-
Journal of Vascular Surgery Oct 2022Emergent endovascular repair of suprarenal (SRAAAs) and thoracoabdominal aortic aneurysms (TAAAs) poses a significant challenge due to the need for branch vessel...
Comparative early results of in situ fenestrated endovascular aortic repair and other emergent complex endovascular aortic repair techniques for ruptured suprarenal and thoracoabdominal aortic aneurysms at a regional aortic center.
INTRODUCTION
Emergent endovascular repair of suprarenal (SRAAAs) and thoracoabdominal aortic aneurysms (TAAAs) poses a significant challenge due to the need for branch vessel incorporation, time constraints, and lack of dedicated devices. Techniques to incorporate branch vessels have included parallel grafting, physician-modified endografts, double-barrel/reversed iliac branch device, and in situ fenestration (ISF). This study describes a single-center experience and the associated outcomes when using these techniques for ruptured SRAAAs and TAAAs.
METHODS
A retrospective review of patients who underwent endovascular repair of ruptured SRAAAs and TAAAs from July 2014 to March 2021 with branch vessel incorporation was performed. Clinical presentation, intraoperative details, and postoperative outcomes of those who underwent ISF were compared with those who underwent repair using non-ISF techniques. The primary outcome of interest was in-hospital mortality. Secondary outcomes were major adverse events including myocardial infarction, respiratory failure, renal dysfunction, new onset dialysis, bowel ischemia, stroke, and spinal cord ischemia.
RESULTS
Forty-two patients underwent endovascular repair for ruptured SRAAAs and TAAAs, 18 of whom underwent ISF repair. Seventy-two percent of ISF patients were hypotensive before surgery, compared with 46% of the patients who underwent repair using non-ISF techniques (physician-modified endografts, parallel grafting, or double-barrel/reversed iliac branch device). The total procedural and fluoroscopy times were similar between the two groups despite a greater mean number of branch vessels incorporated with the ISF technique (3.1 vs 2.2 per patient, P = .015). In-hospital mortality was 19% for all ruptures and 25% for ruptures with hypotension. Compared with the non-ISF group, in-hospital mortality trended lower in the ISF group (11% vs 25%, P = .233), reaching statistical significance when comparing patients who presented with hypotension (8% vs 45%, P = .048). The rate of major adverse events was 57% across all techniques and did not significantly differ between the ISF and non-ISF groups, with postoperative renal dysfunction being the most frequent complication (48%). Overall, ISF became the most commonly used technique later in the study period.
CONCLUSIONS
Although emergent endovascular repair of ruptured SRAAAs/TAAAs remains a challenge, a number of techniques are available for expeditious treatment. In this series, ISF was associated improve survival, including a fivefold reduction in mortality in patients presenting with hypotension, and has now become the dominant technique at our center. Despite these advantages, postoperative complications and reinterventions are common. Further experience and longer-term follow-up are needed to validate these initial results and assess durability.
Topics: Aortic Aneurysm, Thoracic; Aortic Rupture; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Hypotension; Kidney Diseases; Postoperative Complications; Prosthesis Design; Risk Factors; Time Factors; Treatment Outcome
PubMed: 35697311
DOI: 10.1016/j.jvs.2022.04.036 -
Joint Diseases and Related Surgery 2022Spontaneous rupture of quadriceps tendon (QT) is a rare condition and it is commonly associated with systemic comorbidities and medical products assumption, which may...
Spontaneous rupture of quadriceps tendon (QT) is a rare condition and it is commonly associated with systemic comorbidities and medical products assumption, which may lead to tendon degeneration. While unilateral rupture is a quite common injury, spontaneous bilateral ruptures are very rare. Herein, we report two consecutive cases of spontaneous bilateral QT rupture in two patients with a positive history of chronic statin use, successfully treated with bilateral single-stage reconstruction with polyethylene-terephthalate tape augmentation. At 12 months of follow-up, both patients recovered the full extension, a 120° pain-free flexion and knee scores improvement. Magnetic resonance imaging at one year showed a complete, bilateral, bio-integration of the augmentation for each knee. In conclusion, polyethylene terephthalate tape augmentation provides a good structural support with a good grade of bio-integration, allowing a fast recovery.
Topics: Humans; Rupture, Spontaneous; Polyethylene Terephthalates; Tendon Injuries; Rupture; Tendons
PubMed: 36345196
DOI: 10.52312/jdrs.2022.764 -
Medicina (Kaunas, Lithuania) Apr 2023(1) : Achilles tendon rupture is a common sports injury that may result in severe disability. The overall incidence of Achilles tendon rupture is increasing as a result...
