databases, Factual; Endovascular Procedures; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Assessment; Risk Factors; Subclavian Artery; Time Factors; Treatment Outcome; Young Adult
PubMed: 32861861
DOI: 10.1016/j.jvs.2020.07.103 -
PLoS Genetics Oct 2013Short insertions and deletions (InDels) comprise an important part of the natural mutational repertoire. InDels are, however, highly deleterious, primarily because...
Short insertions and deletions (InDels) comprise an important part of the natural mutational repertoire. InDels are, however, highly deleterious, primarily because two-thirds result in frame-shifts. Bypass through slippage over homonucleotide repeats by transcriptional and/or translational infidelity is known to occur sporadically. However, the overall frequency of bypass and its relation to sequence composition remain unclear. Intriguingly, the occurrence of InDels and the bypass of frame-shifts are mechanistically related - occurring through slippage over repeats by DNA or RNA polymerases, or by the ribosome, respectively. Here, we show that the frequency of frame-shifting InDels, and the frequency by which they are bypassed to give full-length, functional proteins, are indeed highly correlated. Using a laboratory genetic drift, we have exhaustively mapped all InDels that occurred within a single gene. We thus compared the naive InDel repertoire that results from DNA polymerase slippage to the frame-shifting InDels tolerated following selection to maintain protein function. We found that InDels repeatedly occurred, and were bypassed, within homonucleotide repeats of 3-8 bases. The longer the repeat, the higher was the frequency of InDels formation, and the more frequent was their bypass. Besides an expected 8A repeat, other types of repeats, including short ones, and G and C repeats, were bypassed. Although obtained in vitro, our results indicate a direct link between the genetic occurrence of InDels and their phenotypic rescue, thus suggesting a potential role for frame-shifting InDels as bridging evolutionary intermediates.
Topics: Amino Acid Sequence; Base Sequence; Directed Molecular Evolution; Escherichia coli; Frameshift Mutation; INDEL Mutation; Mutagenesis, Insertional; Plasmids; Protein Biosynthesis; Repetitive Sequences, Nucleic Acid; Sequence Deletion
PubMed: 24204297
DOI: 10.1371/journal.pgen.1003882 -
Neurology India 2018Results of and the complications encountered during surgery for very large and giant intracranial aneurysms are illustrated.
BACKGROUND
Results of and the complications encountered during surgery for very large and giant intracranial aneurysms are illustrated.
OBJECTIVE
To analyze a consecutive series of patients with very large and giant aneurysms treated with microsurgery.
METHODS
This retrospective study included seventy six very large and giant aneurysms which were managed by clipping and bypass technique. Sixty two (82%) aneurysms were located in anterior circulation, and 14 (18%) aneurysms were located in posterior circulation. The bypasses performed included local bypasses, extra-intracranial bypasses, double bypasses and combination techniques of external carotid-internal carotid (EC-IC) bypass and local bypasses.
RESULTS
73 patients with 76 aneurysms were treated over 13 years. There were 44 very large and 32 giant aneurysms. Twenty-four patients presented with subarachnoid hemorrhage [SAH] (32%) while forty nine patients with 52 aneurysms (68%) were unruptured. These 73 patients underwent 63 bypass procedures with aneurysm occlusion and 13 clipping procedures. Out of 62 anterior circulation aneurysms, bypass surgery was performed in 49 patients while 13 underwent clipping. In posterior circulation aneurysms, all patients were treated with bypass procedures with proximal occlusion or trapping. In the ruptured group, 16 (67%) patients had postoperative modified Rankin Scale (mRs) 0-2, six patients (25%) had mRs 3-5, and two patients (8.4%) died. In the unruptured group, 45 patients (87%) had mRs 0-2, 3 patients (6%) had mRs 3-5, and four patients (7.6%) died.
CONCLUSIONS
In this large series of very large and giant aneurysms treated with microsurgical clipping and bypasses, excellent results were obtained in the long term, in regards to aneurysm occlusion, functional status, and graft patency. Our experience will be very useful to other neurosurgeons who treat these complex lesions.
Topics: Aneurysm, Ruptured; Female; Humans; Intracranial Aneurysm; Male; Microsurgery; Neurosurgical Procedures; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 30504576
DOI: 10.4103/0028-3886.246291 -
Annals of Vascular Diseases Jun 2022The great saphenous vein is the conduit of choice for femoropopliteal or infrapopliteal bypass, but it is traditionally recommended that varicose vein grafts (VVGs)...
