Aim. To analyze the outcomes of popliteal thrombectomy using the standard release technique with vascular instruments and rapid release sensu A. N. Kazantsev in patients with acute popliteal artery thrombosis (PAT) and coronavirus disease 2019 (COVID-19).Material and methods. The present prospective single-center study for the period from April 1, 2020 to March 17, 2021 included 157 patients with acute PAT and COVID-19 at the Alexandrovskaya City Hospital. All patients were divided into 2 groups depending on the popliteal artery access: group 1 (n=88; 56%) — rapid release sensu A. N. Kazantsev; group 2 (n=69; 44%) — standard popliteal artery release using vascular instruments (vascular forceps and scissors) and tourniquets. Rapid popliteal artery release was distinguished by the fact that fasciotomy and hemostasis, the fatty tissue behind it and up to the artery was torn with two index fingers. First, the fingers were joined together at the lateral edges and inserted into the wound middle. Then the wound together with tissues was stretched with fingers to proximal and distal edges until the popliteal artery was visualized. Further, a Beckmann retractor was used to fix the torn fiber to the upper and lower wound walls. The tourniquets were not used.Results. Surgical access duration (group 1, 4,5±1,3 minutes; group 2, 11,41±0,9 minutes; p=0,005), as well as the total procedure duration (group 1, 47,5±2,8 minutes; group 2, 62,15±4,5 min; p=0,001) had the lowest values in the group of rapid popliteal artery release. Moreover, all intraoperative bleedings (n=11; 15,9%) was recorded in group 2 as a result of popliteal vein injuries and/or bleeding from popliteal artery. The retrombosis rate in the rapid release group was lower (group 1, 40,9%; group 2, 55,1%; p=0,03). On the first day after surgery, 18% of thrombosis developed in group 1, and 39% in group 2. The mortality rate was highest in the standard artery release group (group 1, 55,7%; group 2, 86,9%; p<0,0001; OR, 0,18; 95% CI, 0,08-0,42). In all cases, the cause of death was systemic multiple organ failure due to severe pneumonia, pulmonary edema, and cytokine storm.Conclusion. The use of rapid popliteal artery release sensu A. N. Kazantsev significantly reduces the thrombectomy duration in the context of COVID-19. This effect is achieved due to a decrease in the incidence of intraoperative bleeding, no need to use tourniquets and vascular instruments. A decrease in the ischemia duration using novel release technique reduces the retrombosis rate, as well as deaths caused by systemic multiple organ failure against the background of hyperperfusion and compartment syndrome. Reducing the operation duration with the use of rapid popliteal artery release sensu A. N. Kazantsev reduces the time of intraoperative mechanical ventilation, which in COVID-19 patients reduces the risks of pneumothorax, pneumomediastinum, emphysema, and pulmonary embolism. Thus, the rapid popliteal artery release sensu A. N. Kazantsev can be recommended for popliteal thrombectomy in patients with COVID-19.
Aim. To analyze the results of using a novel method of glomus-saving carotid endarterectomy (CEE) sensu A. N. Kazantsev.Materials and methods. This cohort, comparative, prospective, open-label study from January 2018 to April 2020 included 475 patients who undergone one of the three glomus-saving types of CEE. Depending on the implemented revascularization strategy, all patients were divided into 3 groups: group 1 — 136 patients (28,631%) CEE sensu R. A. Vinogradov; group 2 — 125 patients (26,316%) — sensu K. A. Antsupov; group 3 — 214 patients (45,053%) — sensu A. N. Kazantsev. Glomus-saving CEE sensu A. N. Kazantsev was carried as follows. Arteriotomy was performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2 to 3 cm above the mouth, depending on the atherosclerotic lesion, with a transition to the common carotid artery (CCA) (also 2 to 3 cm below the mouth of the ECA). The internal carotid artery (ICA) was cut off at the site formed by the wall of the ECA and CCA. Next, an endarterectomy from the ICA was performed using the eversion technique. The next step was an open endarterectomy from EСA and СCA. Next, the ICA at the saved site was implanted in the previous position.Results. No intergroup differences were observed during hospitalization. Due to intraoperative visualization of an extended lesion of the ICA, in some cases it became necessary to transform the operation: in group 1, 4,4% of cases required ICA prosthetics; in groups 2 and 3 — autologous ICA transplantation in 4,8% and 4,7% of cases, respectively. Also, 1 case of ischemic stroke was recorded in groups 1 and 2. The cause of the latter was ICA thrombosis due to intimal detachment distal to the removed plaque. All cases of ECA thrombosis in the hospital postoperative period were differentiated in group 2.In the long-term follow-up, the groups were also comparable in the complication rate. The cause of all ischemic strokes was the development of restenosis or thrombosis of the ICA/prosthesis. Among patients who underwent forced autologous transplantation of the ICA, restenosis was not recorded. It should also be noted that new ECA occlusions (n=12; 9,6%) were visualized 6 months after reconstruction only in group 2.Conclusion. CEE sensu A. N. Kazantsev is the simplest technique of glomus-saving reconstructions, which have demonstrated their safety and effectiveness.