(1) : Achilles tendon rupture is a common sports injury that may result in severe disability. The overall incidence of Achilles tendon rupture is increasing as a result of growing sports participation. However, cases of spontaneous bilateral Achilles tendon rupture with no underlying disease or risk factors, such as systemic inflammatory disease, steroid or (fluoro)quinolone antibiotics use, are rare. (2) : Here, we report a case of a Taekwondo athlete's bilateral Achilles tendon rupture after kicking and landing. By sharing the experience of treatment and the patient's course, we suggest one of the possible treatment options and the need to establish a treatment method. (3) : A 23-year-old male Taekwondo athlete visited the hospital, presenting foot plantar flexion failure and severe pain in both tarsal joints, which had occurred upon kicking and landing on both feet earlier that day. During surgery, no degenerative changes or denaturation were observed in the ruptured areas of the Achilles tendons. Bilateral surgery was performed using the modified Bunnel method on the right side and minimum-section suturing on the left side was performed using the Achillon system, followed by lower limb casting. (4) : Good outcomes were observed on both sides at 19 months postoperatively. (5) : The possibility of bilateral Achilles tendon rupture during exercise in young subjects with no risk factors should be acknowledged, especially in association with landing. In addition, in athletes, even if there is a possibility of complications, surgical treatment should be considered for functional recovery.
Topics: Male; Humans; Young Adult; Adult; Achilles Tendon; Treatment Outcome; Tendon Injuries; Rupture; Rupture, Spontaneous; Ankle Injuries
PubMed: 37109691
DOI: 10.3390/medicina59040733 -
BMJ Case Reports Sep 2020
Topics: Accidents, Traffic; Adolescent; Humans; Intubation, Intratracheal; Laryngoscopy; Male; Motorcycles; Pneumothorax; Rupture; Subcutaneous Emphysema; Trachea; Trachelectomy
PubMed: 32928817
DOI: 10.1136/bcr-2020-238895 -
A 12-year experience of endovascular repair for ruptured abdominal aortic aneurysms in all patients.Journal of Vascular Surgery Mar 2023Endovascular aneurysm repair (EVAR) has been increasingly performed for ruptured abdominal aortic aneurysms (rAAAs). However, multiple randomized trials have failed to... (Observational Study)
Observational Study
OBJECTIVE
Endovascular aneurysm repair (EVAR) has been increasingly performed for ruptured abdominal aortic aneurysms (rAAAs). However, multiple randomized trials have failed to demonstrate a survival benefit compared with open aortic surgery. During a 12-year period, 100% of patients without a history of aneurysm surgery had undergone EVAR for a rAAA at Örebro University Hospital, with no emergent open aortic surgery performed. In the present study, we evaluated the mortality and technical success during this "EVAR-only" period.
METHODS
A single-center, retrospective observational study was conducted. We identified all patients who had presented to Örebro University Hospital with a rAAA between October 2009 and September 2021. Patients with isolated iliac artery, thoracic, and thoracoabdominal aortic ruptures were not included. Patients who had received previous aortic interventions (open or endovascular) and patients who had received palliative treatment instead of surgical intervention were also excluded. The patient characteristics, perioperative and postoperative data, and mortality rate were investigated.
RESULTS
EVAR had been performed in 100 patients. Preoperative hemodynamic instability had been present in 54 patients (54%), and 18 (18%) had undergone aortic balloon occlusion. The aneurysm location was infrarenal in 89 patients (89%). Bifurcated stent grafts had been used in 97 patients (97%), and adjunct endovascular techniques had been used for 27 patients (27%). Of 98 patients, EVAR had been performed with the patient under local anesthesia for 62 patients (63%). Peri- and postoperative complications at 30 days had occurred in 20 of 100 patients (20%) and 22 of 79 patients (28%), respectively. The overall mortality at 30 days was 27% (27 of 100 patients), and the mortality for those with an isolated infrarenal rAAA was 24% (21 of 89 patients). The overall mortality at 1 year was 39% (39 of 100 patients) and for those with an isolated infrarenal rAAA was 37% (33 of 89 patients). The presence of preoperative hemodynamic instability and the use of ABO were statistically significantly and independently associated with increased 30-day mortality on multivariate logistic regression analysis.
CONCLUSIONS
All 100 patients who had undergone surgery for a rAAA had been treated using EVAR and endovascular adjuncts, with a relatively low mortality rate, thus continuing the "EVAR-only" approach. A low proportion of rAAA patients were considered surgically unsuitable. These findings support the applicability of EVAR for the treatment of all rAAAs at suitable centers.
