Anastomosis, Surgical ; methods ; Humans ; Organ Transplantation ; adverse effects ; methods ; Postoperative Complications ; etiology ; surgery ; Vascular Surgical Procedures ; methods

INTRODUCTIONOne complication of autogenous arteriovenous fistula (AVF) for haemodialysis is the formation of a venous aneurysm.

CLINICAL PICTUREThe clinical picture is typically an expanding aneurysm leading to skin atrophy and ulceration with the risk of rupture and infection. Aneurysm also reduces the potential cannulation area.

TREATMENTThe cases described here used a surgical 'remodelling' technique involving complete skeletonisation of the venous aneurysm, reduction of lumen diameter and retention of vein wall using a Hegar dilatator to remodel a new fistula.

OUTCOMESix patients were treated using this method and the arterior venous shunt (AVS) was used for haemodialysis the following day. No recurrent aneurysm developed.

CONCLUSIONRemodelling of aneurysmal AVF is an effective and low-risk option for managing this kind of complication, allowing direct access for haemodialysis.

Aneurysm ; etiology ; surgery ; Arteriovenous Shunt, Surgical ; adverse effects ; Catheters, Indwelling ; Humans ; Postoperative Complications ; Renal Dialysis ; adverse effects ; methods ; Vascular Surgical Procedures

OBJECTIVETo summarize the experience in surgical treatment of De Bakey type III aortic dissection and discuss the operative indications, techniques, and methods for spinal cord protection.

METHODSFrom January 1994 to January 2000, 49 patients with De Bakey type III aortic dissection were operated on. Of these patients, 35 were subjected to partial thoratical aorta replacement, 4 partial thoratical aorta replacement and plasty, 8 total thoratical aorta replacement, and 2 thoracoabdominal aorta replacement. In the 35 patients, the operations were performed by using the technique which preserved blood was transfused back by pump via the femoral artery.

RESULTSHospital mortality in this group was 6.1% (3/49). Eight patients received emergence operation, and 1 patient died. Paraparesis developed in one patient (2.0%). Other complications included re-exploration for bleeding in 3 patients, and wound infection in 5.

CONCLUSIONSThe rate of mortality and complication is high in patients with De Bakey type III aortic dissection. Appropriate operative techniques and methods of spinal cord protection are essential to resolve this problem.

Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; surgery ; Female ; Humans ; Male ; Middle Aged ; Vascular Surgical Procedures ; adverse effects ; methods

BACKGROUNDPostoperative gastrointestinal dysfunction (PGD) is one of the most common complications following major surgeries under general anesthesia (GA). Despite ongoing research and new drug treatments, abdominal distension within 24 h postoperatively occurs in 8%-28% of all surgeries. We aim to analyze the effectiveness of preventing PGD by preoperatively stimulating Neiguan (PC6), Zusanli (ST36) and Shangjuxu (ST37) bilaterally twice a day compared with sham-acupuncture treatment and standard treatment.

METHODS AND DESIGNThis is a single-center, prospective practical randomized controlled trial. All groups will be given standard treatments. Patients undergoing vascular surgery under GA will be included from the Vascular Surgery Unit in West China Hospital of Sichuan University, China, and divided into three groups. The experimental group will receive routine treatments and acupuncture at PC6, ST36 and ST37 bilaterally with electrical stimulation twice a day for 20 min preoperatively. The sham-acupuncture group will receive pseudo-electroacupuncture at sham acupoints of PC6, ST36 and ST37, which are 1 cun away from the real acupoints. The routine-treatment group will not receive electroacupuncture. The outcomes include the incidence of abdominal distention, abdominal circumference, the degree of abdominal distension, the first time of flatus and defecation, and hospitalization duration.

DISCUSSIONThe results from this study will demonstrate whether preoperative electroacupuncture is an effective method for the prevention of PGD in patients undergoing vascular surgery under GA. This study may also provide a standardized acupuncture treatment for reduction of PGD.

Anesthesia, General ; Electroacupuncture ; methods ; Gastrointestinal Diseases ; therapy ; Humans ; Postoperative Complications ; therapy ; Prospective Studies ; Research Design ; Vascular Surgical Procedures ; adverse effects

BACKGROUNDAlthough it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA) obtain the greatest benefit from endovascular repair (EVAR), convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR).

