514 Background: Lymphedema (LE) is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 16%. SLYMPHA is a safe and relatively simple method, which decreases incidence of LE dramatically. Our initial study showed an 88% decrease in clinical LE rate after a median follow up of 15 months. The aim of this study was to confirm these results after a longer follow up period. Methods: All patients, undergoing ALND between January 2014 and November 2020 were included in the study. During follow-up visits, tape-measuring limb circumference method was used to detect clinical LE. The incidence of clinical LE was compared between patients with and without SLYMPHA. Univariate and multivariate analysis were used to assess the role of other factors in the appearance of clinical LE. Results: 580 patients were included in the study. 35% of cohort underwent SLYMPHA. Mean follow-up time was 44 ±31.9 months. Patients, who underwent SLYMPHA, had a significantly lower LE rate (10% vs 26%; p=0.002; OR 0.4 [0.31-0.77]). Diabetes and removing ³22 lymph nodes also correlated with increased LE however this effect disappeared on multivariate analysis. Conclusions: SLYMPHA is a safe and relatively simple method, which continued its efficacy after 4-years follow up. It should be considered as an adjunct procedure to ALND for all patients during initial surgery.[Table: see text]
e12581 Background: Lymphedema (LE) is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 16%. Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) is a safe and relatively simple method, which decreases incidence of LE dramatically. Our initial study showed an 88% decrease in clinical LE rate. In the initial study, we used arm circumference measurement for the diagnosis of LE and median follow up was 15 months. The aim of this study was to confirm these results after a long-term follow up period and by using bioimpedance spectroscopy (L-Dex) technology in detecting LE. Methods: All patients, undergoing ALND with or without SLYMPHA between January 2014 and November 2020 were included in the study. Patients with no postoperative L-Dex measurements were excluded. A L-Dex score outside the normal range (± 10 L-Dex unit) or >10 L-Dex unit increase above patient’s baseline was considered as LE. The incidence of LE was compared between patients with and without SLYMPHA. Results: 194 patients were included in the study. 57% of cohort underwent SLYMPHA. Mean follow-up time was 47 ±37 months. Patients, who underwent SLYMPHA, had a significantly lower rate of LE (16% vs 32%; p=0.01; OR 0.4 [0.2-0.8]). Conclusions: SLYMPHA is a safe and relatively simple method, which continued its efficacy after a long-term follow up period. It should be considered as an adjunct procedure to ALND for all patients during initial surgery. [Table: see text]
Objectives: Prior studies have shown worse outcomes with infrarenal endovascular aneurysm repair devices when used outside the manufacturer's instructions for use (IFU). This has not, however, been studied with the Zenith Fenestrated (ZFEN; Cook Medical, Bloomington, Ind) device, the only commercially available fenestrated option in the United States. The aim of this study was to compare surgical outcomes of patients treated with ZFEN inside and outside the IFU.Methods: We retrospectively reviewed our ZFEN database and stratified the cohort ba!sed on treatment inside (IFU group) and outside (non-IFU group) the IFU, with criteria being native neck length 4 to 14 mm, neck diameter 19 to 31 mm, and neck angulation of 45 or less. Patients with thoracoabdominal aneurysms or concurrent chimney grafting were excluded.Results: From 2012 to 2018, we identified 100 patients (19% female; mean age, 73.6 years) treated with the ZFEN device for inclusion in this analysis. Mean follow-up was 21.6 months. Fifty-four patients (54%) were treated outside the IFU because of neck length (n ¼ 48), neck diameter (n ¼ 10), and/or excessive angulation (n ¼ 16). Demographics and operative characteristics are compared in the Table. Operative time was similar between IFU and non-IFU patients (174 minutes vs 186 minutes; P ¼ .43), but non-IFU patients were exposed to higher radiation doses (5445 mGy vs 3652 mGy; P ¼ .008). No difference was noted between IFU and non-IFU groups for 30-day mortality (0% vs 3.7%; P ¼ .18) or type Ia endoleak (0% vs 1.9%; P ¼ .41). Target vessel primary patency at 36 months was similar between IFU and non-IFU (89.7% vs 88.8%; P ¼ .36), as was freedom from reintervention (72.6% and 79.8%; P ¼ .18). On multivariate proportional hazard analysis, no individual factors were associated with mortality or proximal endoleak. However, increasing proximal device diameter was independently associated with loss of branch patency (hazard ratio, 1.17; 95% confidence interval, 1.01-1.34) and reintervention (hazard ratio, 1.24; 95% confidence interval, 1.01-1.55).Conclusions: Patients with juxtarenal aortic aneurysms may be treated with the ZFEN device outside the IFU without compromising outcomes. Despite challenging anatomy and increased complexity of these cases, survival, patency and reintervention rates are similar to patients treated inside the IFU.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.