Topics: Humans; Aortic Rupture; Blood Vessel Prosthesis Implantation; Aortic Aneurysm, Abdominal; Endovascular Procedures; Treatment Outcome; Time Factors; Postoperative Complications; Retrospective Studies; Risk Factors
PubMed: 37276170
DOI: 10.1016/j.jvs.2022.10.032 -
Knee Surgery, Sports Traumatology,... Jul 2018Patient reported outcome measures (PROMs) are increasingly being used in clinical research. The Achilles tendon Total Rupture Score (ATRS) is a PROM designed to assess...
PURPOSE
Patient reported outcome measures (PROMs) are increasingly being used in clinical research. The Achilles tendon Total Rupture Score (ATRS) is a PROM designed to assess outcomes in patients with ruptures of the Achilles tendon. The aim of this study was to develop a Norwegian adaption of the ATRS and evaluate its validity and reliability.
METHODS
The ATRS was translated into Norwegian in accordance with recommended guidelines. The study included 94 patients treated for Achilles tendon ruptures from January 2010 until February 2013, and the web-based questionnaires were administered twice. Reliability was assessed by Cronbach's alpha, the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). Construct validity was evaluated by calculating the Spearman's correlation coefficient with the five subclasses of the Foot and Ankle Outcome Score (FAOS), the SF-36 subclass physical function and the SF-36 physical and mental summary scores.
RESULTS
Both internal consistency (Cronbach's alpha = 0.96) and test-retest reliability (ICC = 0.90) were excellent, and the MDC was 2.12 at the group level and 16.98 at the individual level. Construct validity was supported by Spearman's correlation coefficients above 0.7 with the SF-36 subclass physical function and the SF-36 physical summary score as well as the FAOS subclasses Sport/Rec and quality of life. There was no floor effect, and 6 patients (6.4%) achieved a maximum score of 100.
CONCLUSIONS
The Norwegian adaption of the ATRS demonstrates acceptable validity and reliability for use in the Norwegian population to assess clinical outcomes in patients with Achilles tendon ruptures.
Topics: Achilles Tendon; Adult; Female; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Quality of Life; Reproducibility of Results; Rupture; Surveys and Questionnaires; Tendon Injuries; Translations
PubMed: 28823061
DOI: 10.1007/s00167-017-4689-1 -
Journal of the American Veterinary... Aug 2008To characterize ruptures of collateral ligaments (CLs) in metacarpophalangeal and metatarsophalangeal joints in horses.
OBJECTIVE
To characterize ruptures of collateral ligaments (CLs) in metacarpophalangeal and metatarsophalangeal joints in horses.
DESIGN
Retrospective case series.
ANIMALS
17 horses with ruptured CLs.
PROCEDURES
Data were obtained from medical records, including signalment, history, clinical signs, ultrasonographic and radiographic findings, treatment, and outcome. Additional follow-up information was obtained from owners or referring veterinarians.
RESULTS
The lateral CL was ruptured in 11 horses; the medial CL was ruptured in 6 horses. Ultrasonography revealed ipsilateral rupture of the short and long components of the CL in 11 horses and rupture of only 1 component in 6 horses. No biaxial ruptures were detected, but 9 horses had desmitis of the CL on the nonruptured side of the affected joint. All horses were lame (lameness score range, 2/5 to 4/5). Joint instability was palpable in 9 horses; only 4 horses had episodes of joint luxation. Avulsion fractures were identified radiographically in 6 horses and ultrasonographically in another 2 horses. Stress radiography revealed joint instability in 10 horses. Horses were managed by stall confinement, limb immobilization, and gradual return to exercise. Eight horses returned to riding, 2 resumed breeding, 2 were retired, 2 were euthanized, and 3 were doing well 86 to 139 days after injury.
CONCLUSIONS AND CLINICAL RELEVANCE
Ultrasonographic examination is indicated in horses with acute lameness and swelling at the metacarpophalangeal or metatarsophalangeal joint, particularly when stress radiography cannot be performed or findings are equivocal. Affected horses can be conservatively managed. Prognosis for athletic use may be better than originally believed.
Topics: Animals; Casts, Surgical; Collateral Ligaments; Female; Horses; Lameness, Animal; Male; Metacarpophalangeal Joint; Metatarsophalangeal Joint; Radiography; Retrospective Studies; Rupture; Treatment Outcome; Ultrasonography
PubMed: 18673033
DOI: 10.2460/javma.233.3.456 -
Australian Journal of General Practice Nov 2020The prevalence of acute and chronic conditions of the Achilles tendon is increasing among an ageing, active population. These conditions are a common cause of...
BACKGROUND
The prevalence of acute and chronic conditions of the Achilles tendon is increasing among an ageing, active population. These conditions are a common cause of presentation to general practitioners and allied health practitioners. Achilles tendon injuries have a bimodal demographical presentation, with acute injuries commonly occurring in younger people and chronic conditions presenting in patients who are elderly.
