Vascular surgery

209069 Iliac vein intervention with arteriovenous fis- tula in treatment of lower extremity postthrombotic syndrome/Duan Pengfei(段鹏飞,Dept Vascul Surg,2nd Affil Hosp Soochow Univ,Suzhou 215004)…∥Chin J Gen Surg. -2009,24(11). -926～929 Objective To discuss a new method of interven- tional and surgical therapy for the lower extremity post- thrombotic syndrome(PTS).

Incisional Negative Pressure Wound Therapy in the Prevention of Surgical Site Infection after Vascular Surgery with Inguinal Incisions: Rationale and Design of a Randomized Controlled Trial (INVIPS-Trial)

Background/Aims: Inguinal incisions are a common route of access in vascular surgery. Due to anatomical challenges and a diverse bacterial flora in this area, surgical site infections (SSI) represent a common, debilitating and sometimes life-threatening complication. The INVIPS-Trial evaluates the role of Negative Pressure Wound Therapy (NPWT) on closed inguinal incisions in elective vascular surgery to prevent SSI and other wound complications. Methods: This randomized controlled trial (RCT) registered at ClinicalTrials.gov (Identifier: NCT01913132) compares the effects of a NPWT dressing (PICO, Smith & Nephew, UK) and the center’s standard wound dressing (Vitri Pad, ViTri Medical, Sweden) on postoperative wound complications, especially SSI. The study includes two distinct vascular procedures with different SSI risk profiles: endovascular aortic repair (EVAR) and open surgical approaches involving the common femoral artery (OPEN). Results: Four hundred ninety-five groin incisions in both treatment arms are anticipated to be included in the EVAR group and 147 inguinal incisions in both treatment arms in the OPEN group. Since a large percentage of inguinal vascular procedures in both groups but especially in the EVAR group are performed bilaterally, many patients can serve as their own control by randomly receiving NPWT on one and the standard dressing on the contralateral inguinal incision. Conclusions: This ongoing RCT attempts to elucidate the potential benefit of NPWT on closed inguinal incisions after different vascular procedures. Outcome and conclusions of this trial could have implications on postoperative wound care of patients in both vascular surgery and other surgical specialties.

Analysis of the Effect of Problem-Oriented Nursing Intervention on Patients with Lower Extremity Arteriosclerosis Obliterans in Vascular Surgery

Objective: To analyze the effect of problem-oriented nursing intervention on patients with lower extremity arteriosclerosis obliterans (ASO) in vascular surgery. Methods: The clinical data of 128 patients with lower extremity ASO in vascular surgery were selected and randomly divided into groups A and B, with 64 cases each. Group A is the control group, and Group B is the observation group. Group A received the routine nursing intervention, and Group B received the problem-oriented nursing intervention. The compliance, self-care ability, psychological state, quality of life, and nursing satisfaction of the two groups of patients were evaluated based on various indicators. Results: After the intervention, the evaluation of self-care ability (ESCA) score of the patients in Group B was higher than that of Group A, and the symptom checklist-90 (SCL-90) score was lower than that of Group A. The differences were significant (t = 10.019, t = 3.118, P < 0.01). After the intervention, the World Health Organization Quality of Life Brief (WHOQOL-BREF) index scores of the two groups increased and the increase in Group B was significantly higher than Group A (P < 0.001). The compliance rate of Group B (62/ 96.88%) was higher than that of Group A (52/ 81.25%), and the difference was extremely significant (χ2 = 8.020, P < 0.01). Conclusion: Problem-oriented nursing intervention for patients with lower extremity ASO in vascular surgery improved the patient’s self-care ability, and quality of life, reduced the patient’s negative emotions, and enhanced their overall satisfaction.

Electroacupuncture for the prevention of postoperative gastrointestinal dysfunction in patients undergoing vascular surgery under general anesthesia: study protocol for a prospective practical randomized controlled trial

BACKGROUND： Postoperative 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 DESIGN： This 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 fi rst time of fl atus and defecation, and hospitalization duration. DISCUSSION： The 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. TRIAL REGISTRATION： This study is registered with the Chinese Clinical Trial Registry： Chi CTR-TRC-13003649.

Future of robotics in vascular surgery

For over a decade, there has been a paradigm shift to an endovascular, minimally invasive approach whilst treating diseases of the aorta and its branches, with clear advantages in terms of morbidity and mortality in certain vascular beds, especially in patients with multiple co-morbidities that would otherwise be deemed unsuitable for traditional open surgical approaches. Endovascular intervention however, has certain momhological and anatomical constraints.