METHODSA search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods.

RESULTSA search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment (OR = 1.81, P = 0.01), while there are more patients with hemodynamic instability before treatment in OSR group (OR = 1.53, P = 0.031). Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml, P = 0.014). The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days, P < 0.001) and a shorter total postoperative stay (WMD 6.27 days, P < 0.001). The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR = 0.48, P < 0.001 and OR = 0.28, P = 0.043, respectively). The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 (95% confidence interval (CI) 0.41-0.70, P < 0.001). There was not, however, any significant reduction in the medium-long all-cause mortality rate (HR = 1.13, P = 0.381) and re-intervention rate (OR = 2.19, P = 0.243) following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak (OR = 0.33, P = 0.039) at late follow-up period.

CONCLUSIONSOn the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.

Aortic Aneurysm, Abdominal ; surgery ; Aortic Rupture ; surgery ; Female ; Humans ; Male ; Postoperative Complications ; Treatment Outcome ; Vascular Surgical Procedures ; adverse effects ; methods

Although the clinical benefit of laparoscopic splenectomy and devascularization (LSD) has been elaborated in many studies, its application in massive splenomegaly remains controversial. We conducted a retrospective research to assess the curative efficacy of LSD for massive splenomegaly due to portal hypertension. Forty-seven patients with massive splenomegaly due to portal hypertension were enrolled in this study, and divided into two groups. Twenty-one patients underwent open splenectomy and devascularization (OSD) from June 2010 to October 2012 (OSD group). From March 2013 to February 2015, LSD was performed on 26 patients (LSD group). Perioperative variables were analyzed. Compared to OSD, LSD was associated with less blood loss (241.9±110.0 mL vs. 319.0±139.5 mL, P<0.05), more rapid resumption of oral diet (2.46±0.95 days vs. 3.76±1.09 days, P<0.05), and shorter postoperative hospital stay (5.35±1.65 days vs. 7.24±1.55 days, P<0.05). It was concluded that for patients with massive splenomegaly due to portal hypertension, LSD is feasible and as safe as OSD.
Adult ; Blood Loss, Surgical ; Female ; Humans ; Hypertension, Portal ; complications ; Laparoscopy ; adverse effects ; methods ; Length of Stay ; statistics & numerical data ; Male ; Middle Aged ; Splenectomy ; adverse effects ; methods ; Splenomegaly ; etiology ; surgery ; Vascular Surgical Procedures ; adverse effects ; methods

OBJECTIVETo compare the effects and complications of subinguinal microscopic ligation, laparoscopic transperitoneal varicocelectomy, laparoscopic retroperitoneal varicocelectomy, open retroperitoneal high ligation, and interventional embolotherapy in the treatment of varicocele.

METHODSWe conducted a retrospective study that included 632 varicocele patients treated by subinguinal microscopic ligation (group A, n = 79), laparoscopic transperitoneal varicocelectomy (group B, n = 120), laparoscopic retroperitoneal varicocelectomy (group C, n =137), open retroperitoneal high ligation (group D, n = 283), and interventional embolotherapy (group E, n = 13). We compared the baseline and 3-month postoperative semen parameters, postoperative complications, and pregnancy rate among the five groups of patients.

RESULTSThe operation time was longer in groups A ([2.02 ± 1.25] h) and E ([2.17 ± 1.02] h) than in the other three groups, while the postoperative hospital stay was the shortest in group E ([1.1 ± 0.1] d). Intestinal injury or incision bleeding occurred intraoperatively in 2 cases in group B and 1 case in group E. Postoperative scrotal edema developed in 3.7, 17, 10, and 19% of the patients in groups A, B, C, and D, respectively, but not in group E. The rate of 1-year recurrence was the lowest in group A (1.6%) and highest in group E (22%). Sperm concentration and the percentages of progressively motile sperm and morphologically normal sperm were improved postoperatively in all the patients (P < 0. 05), but there were no statistically significant differences among the five groups either in the above three parameters or in the postoperative pregnancy rate (P > 0. 05).

CONCLUSIONIn the surgical treatment of varicocele, laparoscopic retroperitoneal approach involves short operation time and few complications, subinguinal microscopic ligation has the advantages of little injury, rapid recovery, and few complications but requires specialized microsurgical techniques, and interventional embolotherapy leaves no incision scar and needs only local anesthesia and 1-day postoperative hospital stay, which is uitable for those with a contraindication to anesthesia.