OBJECTIVE
The aims of this article are to discuss management of acute Achilles tendon ruptures in the primary care setting, explain the risks associated with calcaneal tuberosity fracture and discuss non-operative and surgical management of acute and chronic overload conditions of the Achilles tendon.
DISCUSSION
Achilles tendon injuries can be divided into acute ruptures and chronic overuse injuries. Both can be debilitating, with significant morbidity for patients; fortunately, both types of injuries respond well to non-operative interventions, with only a small proportion requiring surgery. Management of acute Achilles tendon rupture has evolved, with increasing evidence that non-operative management is appropriate providing patients participate in a functional rehabilitation protocol. Chronic conditions such as the sequalae of an untreated rupture or Achilles tendinopathy can be debilitating but often respond well to non-operative management.
Topics: Achilles Tendon; Chronic Disease; Foot Orthoses; Humans; Rupture; Tendon Injuries
PubMed: 33123713
DOI: 10.31128/AJGP-07-20-5506 -
Asian Pacific Journal of Tropical... May 2012To compare the effect of surgical intervention on functional treatment. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To compare the effect of surgical intervention on functional treatment.
METHODS
By searching the MEDLINE (1966 to October 2011), EMBASE (1980 to October 2011), the Chinese Biomedical Database Databases (1980 to October 2011), a total of 9 related RCT studies comparing surgical intervention with functional treatment were included in our study. RevMan software was taken to analyze the data.
RESULTS
These 9 studies involved a total of 1 268 mostly young adults, including 580 patients with surgical treatment and 688 patients with functional treatment. The results showed the stability of ankle activity in surgical treatment group was better than that in functional treatment group, with the OR and 95% CI of 0.72 (0.52-0.99). No significant difference was found in the recurrence of the surgical and functional group. However, the movement disorder in the surgical treatment suggested increased risk than that in functional group, with the OR and 95% CI of 2.39 (0.98-5.85). Surgical group found more complication than the function group, such as deep vein thrombosis, deep venous thrombosis, tenderness of scar and sensory loss.
CONCLUSIONS
In conclusion, our finding showed that surgical treatment could gain better efficacy than functional treatment, but may bring more complication. Therefore, further large sample size RCT is warranted.
Topics: Adolescent; Adult; Humans; Lateral Ligament, Ankle; Middle Aged; Randomized Controlled Trials as Topic; Recovery of Function; Recurrence; Rupture; Treatment Outcome; Young Adult
PubMed: 22546658
DOI: 10.1016/S1995-7645(12)60066-2 -
BMC Musculoskeletal Disorders Mar 2021Despite the literature on acute Achilles tendon ruptures, there remains a lack of consensus regarding the optimal treatment. The purpose of this survey study was to...
BACKGROUND
Despite the literature on acute Achilles tendon ruptures, there remains a lack of consensus regarding the optimal treatment. The purpose of this survey study was to investigate treatment preferences among Army orthopaedic surgeons when presented with a standardized case of an acute Achilles rupture and determine if surgeon factors correlated with treatment preference.
METHODS
A hypothetical case of a 37-year-old male with history, physical exam, and imaging consistent with an Achilles rupture was sent to board-certified Army orthopaedic surgeons to determine their preferred management. Demographic data was collected to include: practice setting, years from residency graduation, and completion of fellowship. Correlations analyzed between demographics and treatment preferences.
RESULTS
Sixty-two surgeons responded. 62% of respondents selected surgical intervention. Of these, 59% chose a traditional open technique. 50% of respondents were general orthopaedic. There was a correlation between fellowship training and operative management (P = 0.042). Within the operative management group there was no statistical difference (P > 0.05) in need for further imaging, technique used, post-operative immobilization, length of immobilization, weight-bearing protocol, and time to release to running. The majority of non-operative responders would splint/cast in plantarflexion or CAM boot with heel lift for < 3 weeks (50%) and keep non-weight bearing for < 4 weeks (63%). Only 38% of respondents would use DVT chemoprophylaxis.
CONCLUSION
When provided with a hypothetic case of an acute Achilles tendon rupture, queried Army orthopaedic surgeons would more often treat with a surgical procedure. This difference in treatment is secondary to training, fellowship or other. This propensity of surgical management, likely stems from the highly active population and the desire to return to duty.
Topics: Achilles Tendon; Adult; Humans; Male; Orthopedic Surgeons; Rupture; Surveys and Questionnaires; Tendon Injuries; Treatment Outcome
PubMed: 33706741
DOI: 10.1186/s12891-021-04121-y