Zusammenfassung Hintergrund Die Inzidenz tiefer Beinvenenthrombosen (TVT) bei intensivpflichtigen CoViD-19-Patienten wurde bisher nur in wenigen Studien untersucht. Prospektive vergleichende Studien mit Non-CoViD-19-Intensivpatienten fehlen gänzlich. Fragestellung Die Inzidenz TVT bei an CoViD-19 erkrankten Intensivpatienten verglichen mit Non-CoViD-19-Patienten, die im selben Zeitraum auf den Intensivstationen des Universitätsklinikums Augsburg behandelt wurden, wurden erhoben. Zudem soll untersucht werden, welche Art der Antikoagulation zum Zeitpunkt des Auftretens der TVT bei CoViD-19-Patienten vorlag und inwiefern eine TVT bei diesem Patientengut mit einer erhöhten Letalität vergesellschaftet ist. Material und Methoden In der prospektiven Single-Center Studie wurden im Zeitraum vom 18.04.2020 bis 30.04.2020 20 SARS-CoV2-positive Patienten mit 20 Non-CoViD-Patienten auf Intensivstation bezüglich des Auftretens tiefer Beinvenenthrombosen verglichen. Hierzu wurden demographische Daten, Laborparameter und klinische Verläufe erfasst und ausgewertet. Ergebnisse Die Rate an TVT war im untersuchten Kollektiv bei Patienten mit SARS-CoV2 deutlich erhöht (CoViD-19-Patienten: 20 % vs. Non-CoViD-19-Patienten: 5 %). Sowohl das Vorliegen einer TVT sowie deutlich erhöhte D‑Dimer-Werte waren in der vorliegenden Studie mit erhöhter Letalität vergesellschaftet. Diskussion Wir empfehlen bei der stationären Aufnahme von Patienten mit SARS-CoV2-Verdacht oder Nachweis die Bestimmung der D‑Dimere und im Falle erhöhter Werte die großzügige Indikationsstellung zur Kompressionssonographie der tiefen Beinvenen. So können TVT früh erkannt und eine therapeutische Antikoagulation begonnen werden. Alle stationären CoViD-19-Patienten sollten eine Thromboseprophylaxe mit NMH erhalten. Weitere Studien zu Point-of-care-Methoden (TEG®, ROTEM®) zur Erkennung einer Hyperkoagulabilität bei SARS-CoV2 sind notwendig.

Purpose To evaluate the technical features and clinical results after open conversion for complications following endovascular aneurysm sealing (EVAS). Materials and Methods From July 2013 to February 2020, 44 patients (mean age 72±8 years; 36 men) underwent an open conversion due to EVAS complications in a single center. Data were collected on patient characteristics, reasons for conversion, characteristics and duration of the procedure, condition of the polymer, blood loss, time in the intensive care unit (ICU), and intra/postoperative complications. The main outcome measure was mortality at 30 days and in follow-up. Data are presented as the median (IQR) and absolute range. Results On average, the open conversion took place 3 years after the initial EVAS implantation [median 37 months (IQR 23, 50); range 0–64]. Most patients were converted due migration (82%), aneurysm growth (77%), and/or endoleak (75%), with 21 patients (48%) having all 3 events. Less frequent diagnoses were aneurysm rupture (n=7), aortic infection (n=3), technical failure during implantation (n=2), and graft thrombosis (n=1). The majority of patients (n=26) were asymptomatic and converted electively, but 9 were operated on urgently and 9 emergently (7 late rupture and 2 due to technical failure). The median procedure duration was 178 minutes (IQR 149, 223; range 87–417), the median blood loss was 1100 mL (IQR 600, 2600; range 300–5000). Polymer degradation was mentioned in the operative reports of 18 cases (41%). Patients stayed a median of 3 days (IQR 2, 7; range 1–35) in the ICU, while the median length of stay in the hospital was 14 days (IQR 10, 20; range 0–93). The 30-day mortality was 23% (n=10). During a median follow-up of 3 months (IQR 0, 11; range 0–38), no additional deaths occurred, but 12 patients suffered from an adverse event. There were 3 cases of wound dehiscence after laparotomy, 2 cases of leg ischemia, 2 cases of renal failure, and individual cases of urinary obstruction, urinoma, paralytic ileus, gastrointestinal bleeding, and postoperative delirium. A non-elective setting was associated with a significantly increased mortality of 33% in urgent cases and 56% in emergent cases (p=0.007). Based on these results an algorithm for the management of EVAS complications was developed. Conclusion The significantly increased mortality associated with nonelective conversions highlights the need for active surveillance. The presented algorithm offers a structured tool to avoid emergency conversions.

Purpose Technical aspects are crucial for planning and performing endovascular arteriovenous fistula (AVF) creation. The Ellipsys® Vascular Access System represents a minimal invasive method for the creation of a proximal forearm fistula. This report summarizes the essential elements for AVF creation with the Ellipsys® Vascular Access System and investigates feasibility, efficacy, and safety procedures conducted on 16 patients. Materials and methods We performed a retrospective analysis of patients who underwent endovascular AVF creation with the Ellipsys® Vascular Access System between May 2020 and March 2022 at a tertiary referral center. Results The median age was 67.5 years (47–86 years). The mean BMI was 31.4 kg/m2. AV fistula was created on 15/16 patients on their left arm. The technical success was 100%. The mean operation time was 24.2 min. There were no complications associated with the procedure. All patients were examined after 30 days (± 5 days). Primary patency after 30 days was 94% (15/16). The mean fistula flow was 681.1 mL/min and the mean AVF diameter was 6.1 mm. Thirteen out of 15 patients met the criteria for potential hemodialysis. Conclusion With the Ellipsys Vascular Access System exist an additional possibility of an AV fistula creation. Based on above findings, the Ellipsys® Vascular Access System represents a feasible, safe, and effective method for AVF creation.

BackgroundAbdominal aortic aneurysms (AAA) have most probably an inflammatory origin, whereby the elastica is the layer actually involved. In the past, collagen weackness was supposed to be the shared cause of both, AAA and incisional hernias. Since the development of new techniques of closure of the abdominal wall over the last decade, collagen deficency seems to play only a secondary etiologic role.ObjectivesThe aim of the study was to investigate whether the incidence of incisional hernia following laparotomy due to AAA differs from that of colorectal interventions.Material and methodsThis was a retrospective control matched cohort study. After screening of 403 patients with colorectal interventions and 96 patients with AAA, 27 and 72 patients, respectively were included. The match criteria for inclusion of patients with colorectal interventions were: age, benign underlying disease and median xiphopubic laparotomy. The primary endpoint was the incidence of an incisional hernia. The secondary endpoints were the risk profile, length of stay in the intensive care unit and postoperative complications. Data analysis was carried in the consecutive collective from 2006 to 2008.ResultsIn the group with AAA the mean follow-up was 34.5±18.1 months and in the group with colorectal interventions 35.7±21.4 months. The incidence of incisional hernias showed no significant differences between the two groups. In the AAA group 10 patients (13.8%) developed an incisional hernia in contrast to 7 patients in the colorectal intervention group (25.9%).ConclusionsIn our collective patients with AAA did not show an increased incidence of incisional hernia in comparison to patients with colorectal interventions with comparable size of the laparotomy access and age. The quality of closure of the abdominal wall seems to be an important factor for the prevention of incisional hernia.