RESUMEN
Transfemoral access is nowadays required for an increasing number of percutaneous procedures, such as structural heart interventions, mechanical circulatory support, and interventional electrophysiology/pacing. Despite technological advancements and improved techniques, these devices necessitate large-bore (≥12 French) arterial/venous sheaths, posing a significant risk of bleeding and vascular complications, whose occurrence has been related to an increase in morbidity and mortality. Therefore, optimizing large-bore vascular access management is crucial in endovascular interventions. Technical options, including optimized preprocedural planning and proper selection and utilization of vascular closure devices, have been developed to increase safety. This review explores the comprehensive management of large-bore accesses, from optimal vascular puncture to sheath removal. It also discusses strategies for managing closure device failure, with the goal of minimizing vascular complications.
Asunto(s)
Cateterismo Periférico , Remoción de Dispositivos , Arteria Femoral , Técnicas Hemostáticas , Punciones , Dispositivos de Cierre Vascular , Humanos , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/instrumentación , Técnicas Hemostáticas/instrumentación , Técnicas Hemostáticas/efectos adversos , Remoción de Dispositivos/efectos adversos , Factores de Riesgo , Resultado del Tratamiento , Hemorragia/prevención & control , Hemorragia/etiología , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/prevención & control , Dispositivos de Acceso Vascular , Diseño de Equipo , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentaciónRESUMEN
BACKGROUND: posterior pedicle screw fixation is common method, one of the most severe complications is iatrogenic vascular damage, no report investigated association of different introversion angles (INTAs) and length of pedicle screw. The aims were to investigate the optimal introversion angle and length of pedicle screw for improving the safety of the operation, and to analyze the differences of vascular damage types at L1-S1. METHODS: Lumbar CT imaging data from110 patients were analyzed by DICOM software, and all parameters were measured by new Cartesian coordinate system, INTAs (L1-L5:5°,10°,15°,S1: 0°, 5°,10°,15°), DO-AVC (the distance between the origin (O) with anterior vertebral cortex (AVC)), DAVC-PGVs (the distance between AVC and the prevertebral great vessels (PGVs)), DO-PGVs (the distance between the O and PGVs). At different INTAs, DAVC-PGVs were divided into four grades: Grade III: DAVC-PGVs ≤ 3 mm, Grade II: 3 mm < DAVC-PGVs ≤ 5 mm, Grade I: DAVC-PGVs > 5 mm, and N: the not touching PGVs. RESULTS: The optimal INTA was 5° at L1-L3, the left was 5° and the right was 15° at L4, and screw length was less than 50 mm at L1-L4. At L5, the left optimal INTA was 5° and the right was 10°, and screw length was less than 45 mm. The optimal INTA was 15° at S1, and screw length was less than 50 mm. However, screw length was less than 40 mm when the INTA was 0° or 5° at S1. CONCLUSIONS: At L5-S1, the risk of vascular injury is the highest. INTA and length of the pedicle screw in lumbar operation are closely related. 3 mm interval of screw length may be more preferable to reduce vascular damage.
