A directional needle with a closed pencil-point tip and a distal side hole was developed to permit antegrade guide wire placement by way of a 90 degrees puncture angle. It has been used in over 25 patients without technical difficulties or complications. It has been very effective for catheterization of the superficial femoral artery for angioplasty, diagnostic studies, and chemotherapy infusion, providing easy antegrade access in patients in whom the traditional antegrade approach may be difficult.
Methods: TRIPOD guidelines were followed. A validation cohort (VC) was created with the 2014 hepatectomy ACS-NSQIP dataset. Characteristics of the VC and development cohort (DC) were compared. Risk groups for RBCT within 72 hours of surgery were created using anemia (hematocrit 36%), major liver resection (4 segments) and primary liver malignancy according to the TRS. The association between TRS variables and RBCT was examined with multivariable logistic regression. Area under the receiver operating characteristic curve (AUROC) assessed discrimination. HosmereLemeshow test for goodness of fit assessed calibration. Results: Of 3064 hepatectomies in VC, 18.9% received RBCT, compared to 23.3% in DC. The TRS stratified patients from low (8.5%) to very high risk (40.6%) of RBCT (Figure 1). All TRS variables were independently associated with RBCT in VC and DC. The final TRS was associated with RBCT in VC (odds ratio OR: 2.23; 95% confidence interval 95% CI: 1.99e2.51) and DC (OR 2.29; 95% CI 1.92e2.73). AUROC was 0.68 (95% CI 0.66e 0.70) in VC compared to 0.66 (95% CI 0.63e0.69) in DC. HosmereLemeshow test and calibration curves supported good predictive performance of the model in VC. Conclusion: The TRS adequately discriminated risk of RBCT in an external sample of patients undergoing hepatectomy. It provides a simple method to identify pre-operatively patients at high transfusion risk. Tailored patient blood management initiatives can be utilized to reduce the use of RBCT.
modate large canal diameters and provide excellent pressurisation.
TECHNIQUEThe technique involves the application of Spongostan ® foam on to a Surgicel ® mesh, which is rolled on to the Spongostan ® foam, forming a uniform cylindrical structure. The diameter of the restrictor is adjusted to the desired femoral canal diameter by increasing the thickness of the Spongostan ® foam. The restrictor is inserted into the medullary canal and guided to the appropriate position using a standard cement restrictor inserter, where it expands uniformly, creating an effective restrictor. Bone cement is applied and pressurisation commenced prior to implant insertion. The bespoke restrictor glides with minimal resistance and maintains its form during insertion.
DISCUSSIONNumerous plug designs and materials are available, ranging from nonresorbable to resorbable. All restrictors should avoid intramedullary cement leakage and plug migration during cement and stem insertion to ensure adequate intramedullary pressures. The use of the Surgicel ® -Spongostan ® haemostatic restrictor overcomes some of the limitations of standard cement restrictors. These include the ability to bypass a narrow femoral isthmus, accommodate large femoral canals (particularly in revision procedures), and the flexibility of adjusting the restrictor to the desired diameter of the medullary canal, providing a bespoke cement restrictor.
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