Embolization, Therapeutic ; adverse effects ; methods ; Female ; Humans ; Laparoscopy ; adverse effects ; methods ; Length of Stay ; Ligation ; adverse effects ; methods ; Male ; Operative Time ; Postoperative Complications ; Postoperative Hemorrhage ; Pregnancy ; Pregnancy Rate ; Recurrence ; Retroperitoneal Space ; Retrospective Studies ; Sperm Count ; Urogenital Surgical Procedures ; adverse effects ; Varicocele ; surgery ; Vascular Surgical Procedures ; adverse effects ; methods

In this report, we present a rare case of traumatic carotid cavernous fistula that was occluded during the interventional procedure by incidentally formed blood clot. Sudden occlusion of the fistula and the resolution process of the precarious blood clot can be clearly seen on the serial angiogram.
Vascular Surgical Procedures/*adverse effects ; Treatment Outcome ; Male ; Incidental Findings ; Humans ; Craniocerebral Trauma/*complications ; Carotid-Cavernous Sinus Fistula/etiology/*radiography/*surgery ; Carotid Artery Thrombosis/*etiology/*radiography ; Adult

OBJECTIVETo evaluate and summarize the possibility and experience of reconstructive vascular operation for kinking of internal carotid artery.

METHODSReconstructive vascular operation was performed on 5 patients with symptomatic kinking of internal carotid artery between July 2008 and June 2009. There were 2 male and 3 female patients, age ranged from 53 to 68 years (mean 62 years). Cutting the internal carotid artery at the bifurcation, mobilizing and stretching the internal carotid artery, then anastomosing the internal and common carotid artery. Two of them underwent endarterectomy simultaneously.

RESULTSFor the 5 patients, postoperative recovery went smoothly and symptoms were well improved. Except that mild high perfusion syndrome happened in 1 patient, no other obvious complications. Kinking of internal carotid artery had been stretched in the postoperative CT angiography. In the 5-16-month follow-up, no transient ischemic attack or cerebral infarction happened, and no restenosis appeared.

CONCLUSIONSReconstructive vascular operation is an effective surgical approach to kinking and coiling of the internal carotid artery. For some risk exists, all-round evaluation should be performed before operation, and operative indication should be strictly controlled.

Aged ; Carotid Artery, Internal ; Carotid Stenosis ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Vascular Surgical Procedures ; adverse effects ; methods

ObjectiveTo compare the clinical effects and postoperative complications of microsurgical subinguinal varicocelectomy (MSV) with or without delivery of the testis and ligation of gubernacular veins in the treatment of varicocele.

METHODSWe retrospectively analyzed the clinical data about 163 varicocele patients treated by MSV, 40 with (group A) and the other 123 without delivery of the testis and ligation of gubernacular veins (group B). We compared the operation time, postoperative complications, rate of recurrence, and semen parameters before and at 3 months after surgery between the two groups of patients.

RESULTSThe operation time was significantly longer in group A than in B (［81.1 ± 20.0］ vs ［62.3 ± 9.6］ min, P = 0.041). Sperm concentration, total sperm count per ejaculate, sperm viability, and the percentage of progressively motile sperm were significantly improved in both groups at 3 months after MSV as compared with the baseline (P < 0.05). There were no statistically significant differences in the above semen parameters between the two groups of patients with grade Ⅲ varicocele before and after surgery (P < 0.05). Scrotal edema developed in 5 cases in group A and wound infection in 2 cases in group B after MSV, but no postoperative testicular atrophy or recurrence was observed in either of the two groups.

CONCLUSIONSMSV with delivery of the testis and ligation of gubernacular veins showed no advantages over that without in reducing varicocele recurrence and improving semen parameters, but rather involved longer operation time and a higher incidence rate of postoperative complications.

Edema ; etiology ; Humans ; Ligation ; Male ; Microsurgery ; adverse effects ; methods ; Operative Time ; Postoperative Complications ; etiology ; Recurrence ; Retrospective Studies ; Semen ; Semen Analysis ; Sperm Count ; Spermatozoa ; Testis ; Treatment Outcome ; Varicocele ; surgery ; Vascular Surgical Procedures ; adverse effects ; methods ; Veins ; surgery