Hemobilia is a potentially life-threatening clinical issue, the etiology of which iatrogenesis is playing increasingly more prominent role. Nowadays the most frequent etiology of hemobilia has shifted toward iatrogenesis owing to increasingly more frequent performance of liver procedures, either open or minimally invasive. Here we report a rare case of recurrent hemobilia after transarterial embolization. A man, aged 57 years, presented with Quincke's triad after cholecystectomy. Computed tomography imaging revealed a pseudoaneurysm of the right hepatic artery. Transarterial embolization failed, and hemobilia recurred. The patient underwent open ligation of the right hepatic artery. Transarterial embolization is a definitive treatment of hemobilia due to vascular issues. The choice of embolizing agent is crucial in transarterial embolization.
<p><strong>Aim.</strong> Analysis of the results of hospital and medium-long-term results obtained using a new method of glomus-saving carotid endarterectomy (CEE) according to A. N. Kazantsev.</p><p><strong>Methods.</strong> This prospective study was conducted during January 2018 to April 2020 on 214 patients who were operated for occlusive stenotic lesions of the internal carotid artery (ICA) using holomus-saving CEE as per the method described by <br />A.N. Kazantsev. The average observation duration was 17.2 ± 6.5 months.<br />Glomus-saving CEE as per the method by A. N. Kazantsev is performed as follows. Arteriotomy is performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2–3 cm above the mouth, depending on the distribution of atherosclerotic plaque, with a transition to the common carotid artery (also 2–3 cm below the ECA mouth). The ICA was cut off at the site formed by the wall sections of the ECA and the common carotid artery. Thereafter, an endarterectomy from the ICA was performed using the eversion technique. The next step was an open endarterectomy from the ECA and OCA. Then, the ICA at the saved site was implanted in the previous position. A 6-0 Prolene thread was used as the suture material for performing a vascular anastomosis.</p><p><strong>Results.</strong> The average ICA clamping time was 33.1 ± 3.4 min. Considering the intraoperative visualisation of an extended atherosclerotic plaque in the ICA, in some cases, there was a need to transform the operation. In 4.7% (n = 10) cases, autologous ICA transplantation was performed as per E. V. Rosseykinu. During the hospitalisation, the observation of cardiovascular complications was not recorded. When analysing the dynamics graph of systolic blood pressure, it was revealed that after glomus-saving CEE as per the method by A. N. Kazantsev, stable numbers are maintained during preoperative antihypertensive therapy and do not rise above 137.9 ± 7.5 mm Hg. In the mid-long-term follow-up, 1 (0.46 %) death was recorded, 1 (0.46%) due to myocardial infarction, 1 (0.46%) due to non-lethal ischaemic stroke, and 2 (0.9%) due to hemodynamically significant restenosis 12 mon after CEE. The combined endpoint (death + myocardial infarction + stroke) was reached in 3 (1.4%) patients. The cause of the lethal outcome was circular myocardial infarction that developed, given the patient's refusal to follow double disaggregant therapy (2 stents were previously implanted in the anterior descending and right coronary arteries). The cause of ischaemic stroke was the development of ICA restenosis (12 mon after CEE) owing to neointimal hyperplasia, as shown by histological examination after repeated surgery.</p><p><strong>Conclusion.</strong> CEE as per the method by A. N. Kazantsev is the simplest method of operation for known glomus-preserving reconstructions. The absence of complex arteriotomy, the preservation of carotid bifurcation structures, and the possibility of transformation of the intervention into autologous autologous transplantation with prolonged lesion is preferred over other methods. An additional opportunity for high-quality endarterectomy from ЕCA also creates preventive conditions in the prevention of cerebral haemodynamics. Stable blood pressure indicators in the hospital and mid-term follow-up periods demonstrate the importance of the preservation of the carotid glomus during reconstructive surgery on the carotid arteries. Thus, the presented type of CEE meets all the requirements of modern carotid surgery and can be an elective operation in the personalised treatment of patients with occlusal-stenotic lesions of the carotid arteries.</p><p>Received 10 May 2020. Revised 25 May 2020. Accepted 26 May 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Method development and testing: A.N. Kazantsev<br />Conception and design: T.E. Zaitseva, A.E. Chikin, A.N. Kazantsev<br />Drafting the article: A.N. Kazantsev<br />Drawing up tables: E.Yu. Kalinin<br />Statistical analysis: K.P. Chernykh<br />Literature review: R.Yu. Leader, G.Sh. Bagdavadze<br />Critical revision of the article: N.E. Zarkua, K.G. Kubachev<br />Final approval of the version to be published: A.N. Kazantsev, K.P. Chernykh, R.Yu. Leader, N.E. Zarkua, K.G. Kubachev, <br />G.Sh. Bagdavadze, E.Yu. Kalinin, T.E. Zaitseva, A.E. Chikin, Yu.P. Linets</p>
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.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.