Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Verebral arteries anatomical lesions: diagnostic and therapeutic approach: correlation of vertebral artery disease with coronary artery disease

This MD thesis deals with the diagnosis and treatment of vertebral artery stenosis. We studied 95 patients, 81 of them were male and 14 female, with a mean age of 67±8.We also studied the correlation between vertebral artery atheromatosis and coronary artery disease.For assessing the above we used ultrasound (Doppler) and digital angiography .We also used intracranial Doppler, brain CT scan and brain MRI before and after angioplasty and brain oxymetry during PTA.All the patients underwent coronary angiography as well.In addition we submitted 250 patients with proven coronary artery disease to duplex scan of supraortic vessels in order to diagnose concomitant vertebral and carotid artery stenosis.We controlled all risk factors for atheromatosis with medical therapy and subscribed to all patients statins in order for LDL cholesterol levels to be <100mg/dl.We followed the patients at 1, 3, 6, 12 months and every year after that, with ultrasound with a mean surveillance of 48.4 ±16.2 months and in asymptomatic patients who did not undergo PTA we assessed the diameter and the echolucency of the stenosis.The percentages of complications were 1.5% TIA and there was no event of myocardial infarction or death during PTA. This, along with other results, documented that vertebral artery angioplasty can take place in: Symptomatic patients with major bilateral vertebral artery stenosis or with stenosis of the dominant vertebral artery and ischemia of the cerebral artery.Asymptomatic patients with major bilateral vertebral artery stenosis or vertebral artery stenosis with internal carotid artery stenosis.Moreover the results given by ultrasound for the diagnosis of vertebral artery stenosis were the same as those using digital angiography which should be always done in patients with severe stenosis that are candidates for angioplasty.Finally vertebral artery stenosis comes out to be a prognostic factor for the existence of coronary artery disease.Στη διατριβή αυτή προσεγγίσαμε διαγνωστικά και θεραπευτικά την στένωση των σπονδυλικών αρτηριών με την μελέτη 95 ασθενών με στένωση σπονδυλικών αρτηριών, 81 άνδρες και 14 γυναίκες ηλικίας 59-76 ετών. Ακολούθως ασχοληθήκαμε με την συσχέτιση της αθηρωμάτωσης των σπονδυλικών αρτηριών με την στεφανιαία νόσο. Ο ανωτέρω σκοπός πραγματοποιήθηκε με την αξιολόγηση των στενώσεων με το κλασσικό υπερηχογράφημα (Doppler) και την ψηφιακή αγγειογραφία. Επίσης σε όλους τους ασθενείς της μελέτης εφαρμόσαμε έγχρωμο διακράνιο υπέρηχο (Doppler) και στις περιπτώσεις που χρησιμοποιήθηκε εγκεφαλική προστασία κατά την αγγειοπλαστική, έγινε εργαστηριακή ανάλυση και επεξεργασία του αθηρωθρομβοτικού υλικού που αποκολλήθηκε κατά την διάρκεια της αγγειοπλαστικής των σπονδυλικών από την πλάκα της στένωσης. Μελετήσαμε την αξονική (CT) και μαγνητική (MRI) τομογραφία του εγκεφάλου πριν και μετά την αγγειοπλαστική των σπονδυλικών και εφαρμόσαμε εγκεφαλική οξυμετρία για την παρακολούθηση του ποσοστού κορεσμού της οξυαιμοσφαιρίνης στο φλεβικό αίμα σε συγκεκριμένη περιοχή του εγκεφάλου κατά την αγγειοπλαστική και τοποθέτηση stent στις σπονδυλικές αρτηρίες.Για την μελέτη του συσχετισμού τις στένωσης της σπονδυλικής αρτηρίας με την στεφανιαία νόσο υποβάλαμε τους 95 ασθενείς της μελέτης σε στεφανιογραφία πριν την αγγειοπλαστική της σπονδυλικής αρτηρίας. Επίσης υποβάλαμε 250 ασθενείς με τεκμηριωμένη στεφανιαία νόσο σε υπέρηχο (Duplex scan) υπεραορτικών αγγείων προκειμένου να διαγνωστεί ο αριθμός των πασχόντων με συνυπάρχουσα στένωση των σπονδυλικών αρτηριών και των καρωτίδων. Ρυθμίσαμε φαρμακευτικά τους παράγοντες κινδύνου για την αθηρωματική νόσο, και κυρίως χορηγήσαμε στατίνες σε όλους τους ασθενείς της μελέτης προκειμένου να ρυθμιστούν τα επίπεδα της LDL χοληστερίνης <100 mg/dL. Ακολούθως παρακολουθήσαμε τους ασθενείς με υπέρηχο 1,3,6 και 12 μήνες και ακολούθως ανά έτος με μέση παρακολούθηση των ασθενών 48,4 ± 16,2 μήνες και στους ασυμπτωματικούς ασθενείς που δεν υποβλήθηκαν σε αγγειοπλαστική καταγράφαμε την διάμετρο και την ηχογένεια της στένωσης στις σπονδυλικές αρτηρίες. Το ποσοστό των επιπλοκών ήταν 1,5% (T.I.A) και δεν σημειώθηκε έμφραγμα μυοκαρδίου ή θάνατος κατά την αγγειοπλαστική. Αυτό μαζί με τα άλλα αποτελέσματα που είχαμε έδειξαν ότι αγγειοπλαστική των σπονδυλικών αρτηριών μπορεί να είναι εφικτή σε •Συμπτωματικούς ασθενείς με σημαντική:Στένωση σπονδυλικών αρτηριών άμφωΣτένωση της επικρατούσας σπονδυλικής αρτηρίας με ισχαιμία στην πρόσθια η οπίσθια εγκεφαλική αρτηρία•Ασυμπτωματικοί ασθενείς με σημαντική : Στένωση σπονδυλικών αρτηριών άμφωΣτένωση σπονδυλικής σε ασθενείς που χρειάζονται παράπλευρη υποστήριξη της κυκλοφορίας (Στενώσεις έσω καρωτίδων)Τέλος από τα αποτελέσματα της παρούσης διατριβής παρατηρούμε ότι η διάγνωση της στένωσης των σπονδυλικών αρτηριών με την χρήση των υπερήχων μας δίνει ικανοποιητικά και αξιόπιστα αποτελέσματα ίδια με τα αποτελέσματα της ψηφιακής αγγειογραφίας. Επιπλέον με το υπέρηχο (Dupplex scan) γίνεται μελέτη των χαρακτηριστικών των αθηρωματικών βλαβών για τον καθορισμό του βαθμού επικινδυνότητας της στένωσης κατά την αγγειοπλαστική των σπονδυλικών αρτηριών

