Introduction: Surgical site infection (SSI) presents a ubiquitous concern to surgical specialties, especially in the presence of prosthetic material. Antibiotic-impregnated beads present a novel and evolving means to combat this condition. This review aims to analyze the quality of evidence and methods of antibiotic bead use, particularly for application within vascular surgery. Methods: A systematic scoping review was conducted within Embase, MEDLINE, and the Cochrane Registry of Randomized Controlled Trials. Articles were evaluated by 2 independent reviewers. Level of evidence was evaluated using the Oxford Center for Evidence-Based Medicine Criteria and the Cochrane Risk of Bias Tool for Randomized Controlled Trials. Results: The search yielded 6951 papers, with 275 included for final analysis. Publications increased in frequency from 1978 to the present. The most common formulation was polymethyl methacrylate; however publications on biodegradable formulations, including calcium sulfate beads, have been published with increasing frequency. Most publications had positive conclusions (94.2%); however, the data was mainly subjective and may be prone to publication bias. Only 11 randomized controlled trials were identified and all but one was evaluated to be at a high risk of bias. The most common indication was for osteomyelitis (52%), orthopedic prosthetic infections (20%), and trauma (9%). Within vascular surgery, beads have been used primarily for the treatment of graft infection, with freedom from recurrence rates being reported from 41% to 87.5%. Conclusions: Antibiotic-impregnated beads provide a means to deliver high doses of antibiotic directly to a surgical site, without the risks of parenteral therapy. There has yet to be significant high-level quality data published on their use. There is a large body of evidence that suggests antibiotic beads may be used in SSIs in high-risk patients, prosthetic infections, and other complex surgical infections. Important potential areas of application in vascular surgery include graft infection, prevention of wound infection in high-risk patients, and diabetic foot infection.
year. Secondary outcomes were cranial nerve injury, myocardial infarction (MI), hematoma, wound infection, cerebral hyperperfusion, and transient ischemic attacks within 30 days. Primary and secondary outcomes were compared between patients $80 years and <80 years old. Results: There were 359 patients included in this study, with a mean age of 70.1 6 9.5 years (n ¼ 246 [68.5%] male; n ¼ 272 [75.8%] symptomatic). Elderly patients were more often symptomatic (93.8% vs 71.8%; P < .0001) and had an increased length of stay (2.89 6 5.3 days vs 1.59 6 1.76 days; P ¼ .006). There was no statistically significant difference in primary outcomes between patients <80 years and $80 years, including 30-day stroke (2% vs 0%), death (no deaths in either group), or restenosis (9.2% vs 12.3%) and 1-year stroke (2% vs 0%), death (0.3% vs 0%), or restenosis (16.7% vs 13.8%). However, elderly patients had significantly increased MI risk postoperatively (4.6% vs 0.7%; P ¼ .01). Other complications, including cranial nerve injury (6.1% vs 6.2%), were similar between groups. Conclusions: We found that CEA in the elderly does not have an increased risk of stroke or death up to 1 year postoperatively. However, the postoperative length of stay is increased and complicated by significantly more MIs, which should weigh into the decision of whether to operate on an elderly patient.
as important (P < .01; Fig). Similarly, patients placed more importance on 2-year mortality (P < .01), time to ambulation (P < .01), impact on cognition (P < .01), changes in energy level (P < .01), problems with urination (P < .01), problems with bowel function (P < .01), and pain/numbness in the legs (P < .01), than surgeons did. Both hospital length of stay and size of incision were deemed less important (Table). Conclusions: Although agreement exists in the importance of avoiding early postoperative mortality and complications, patients placed more importance on avoiding an aortic reintervention, functional and cognitive outcomes, and 2-year mortality than surgeons did. Given this discordance, patient engagement into the selection of outcomes is important in evaluating different methods of AAA repair. Certain outcomes rated highly by both groups (recovery, cognition, independence) are poorly studied and should be the focus of further evaluations of AAA repair.
Background: Currently there is lack of consensus amongst physicians regarding the management of a mobile floating atheromatous plaque (MFAP). Our case report contributes to the on-going body of literature in an attempt to establish precedent on current management of MFAP.
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