The great saphenous vein is the conduit of choice for femoropopliteal or infrapopliteal bypass, but it is traditionally recommended that varicose vein grafts (VVGs) should not be used for bypass conduits owing to the risk of immediate rupture or long-term aneurysmal change. Herein, we report two cases of femoropopliteal bypass with VVGs. They achieved primary patency without aneurysmal formation after 32 and 17 months. Therefore, VVGs without morphologically conspicuous abnormalities are worth considering for usage as a vein graft.
PubMed: 35860823
DOI: 10.3400/avd.cr.21-00120 -
Inquiry : a Journal of Medical Care... 2019The outpatient sector represents a growing share of health care. This review examines how patients choose their physician for continuous outpatient care and why they are... (Review)
Review
The outpatient sector represents a growing share of health care. This review examines how patients choose their physician for continuous outpatient care and why they are willing to bypass the nearest physician. It was conducted according to the PRISMA extension for scoping reviews (PRISMA-ScR). Three databases (PubMed/Medline, ScienceDirect, and Ovid Medline) were searched, focusing on articles in which distance influenced the choice of physician. In all, 1,308 articles were accessed, and 17 selected for final review. First, we extracted methods for assessing distance traveled and bypassing. Second, we identified determinants that directly influence the traveled distance and transferred all into a conceptual framework. The center of this framework is the individual "willingness-to-go", which reflects the willingness of patients to accept additional distances. Our findings can support studies on patient mobility and physician choice, which are essential for examining both the distribution and use of medical services, as well as for adequate need related planning.
Topics: Ambulatory Care; Choice Behavior; Health Services Accessibility; Health Services Research; Humans; Patient Satisfaction; Professional-Patient Relations; Travel
PubMed: 31375038
DOI: 10.1177/0046958019865434 -
Annals of Surgery May 1978Controversy continues regarding the optimal surgical treatment of Crohn's disease involving the ileum and cecum. Over 43-years, 161 patients underwent primary surgery...
Controversy continues regarding the optimal surgical treatment of Crohn's disease involving the ileum and cecum. Over 43-years, 161 patients underwent primary surgery for this disease at The New York Hospital-Cornell Medical Center. Resection was performed in 115 patients, bypass with exclusion in 25, and side-to-side ileotranverse colostomy in 21. Overall recurrence rates were 25% for resection, 63% for bypass with exclusion, and 75% for simple bypass. Expressed as 15 year follow-up, recurrence rate were 65% for resection, 82% for bypass with exclusion, and 94% for simple bypass. Much of the difference in final outcome was accounted for by early recurrence or by persistent disease in the two bypass groups. This amounted to 21% for the bypass with exclusion and 45% for simple bypass as compared to 3% for patients who had resection. Conclusions from this review are that 1) resection can be performed with a morbidity and mortality equivalent to either of the bypass procedures; 2) the recurrence rat following resection is significantly lower than bypass with exclusion or simple bypass, and amounts to about 4% per year; 3) continuing disease in the bypassed loop accounts for a high percentage of reoperations in the bypass groups, while appearance of new disease is the usual problem following resection; 4) resection is the surgical treatment of choice for ileocecal Crohn's disease.
Topics: Adult; Colostomy; Crohn Disease; Evaluation Studies as Topic; Follow-Up Studies; Humans; Intestinal Fistula; Postoperative Complications; Recurrence
PubMed: 646491
DOI: 10.1097/00000658-197805000-00011 -
Journal of Vascular Surgery Apr 2018Technical progress in angioplasty expanded its application to very distal arterial lesions of the lower extremity. In cases of unsuccessful angioplasty tibiodistal...
OBJECTIVE
Technical progress in angioplasty expanded its application to very distal arterial lesions of the lower extremity. In cases of unsuccessful angioplasty tibiodistal bypass surgery may be required for limb salvage. We investigated the long-term outcome of this technique in patients with critical limb ischemia. The purpose of this study was to evaluate whether tibiodistal bypasses done after unsuccessful tibial angioplasty had inferior patency, limb salvage, or survival rates compared with primary tibiodistal bypasses.
METHODS
This single-center, retrospective data analysis included all distal bypass procedures originating from a tibial artery. Primary study end points were primary patency, secondary patency, and limb salvage. Secondary end points included survival, wound healing, and systemic and local complications. Society for Vascular Surgery reporting standards were applied.