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Vértebras Lumbares , Tornillos Pediculares , Fusión Vertebral , Lesiones del Sistema Vascular , Humanos , Femenino , Masculino , Persona de Mediana Edad , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Anciano , Lesiones del Sistema Vascular/prevención & control , Lesiones del Sistema Vascular/etiología , Adulto , Fusión Vertebral/métodos , Fusión Vertebral/instrumentación , Tomografía Computarizada por Rayos X , Sacro/cirugía , Sacro/diagnóstico por imagen , Sacro/lesiones , Estudios RetrospectivosRESUMEN
INTRODUCTION: The aim of this study is to assess the risk of peroneal artery injury of hardware placement at the fixation of syndesmotic injuries. MATERIALS AND METHODS: The lower extremity computed tomography angiography was used to design the study. The syndesmosis screw placement range was simulated every 0.5 cm, from 0.5 to 5 cm proximal to the ankle joint. The screw axes were drawn as 20°, 30° or individual angle according to the femoral epicondylar axis. The proximity between the screw axis and the peroneal artery was measured in millimeters. Potential peroneal artery injury was noted if the distance between the peroneal artery to the axis of the simulated screw was within the outer shaft radius of the simulated screw. The Pearson chi-square test was used and a p-value < 0.05 was considered significant. RESULTS: The potential for injury to the peroneal artery increased as the syndesmosis screw level rose proximally from the ankle joint level or as the diameter of the syndesmosis screw increasds. In terms of syndesmosis screw trajection, the lowest risk of injury was observed with the syndesmosis screw angle of 20°. Simulations with a screw diameter of 3.5 mm exhibited the least potential for peroneal artery injury. CONCLUSION: Thanks to this radiological anatomy simulation study, we believe that we have increased the awareness of the peroneal artery potential in syndesmosis screw application. Each syndesmosis screw placement option may have different potential for injury to the peroneal artery. To decrease the peroneal artery injury potential, we recommend the followings. If individual syndesmosis screw angle trajection can be measured, place the screw 1.5 cm proximal to the ankle joint using a 3.5 mm screw shaft. If not, fix it with 30° trajection regardless of the screw diameter at the same level. If the most important issue is the peroneal artery circulation, use the screw level up to 1 cm proximal to the ankle joint regardless of the screw angle trajection and screw diameter.
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Tornillos Óseos , Angiografía por Tomografía Computarizada , Humanos , Tornillos Óseos/efectos adversos , Angiografía por Tomografía Computarizada/métodos , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/prevención & control , Lesiones del Sistema Vascular/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/efectos adversos , Traumatismos del Tobillo/cirugía , Traumatismos del Tobillo/diagnóstico por imagen , Arterias/lesiones , Arterias/diagnóstico por imagen , Arterias/anatomía & histologíaRESUMEN
BACKGROUND: Iatrogenic vascular injury during total hip arthroplasty (THA) is rare, reported at rates of 0.05 to 0.3%, but a potentially limb-threatening and life-threatening complication. We aimed to describe safe and danger zones for the superior gluteal vessel bundle (SGV bundle) with reference to different THA approaches. METHODS: There were 27 formalin-fixed cadavers with 49 hemipelves dissected. The course and distribution of the SGV bundle were investigated with the help of anatomical landmarks like the greater trochanter, the iliac tubercle (IT), and the ischial tuberosity. RESULTS: We found and exposed the SGV bundle in all 49 specimens with no sex-specific differences. No SGV bundle was encountered up to 28 mm from the greater trochanter and up to 16 mm below the IT. The zone with the highest probability of finding the vessels was 25 to 65 mm below the IT in 39 (80%) cases - defining a danger zone (in relation to the skin incision) in the proximal fourth for the direct anterior approach, in the proximal half for the antero-lateral approach, in the proximal fifth for the direct lateral approach, and almost no danger zone for the posterior approach. CONCLUSIONS: Special care in proximal instrument placement should be taken during THA. When extending one of the surgical approaches, manipulations in the proximal, cranial surgical window should be performed with the utmost care to avoid SGV bundle injury.