New distal embolic protection device the fibernet (R) - 3 dimensional filter: First carotid human study

Objective: Evaluate the performance and safety of the FiberNet (R) Embolic Protection System during carotid artery intervention. Background: Carotid Angioplasty and Stenting (CAS) can be proposed to treat the majority of carotid stenoses. Brain embolization takes place and routine use of Embolic Protection Devices (EPD) is warranted. Many EPDs have significant limitations, which may be addressed by a new EPD, the FiberNet (R) (Lumen Biomedical, Plymouth, MN). Methods: The system consists of a 3-dimensional expandable filter made of fibers, which expand radially, mounted onto a 0.014 ‘’ wire and retrieval catheter. FiberNet can capture particles as small as 40 mu m without compromising flow. Results: 35 lesions treated in 34 patients. Male 67.6%. Age: 71.4 +/- 8.8 (50-85). Average stenosis 84.5% +/- 7.9 (70-99). 29.4% were symptomatic. Technical success: 34/35 (97%). No stroke or death within 30 days. Neurological events: two permanent amaurosis, one amaurosis fugax. All samples visually contained significant amounts of emboli. The mean surface area of debris caught was 63.8 mm(2) (37.7-107.5). Comparisons were made with other EPDs. The mean surface area of debris caught was 12.2 mm(2) (2.7-34.3). No changes were noted in CT/MRI at 30-day post procedure. Conclusion: The first human use of this new novel EPD in carotid artery stenting is encouraging. The FiberNet was easy to use and confirmed the ability to capture particles less than 100 Rm. The feasibility of the FiberNet has been demonstrated. Additional patients will demonstrate the overall safety and efficacy of this new EPD device. (C) 2007 Wiley-Liss, Inc

Endovascular Treatment of Aneurysm With Side Branches - A Simple Method. Myth or Reality?

PURPOSE: The aim of this study is to present performance data on the use of the multilayer stent which is a 3-dimensional (3D) braided mesh made of interconnected layers, particularly in patients with side branches within the aneurysm. METHODS:&nbsp;&nbsp;A study protocol was designed to examine the safety and efficacy of the multilayer stent in patients with aneurysms in different target vessels. Between December 2006 and November 2009, 19 patients were enrolled in the study. Four patients had a renal aneurysm (1 male / 3 females) (mean diameter: 18 mm), while the other 15 patients (all males) had iliac artery (n=12, mean diameter: 25 mm),&nbsp; popliteal artery (n=1, diameter: 55 mm), thoracic aorta (n=1, diameter: 57mm) and abdominal aorta (n=1, diameter: 97.3 mm) aneurysms. RESULTS: The multilayer stent was successfully deployed in all patients (100% technical success); Mean follow-up for the peripheral aneurysms was 28 months (range 12 to 36) and for the aortic aneurysms was 3 months. The occlusion rate of the aneurysm at the peripheral arteries was 100% and all the side branches remained patent. For the thoracic and the abdominal aneurysms, the 3 months computed tomography angiography (CTA) showed patent artery side branches and reduced blood flow inside the sac. CONCLUSION: The multilayer stent seems to be efficient with regard to the side branches which remain patent and the aneurysm is excluded. The question remains about the time needed to achieve the exclusion of the aneurysm in large arteries such as the thoracic and abdominal aorta; we believe this is related to the number and size of the branches within the aneurysm as well as the size of the target vessel itself. A larger multi center study is needed to confirm the suitability of the multilayer stent for the large thoracic, abdominal and thoracoabdominal aneurysms

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)