We present a case of an elderly man with the persisting type II endoleak following endovascular aneurysm repair. In a view of the multiple comorbidities, the patient was denied an open elective repair. However, when presented with a ruptured aneurismal sac, he underwent an emergency open abdominal aortic aneurysm repair. Overall, the patient has made a good postoperative recovery.
Ischemic colitis is the most common form of an iatrogenic intestinal ischemia following an aortic surgery. It can be transient and self-limiting but, when severe, is associated with mortality even as high as 80%. Careful preoperative assessment can help to anticipate the need for the inferior mesenteric artery (IMA) reimplantation. Some patients lack the suffi cient collateral blood supply to the colon and can benefi t from the IMA reimplantation, which not only reduces the risk of postoperative colonic necrosis but also can be lifesaving. We report a case of a successful reimplantation of the IMA based on the careful preoperative planning. If unrecognized, this undoubtedly would lead to postoperative colonic ischemia. Therefore, we feel it is important to share our experience regarding the successful management of the presented case.
Aims: Pancreaticoduodenectomy (PD) is a commonly performed procedure for patients with periampullary tumors. Although the rate of perioperative mortality and morbidity has significantly decreased over the past few decades, the incidence of local reccurence still remains high. In the majority of cases, local recurrences are considered non-resectable, but in selected cases completion pancreatectomy (CP) may be regarded as a curative option. However, this procedure is suitable for only a minor fraction of patients. In this small study we describe our experience in performing laparoscopic completion pancreatectomy (LCP) in two patients with a history of PD for periampullary malignant tumors. Methods: Two patients with recurrences of malignant tumors in the pancreatic remnant underwent LCP in our institution. The patient journals were retrospectively reviewed. The first patient was diagnosed a recurrence from the adenocarcinoma of the ampulla of Vater 3 years after initial PD. The second patient had previously undergone PD for metastases from renal cell carcinoma in the pancreatic head and now had a recurrence, detected in pancreatic remnant. Preoperative clinical characteristics, imaging studies, operation details, postoperative features and follow-up data were analyzed. Results: Despite of challenging anatomical alterations, both operations were carried out without major intraoperative unfavourable incidents. Although one of the patients was reoperated laparoscopically for haemorrhage on the first postoperative day, further postoperative course was uneventful. Conclusions: In this cases LCP was demonstrated to be a feasible and appropriate technique. Thus, LCP should be taken into consideration as an option in the surgical management for selected cases with recurrence in pancreatic remnant after initial PD. Aims: The management of metastatic Renal cell carcinoma (RCC) confers poor results with median 5-year survival 5e 20%. Surgery is a possible option for oligometastatic disease of the liver and pancreas. The aim of our study is to investigate the outcomes of the surgical management of these patients in our institution. Methods: This is a retrospective review of 13 patients who had liver or pancreatic resection for RCC metastasis in our institution over the last 11 years. Pancreatic metastasis was diagnosed at a median of 73 months (range: 9e292) after nephrectomy, while hepatic metastasis at a median of 29 months (range: 4e129). Results: Seven pancreatic (3 pancreaticoduodenectomies, 2 total pancreatectomies and 2 distal pancreatectomies) and 7 liver resections (1 right hepatectomy and 6 non-anatomical liver resections) were performed. The postoperative complication rate was 42.8% after pancreatic and 14.3% after liver resection. The median length of stay was 18 days (range: 8e28) after pancreatic and 9 days (range: 4e27) after liver resection. Seven patients developed subsequent metastatic disease (median time: 10 months, range: 3e54). The median disease free survival after pancreatic resection was 27 months (ran...
Purpose: Revascularization of arterial chronic total occlusions (CTO's) can result in a subintimal course, requiring true lumen reentry to establish antegrade flow. Here we report a retrospective study investigating the efficacy of the low profile OUTBACK® LTD re-entry catheter (Cordis, Milpitas CA) in above and below the knee subintimal recanalization of CTO'S when conventional techniques fail. Materials: Single-center review of lower extremity revascularizations between March 2013 and July 2018 using the 6 Fr OUTBACK® LTD catheter was conducted. The catheter was used in a total of 58 patients (37 male, mean age 72.3±12.2) with CTO's. Vascular claudication was the primary indication in 17.2% (10/58) of patients, while critical limb ischemia (CLI) (72.4%, 42/ 58) accounted for the remainder. 60.3% (35/58) of occlusions were suprapopliteal, while the remaining 39.7% (23/58) were at or below the level of the popliteal artery including the proximal tibial arteries. If conventional recanalization methods were unsuccessful, the catheter was utilized in an antegrade or retrograde fashion to gain re-entry beyond the occlusion in the subintimal space. Technical success rate of re-entry into the true lumen, achievement of arterial patency, and major/minor complication rate were evaluated. Results: The catheter successfully achieved true lumen re-entry beyond the occlusion at a rate of 86.2% (50/58). Final intervention was then performed with balloon angioplasty and/or stenting in 96% (48/50) as deemed appropriate; two failures were due to intraprocedural thrombosis of the recanalized artery. No significant difference was observed when assessing the rate of true lumen reentry by site of occlusion (29/35 suprapopliteal occlusions vs 21/23 occlusions at or below the level of the popliteal artery, p¼0.458). The observed minor complication rate was 10.3% (4 thromboses, 1 postprocedural hematoma, 1 dissection). No major complications were observed. Conclusions: If conventional recanalization methods are unsuccessful, the OUTBACK® LTD catheter is safe and effective in achieving luminal re-entry for subsequent recanalization in lower extremity arterial chronic total occlusions, independent of occlusion site.
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