Open surgery:Still a great option to treat patients with posttraumatic arteriovenous fistulas:A case report

BACKGROUND In the modern era of endovascular surgery percutaneous interventions are being widely used to treat a number of vascular disorders including arteriovenous fistulas(AVF).Still,patients with hostile anatomy or complicated cases such as large post-traumatic AVFs may be successfully treated using conventional vascular surgery.CASE SUMMARY This paper presents state-of-the-art treatment options in subjects with posttraumatic AVFs and a case-report of a successful open surgical approach in a patient with a 25 year old history of a post-traumatic AVF between the common femoral artery and common femoral vein.CONCLUSION Open surgery is still a great option to treat patients with post-traumatic arteriovenous fistulas with hostile anatomy or in complicated cases.Concomitant conditions and complications should be addressed promptly.

Psychosomatic Medicine and Evidence-Based Surgery:Reflections and Perspectives

This article reflects on the need for psychosomatic medicine research in the field of surgery by complementing psychological/psychiatrist approaches with a physician’s(particularly surgeon’s)point of view.Focusing on esthetic/cosmetic surgery,a broader notion of“psychosomatic surgery”is also used regarding plastic surgery as well as examples of vascular and general surgery.Relevant literature reviews are utilized to gain a more comprehensive bio-psycho-social perspective.By providing a deeper understanding in the specialty areas,it makes a case for evidence-based practice by shedding light on psychosomatic medicine research on surgery in the United States with cross-cultural implications.

Penile revascularization--contemporary update

Contemporary therapies for erectile dysfunction are generally targeted towards older men and universally engage pharmacological and/ or device related treatment options. Penile revascularization, using microvascular arterial bypass surgical techniques, is a non-pharmacological, non-device-related, and reconstructive surgical strategy for men with erectile dysfunction that was first described by Dr Vaclav Michal in 1973.

Transthoracic arterial bypass for the treatment of severe cerebral ischemia induced by brachiocephalic arteritis: A report of 15 cases

BACKGROUND： Carotid arterial reconstruction is hard to cure the extensive lesions of carotid arteries and subclavian arteries in patients with brachiocephalic arteritis; however, transthoracic arterial bypass surgery provides an opportunity for the treatment of brachiocephalic arteritis. OBJECTIVE： To report the improving effects of transthoracic arterial bypass surgery on the clinical symptoms of severe cerebral ischemia induced by brachiocephalic arteritis and observe the occurrence of complications after the intervention. DESIGN： Case observation. SETTING： Department of Vascular Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. PARTICIPANTS： Fifteen patients with Takayasu arteritis, including 1 male and 14 females, were selected from Department of Vascular Surgery, Wuhan Union Hospital from June 2003 to June 2007. Their ages ranged from 16 to 37 years. All patients were finally diagnosed by clinical histories, health examinations and color Doppler detection. All patients provided the confirmed consent. METHODS： All patients had received transthoracic artificial vascular bypass surgery. Among them, 6 patients had the bridge from ascending aorta to bilateral axillary arteries to lateral internal carotid artery; 3 from ascending aorta to bilateral axillary arteries; 5 from ascending aorta to lateral axillary artery to lateral internal carotid artery; In particular, one patient combining with abdominal aorta occlusion had received two step surgical interventions. In the first step, bridging surgery was performed from ascending aorta to bilateral axillary arteries to lateral internal carotid artery; in the second step, patients received left axillofemoral bypass. MAIN OUTCOME MEASURES：① Detecting blood velocity in variously intracranial-arterial systoles by using transcranial Doppler postoperatively; ② following-up the improve of clinical symptoms at 40 months after surgery; ③ observing postoperative complications. RESULTS： All 15 patients were involved in the final analysis. ① Intracranial-arterial blood velocity： Average intracranial-arterial blood velocity was significantly increased postoperatively （P 〈 0.01）. ② Following-up results of clinical symptoms： All patients did not have death and blindness; while, transient cerebral ischemia, dizzy, photophobia, giddiness, hemoptysis and other symptoms disappeared gradually; therefore, patients were able to live by themselves. ③ Postoperative complications： Among them, 3 patients had injury of hypoglossal nerve and 3 patients had injury of recurrent laryngeal nerve. All recovered after 1 - 3 months conservative treatment. One patient with injury of brachial plexus nerve on one side relieved gradually after a half-year treatment. One patient had occlusion in subclavian arterial bridge on the third day after surgery and once more embolism after arterial embolectomy on the next day; however, the limb did not have obvious ischemic symptoms but low skin temperature as compared with the contralateral side. CONCLUSION： Transthoracic arterial bypass surgery can relieve clinical symptoms of brachiocephalic arteritis postoperatively, complications are mild, and the effects are confirmed.

How to balance between carotid endarterectomy and carotid artery stenting

Stroke is one of the most common causes of permanent disability in industrialized countries and become increasingly prevalent in developing countries. Management of stroke consumes $45 billion annually, and is responsible for greater than one million hospital admissions each year in the U.S. Neurologic sequelae related to cerebral vascular accidents （CVA） severely limit a patient＇s ability to carry out activities of daily living and invariably create an enormous burden on health care costs. As a result, the prevention of CVA with safe treatment of extra-cranial carotid occlusive disease remains an important health care goal.