RESUMEN
AIM OF STUDY: The aim of this study was to evaluate management of children with an anterior midline neck swelling by establishing 1) whether a preoperative ultrasound scan (USS) was appropriately requested, performed and reported; 2) whether there was preoperative infection; 3) whether a Sistrunk procedure was performed; 4) the rate of thyroglossal duct cyst (TGDC) recurrence following simple excision vs. Sistrunk procedure. METHODS: A single centre retrospective study of children who underwent surgery for anterior midline neck swelling between April 2000 and May 2015 at our institution was performed. These were identified using a clinical coding system, and data were collected from electronic medical records, radiology, and histopathology reports. Recurrence rates between simple excision and Sistrunk groups were compared using Chi-square test. MAIN RESULTS: 227 patients were identified (115 male, 112 female). 169 (74%) had a preoperative USS. The presence of a thyroid gland was stated in 79% of USS reports. This increased to 92% when the requesting surgeon had specifically asked about this. 48 (21%) patients underwent simple excision, while 175 (77%) had a Sistrunk procedure. Recurrence was significantly more likely following simple excision than a Sistrunk procedure (29% vs 6.9%; P<0.0001). Of 25 TGDC recurrences, 9 (36%) had an inconclusive or alternative histopathological diagnosis at first operation. CONCLUSION: Preoperative USS should be performed in all patients with an anterior midline neck swelling. Appropriate requesting increases likelihood of a report confirming (or otherwise) the presence of a thyroid gland. A Sistrunk procedure is the operation of choice in all children presenting with an anterior midline neck swelling. The surgeon cannot reliably differentiate a TGDC from alternative pathology intraoperatively. LEVEL OF EVIDENCE: Treatment study: level IV.
Asunto(s)
Pautas de la Práctica en Medicina/estadística & datos numéricos , Quiste Tirogloso/diagnóstico por imagen , Quiste Tirogloso/cirugía , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Recurrencia , Estudios Retrospectivos , Quiste Tirogloso/complicaciones , UltrasonografíaRESUMEN
OBJECTIVE: An adequate distal sealing zone is a prerequisite for successful endovascular aneurysm repair (EVAR). Poor engagement of iliac limbs within the common iliac artery potentially increases the risk of limb-related complications. The aim of this study was to investigate the proportion of common iliac artery used for distal sealing as a predictor of iliac limb complications following standard EVAR. METHODS: This was a retrospective case controlled study where an iliac complication group was compared to a larger control group from the unit database. Core analysis of postoperative computed tomography scans was used to ascertain the percentage engagement of the iliac limb of the stent graft within the native iliac artery in both groups. RESULTS: There were 240 limbs in the control group and 33 limbs in the complications group. Complications included 10 endoleaks, 1 iliac limb dislocation, 2 insufficient engagement, 4 occlusions, and 16 kinks. The proportion of common iliac artery engagement was significantly higher in the control group compared with the complications group (75.3:68.6%, P = .003). CONCLUSIONS: Increased engagement in the common iliac artery following standard EVAR reduces the risks of limb complications. A clinical guide utilization of more than 70% of the total length of common iliac artery could be used as this was associated with a significantly lower rate of iliac limb complications following standard EVAR.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Endofuga/etiología , Procedimientos Endovasculares/efectos adversos , Migración de Cuerpo Extraño/etiología , Oclusión de Injerto Vascular/etiología , Arteria Ilíaca/cirugía , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aortografía/métodos , Endofuga/diagnóstico por imagen , Endofuga/prevención & control , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/prevención & control , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/prevención & control , Humanos , Arteria Ilíaca/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: Aortoiliac tortuosity is often cited subjectively as a causative factor in iliac limb complications after endovascular aneurysm repair (EVAR); however, evidence on this subject is poor. The aim of this study was to investigate the impact of stent grafting on aortoiliac tortuosity and to explore the role of the tortuosity index (TI) as a predictor of iliac limb complications after EVAR. METHODS: A retrospective case-control study was performed comparing an iliac limb complication group with a control group. Reconstructed computed tomography angiography images were analyzed to calculate TI of the aortoiliac segments. RESULTS: This study included 153 patients, 120 in the control groups (40 Zenith flex [Cook Medical, Bloomington, Ind], 40 Endurant II [Medtronic, Minneapolis, Minn], and 40 Excluder [W. L. Gore and Associates, Flagstaff, Ariz] stent grafts) and 33 in the complications group (13 Zenith flex, 14 Endurant II, 4 Excluder, and 2 Aorfix [Lombard Medical, Oxfordshire, UK] stent grafts). There was a significant reduction in aortic and iliac TI after EVAR. This was greatest with the Zenith Flex compared with Endurant, with the least change in TI seen after Gore Excluder implantation. Iliac limb complications included 10 type Ib endoleaks, one iliac limb modular dislocation, two limbs with insufficient engagement, four occlusions, and 16 iliac limb kinks. There was no significant difference in complication rates between the three stent grafts (Zenith flex, 1.4%; Endurant, 2.9%; Excluder, 1.9%; P = .115). The median time to iliac complication was 14 months (range, 1-90 months). The iliac limb complication group was found to have a significantly increased aortoiliac TI on both preoperative and postoperative computed tomography imaging. CONCLUSIONS: EVAR has a significant effect on aortoiliac tortuosity. Despite the reduction of aortoiliac tortuosity after the insertion of a stent graft, TI may serve as a predictor of iliac limb complications after EVAR.