RESULTS
There were 61 tibiodistal vein bypasses for critical limb ischemia performed in 23 years. Indications for tibiodistal bypass was Rutherford category 5 in 41 cases (67%) and category 6 in 20 cases (33%). Procedures were allocated to group A (primary bypass; n = 28) and group B (bypass after unsuccessful tibial angioplasty; n = 33). Primary patency was 55% versus 53% at 1 year and 47% versus 44% at 3 years (P = .58). Secondary patency was 59% versus 64% at 1 year and 52% versus 55% at 3 years (P = .36). Limb salvage was 96% versus 90% at 1 year and 91% versus 85% at 3 years (P = .44). Overall survival rates were 91% versus 97% at 1 year and 85% versus 92% at 3 years (P = .76). The median follow-up was 4.0 years in group A and 4.9 years in group B. In multivariate analyses for loss of primary patency and limb loss, no significant predictors could be identified.
CONCLUSIONS
This study showed that tibiodistal vein bypass is a feasible, efficient, and safe technique in patients with critical limb ischemia. It provides acceptable primary and secondary patency rates to prevent major amputation and ensure survival. Previous unsuccessful tibial angioplasty had no significant impact on tibiodistal vein bypass outcome. This technique should be part of the armamentarium of vascular surgeons.
Topics: Aged; Aged, 80 and over; Angioplasty; Austria; Critical Illness; Female; Humans; Ischemia; Kaplan-Meier Estimate; Limb Salvage; Lower Extremity; Male; Middle Aged; Peripheral Arterial Disease; Proportional Hazards Models; Retrospective Studies; Risk Factors; Tibial Arteries; Time Factors; Vascular Grafting; Vascular Patency; Veins; Wound Healing
PubMed: 28964617
DOI: 10.1016/j.jvs.2017.07.127 -
DNA Repair Dec 2021DNA lesion bypass facilitates DNA synthesis across bulky DNA lesions, playing a critical role in DNA damage tolerance and cell survival after DNA damage. Assessing...
DNA lesion bypass facilitates DNA synthesis across bulky DNA lesions, playing a critical role in DNA damage tolerance and cell survival after DNA damage. Assessing lesion bypass efficiency in the cell is important to better understanding of the mechanism of carcinogenesis and chemoresistance. Here we developed a chromatin immunoprecipitation (ChIP)-based method to measure lesion bypass activity across cisplatin-induced intrastrand crosslinks in cancer cells. DNA lesion bypass enables the replication to continue in the presence of replication blocks. Thus, the successful lesion bypass should result in the coexistence of DNA lesions and the newly synthesized DNA fragment opposite to this lesion. Using ChIP, we precipitated the cisplatin-induced intrastrand crosslinks, and quantitated the precipitated newly synthesized DNA that was labeled with BrdU. We validated this method on ovarian cancer cells with inhibited TLS activity. We then applied this method to show that ovarian cancer stem cells exhibit high lesion bypass activity relative to bulk cancer cells from the same cell line. In conclusion, this novel ChIP-based lesion bypass assay can detect the extent to which cisplatin-induced DNA lesions are bypassed in live cells. Our study may be applied more broadly to the study of other DNA lesions, as specific antibodies to these specific lesions are available.
Topics: Chromatin Immunoprecipitation; DNA; DNA Damage; DNA Repair; DNA Replication; DNA-Directed DNA Polymerase
PubMed: 34571449
DOI: 10.1016/j.dnarep.2021.103230 -
Frontiers in Surgery 2022Chronic internal carotid artery occlusion (CICAO) has high prevalence and incidence rates, and patients with CICAO can be completely asymptomatic, experience a... (Review)
Review
Spotlight on clinical strategies of Chronic Internal Carotid Artery Occlusion: Endovascular interventions and external-intracarotid bypasses compared to conservative treatment.
Chronic internal carotid artery occlusion (CICAO) has high prevalence and incidence rates, and patients with CICAO can be completely asymptomatic, experience a devastating stroke or die. It is important to note that CICAO causes cerebrovascular accidents. Currently, the external carotid-internal carotid (EC-IC) bypass technique is used to treat CICAO. However, many clinical studies showed that EC-IC bypass was not beneficial for many patients with CICAO. Meanwhile, endovascular intervention treatment options for CICAO are evolving, and an increasing number of patients are undergoing endovascular intervention therapy. Accordingly, a review comparing both techniques is warranted. For this review, we searched PubMed and collected relevant case study reports comparing endovascular interventional therapy and internal and external cervical bypass surgeries to provide strategies for clinical treatment.
PubMed: 36425889
DOI: 10.3389/fsurg.2022.971066