A case report of retrograde suction decompression of a large paraclinoid aneurysm

Surgical clipping of large Paraclinoidal IC (Internal carotid) aneurysm pose a great challenge as there are adhesions hindering exposure of aneurysm dome and parent artery . Obtaining adequate visualization of the aneurysm neck is very difficult in these aneurysms, also in the access of proximal control. There are many methods to obtain a proximal control in these aneurysms. Retrograde suction decompression provides adequate visualization of the aneurysm neck and its relation with the optic apparatus. Retrograde suction decompression can be done by many methods. The technique done via open catheterization of superior thyroid artery is readily accessible and provides adequate relaxation of the aneurysm dome enabling complete dissection of the aneurysm from the surrounding important neurovascular structures. In this report of a case of left Paraclinoidal ICA aneurysm which was clipped applying this method, we elaborate on the technique and discuss other methods available for proximal control in these difficult aneurysms

Atrophy of the abdominal wall muscles after extraperitoneal approach to the aorta

AbstractObjectiveWe retrospectively assessed computed tomography (CT) scans to determine degree of anterolateral abdominal muscle atrophy in patients who underwent infrarenal aortic repair with 2 kinds of incisions for the extraperitoneal approach.MethodsCT scans obtained before surgery and final scans obtained 2 to 100 months after surgery were assessed in 12 patients with paramedian incision (PM group) and 27 patients with flank incision (F group) who could be followed up at our hospital. We considered muscle thickness before surgery on the incision side to be 100% thickness (baseline value), and we calculated, by measuring the incision side after surgery, the corrected percent thickness (CPT%), which represents percentage of remaining muscle thickness that has escaped incision-induced atrophy. CT scans obtained at the level of the third (L3) and fifth (L5) lumbar vertebrae and the center of the sacrum (S) were selected for CPT% measurement.ResultsDuration from surgery to final CT scan was 2 to 65 months (mean ± SD, 34.33 ± 21.38 months) in PM group and 3 to 96 months (27.85 ± 20.74 months) in F group. In PM group, mean CPT% values of the rectus abdominis muscle were 55.83 ± 21.65% at L3, 35.50 ± 10.79% at L5, and 31.92 ± 11.00% at S; these values were statistically much smaller than baseline (P < .01). Mean CPT% values of the lateral abdominal muscles were not statistically different from baseline. In F group, mean CPT% values of the rectus abdominis muscle were 82.19 ± 23.15% at L5 and 64.41 ± 31.34% at S; these values were statistically smaller than baseline (P < .01). Mean CPT% values of the lateral abdominal muscles were 87.59 ± 22.30% at L3 and 84.59 ± 26.90% at L5; these values were statistically smaller than baseline (P < .05).ConclusionsParamedian incision induced severe rectus abdominis muscle atrophy. Although flank incision induced various degrees of atrophy in both muscles, some patients had no muscle atrophy. These data indicate that further anatomic investigation into the relation between flank incision and abdominal wall innervation may contribute to prevention of muscle atrophy after flank incision

Retrospective study on early outcomes of carotid stenting: Institutional experience

Objective: This study is conducted to evaluate the early events after Carotid artery stenting (CAS) among our patients in a single institute. Methods: This study was conducted on 40 patients. These patients underwent stenting of extracranial carotid arteries. Stenting was performed on symptomatic patients with carotid artery stenosis of more than 50 per cent of asymptomatic patients with more than 70 per cent carotid artery stenosis on Doppler ultrasonography. Follow up period for this study was of one month.  Results: 40 patients who underwent CAS between August 2018 and June 2019 were included in the study. Self-expandable hybrid stents were implanted in all patients and pre or poststent-dilatation was performed if required after implantation. None of the patients suffered from a stroke, myocardial infarction or death due to CAS during their hospital stay. Only one patient had a minor stroke during follow up, which was managed conservatively. No transient ischemic attack (TIA), myocardial infarction or death during the follow-up period. Re-stenosis was not observed in the follow-up carotid Doppler ultrasonography; flow rates were within normal limits. Conclusions: Carotid stenting is a safe alternative to CEA (carotid endarterectomy) in the treatment of carotid stenosis regardless of age. CAS with cerebral protection can be performed safely in patients who are at high surgical risk, with low perioperative morbidity and mortality. The durability of the procedure must be determined with a longer follow-up. Further high-quality RCTs are required to address other shortcomings and controversies