Background: Anastomotic leak is an important cause of morbidity and mortality after esophagectomy for esophageal cancer patients. Calcification of the arteries supplying the gastric tube has been found to be associated with leakage after esophagectomy with cervical anastomosis in Europeans. The purpose of this study is to evaluate the association between calcifications of the supplying arteries of the gastric tube and the occurrence of anastomotic leakage after esophagectomy with cervical anastomosis in Chinese patients with esophageal cancer. Methods:The demographic, clinical, and pathological features as well as the vascular calcification of arteries of 709 esophageal cancer patients who had undergone esophagectomies with cervical anastomosis were analyzed. Univariable and multivariable logistic regression were used to identify the association between the postoperative anastomotic leakage and calcifications of the arteries supplying the gastric tube.Results: Among the 709 patients, 122 (17.2%) had developed anastomotic leakage. Thirty-day mortality and length of hospital stay were higher for patients with anastomotic leakage. Upper digestive tract ulcer, peripheral vascular disease, renal insufficiency, American society of Anesthesiologists (ASA) risk class, and calcifications of aorta and celiac axis were found to be independent risk factors for the anastomotic leakage.Conclusions: Calcification of the aorta and celiac axis that supply the gastric tube is an independent risk factor for cervical anastomotic leakage after esophagectomy in Chinese esophageal cancer patients.

WHAT THIS PAPER ADDS This study retrospectively reviewed 57 cases of extracranial carotid aneurysm treated by open and endovascular surgery with mid term follow up. Outcomes of the two therapy groups were analysed. Endovascular surgery may be a safe and durable method for selected aneurysms, while for severe tortuous aneurysms, endovascular surgery alone may be difficult to apply.Objective: The objective of this study was to evaluate the outcomes of open surgery (OS) and endovascular surgery (ES) for extracranial carotid aneurysm (ECCA) in the authors' centre. Methods: Fifty-seven consecutive patients who were diagnosed with ECCA and underwent intervention from January 2005 to July 2019 at Zhongshan Hospital, Fudan University, were reviewed retrospectively. Patient characteristics and surgical outcomes for OS and ES were analysed. ECCAs were divided into three morphological subgroups: subgroup I, no severe tortuosity of the internal carotid artery (ICA) or common carotid artery (CCA) proximal to the aneurysm, tortuosity of the aneurysm and 1 cm of peri-aneurysmal carotid artery 90 ; subgroup II, severe ICA or CCA tortuosity proximal to the aneurysm, tortuosity of the aneurysm and 1 cm of peri-aneurysmal carotid artery 90 ; subgroup III, aneurysm tortuosity and 1 cm perianeurysmal carotid artery > 90 . Results: 35 patients underwent OS, 20 patients underwent ES and 2 patients underwent OS after the failure of ES. Thirty-six cases were classified in subgroup I, 11 cases in subgroup II, and 10 cases in subgroup III. ES was achieved successfully in all 18 cases of subgroup I, but failed in three of four cases in subgroups II and III. With a mean duration of 62.9 AE 44.5 months of follow up, five deaths were recorded in the OS group, two of which were caused by ipsilateral stroke and three were not neurologically related. There was no stroke or death in the ES group during follow up. One case of stroke and two cases of death occurred in symptomatic patients, while one case of stroke and three cases of death occurred in asymptomatic patients. Conclusion:This series demonstrates that ES may be a safe and durable option for ECCA in subgroup I, while in subgroups II and III, ES alone may be difficult to apply. A 30 day stroke rate around 5% existed in ECCAs with interventions, which should be considered before the intervention.

BackgroundPatients who use angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs) are prone to developing side effects like hypotension and even refractory hypotension during anesthesia use, and whether ACEIs/ARBs should be continued or discontinued in such patients remains debatable. The present systematic review and meta-analysis was conducted to clarify the consequences of continuing or withholding these drugs, especially with regards to the incidence of intraoperative hypotension, in patients who continue to use ACEIs/ARBs on the day of their scheduled surgery.MethodsStudies with data pertinent to the incidence of intraoperative hypotension during anesthesia use in patients who continued the use of ACEIs/ARBs on the day of their scheduled surgery were considered for inclusion.ResultsThirteen studies reporting on the incidences of intraoperative hypotension between patients who continued receiving ACEIs/ARBs and those who did not on the day of their surgical procedure were included. The pooled effects showed that hypotension during anesthesia was more likely to develop in patients who continued to take ACEIs/ARBs when compared to those who did not (RR = 1.41, 95% CI: 1.21–1.64). However, there were no significant differences between these groups of patients with regards to postoperative complications including ST-T abnormalities, myocardial injury, myocardial infarction, stroke, major adverse cardiac events, acute kidney injury, or death (RR = 1.25, 95% CI: 0.76–2.04). The differences remained similar in subgroup analyses and sensitivity analyses.ConclusionsNo sufficient available evidence to recommend discontinuing ACEIs/ARBs on the day of surgery was found in this literature review and meta-analysis. However, anesthetists should be cautious about the risk for intraoperative hypotension in patients chronically receiving ACEIs/ARBs, and should know how to treat it effectively.

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