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Artroplastia de Reemplazo de Cadera , Lesiones del Sistema Vascular , Humanos , Nalgas/cirugía , Cadáver , Fémur , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/prevención & controlRESUMEN
OBJECTIVE: During proximal femoral nailing, deep femoral artery injury, a rare condition, is often missed and found late, leading to intractable complications such as false aneurysm, hematoma, and anemia. We aimed to determine the novel indicators of the high-risk vertical range and axial angle for deep femoral artery injury that can be easily confirmed intraoperatively using fluoroscopy for hip fracture. METHODS: In a single hospital, the lower extremity computed tomography angiographies of 88 patients (50 men and 38 women) were analyzed. A reference plane was defined as the femoral neck and shaft on the same straight line in the lateral view. Reference points were the lower end of the lesser trochanter and distal femur at 140 mm from the tip of the greater trochanter. To determine the high-risk angle for deep femoral artery injury based on the reference plane, the angle from the reference plane to the deep femoral artery (bone-arterial angle) and the shortest distance between the surfaces of the femur and the deep femoral artery (bone-artery distance) were measured at the lesser trochanter and the greater trochanter. We analyzed the bone-arterial angle and bone-artery distance values, their differences among the sexes, and their correlation with body height and body weight. RESULTS: Overall, in the lesser trochanter, the mean bone-arterial angle and bone-artery distance were 19.2° ± 8.0° and 22.9 ± 4.7 mm, respectively. In the greater trochanter, the mean bone-arterial angle and bone-artery distance were -33.9° ± 17.0° and 11.3 ± 4.1 mm, respectively. The mean bone-artery distance of the lesser trochanter was significantly longer in men than in women (24.1 ± 4.5 mm and 21.4 ± 4.5 mm, respectively, P < 0.01), and for the lesser trochanter, positive correlations were found between body height and both bone- arterial angle and bone-artery distance (r=0.373, P < 0.001; and r=0.456, P < 0.0001, respectively), with body weight and bone-artery distance positively correlated (r=0.367, P < 0.001). At the greater trochanter, there were negative correlations between body height and bone-arterial angle (r=-0.5671, P < 0.0001), body weight, and bone-arterial angle (r=-0.338, P < 0.01). CONCLUSION: The knowledge of our reference plane and high-risk angles and distances allows surgeons to minimize the risk of deep femoral artery injury. These are easily confirmed intraoperatively using fluoroscopy, allowing surgeons to avoid maneuvering in the deep femoral artery range. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.
Asunto(s)
Fracturas del Fémur , Fijación Intramedular de Fracturas , Fracturas de Cadera , Lesiones del Sistema Vascular , Masculino , Humanos , Femenino , Fijación Intramedular de Fracturas/efectos adversos , Arteria Femoral/diagnóstico por imagen , Fémur/diagnóstico por imagen , Fémur/cirugía , Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/cirugía , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/prevención & control , Extremidad Inferior , Peso Corporal , Fracturas del Fémur/cirugíaRESUMEN
Background Restenosis is one of the main bottlenecks in restricting the further development of cardiovascular interventional therapy. New signaling molecules involved in the progress have continuously been discovered; however, the specific molecular mechanisms remain unclear. MTMR14 (myotubularin-related protein 14) is a novel phosphoinositide phosphatase that has a variety of biological functions and is involved in diverse biological processes. However, the role of MTMR14 in vascular biology remains unclear. Herein, we addressed the role of MTMR14 in neointima formation and vascular smooth muscle cell (VSMC) proliferation after vessel injury. Methods and Results Vessel injury models were established using SMC-specific conditional MTMR14-knockout and -transgenic mice. Neointima formation was assessed by histopathological methods, and VSMC proliferation and migration were assessed using fluorescence ubiquitination-based cell cycle indicator, transwell, and scratch wound assay. Neointima formation and the expression of MTMR14 was increased after injury. MTMR14 deficiency accelerated neointima formation and promoted VSMC proliferation after injury, whereas MTMR14 overexpression remarkably attenuated this process. Mechanistically, we demonstrated that MTMR14 suppressed the activation of PLK1 (polo-like kinase 1) by interacting with it, which further leads to the inhibition of the activation of MEK/ERK/AKT (mitogen-activated protein kinase kinase/extracellular-signal-regulated kinase/protein kinase B), thereby inhibiting the proliferation of VSMC from the medial to the intima and thus preventing neointima formation. Conclusions MTMR14 prevents neointima formation and VSMC proliferation by inhibiting PLK1. Our findings reveal that MTMR14 serves as an inhibitor of VSMC proliferation and establish a link between MTMR14 and PLK1 in regulating VSMC proliferation. MTMR14 may become a novel potential therapeutic target in the treatment of restenosis.
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Monoéster Fosfórico Hidrolasas , Proteínas Serina-Treonina Quinasas , Lesiones del Sistema Vascular , Animales , Ratones , Movimiento Celular , Proliferación Celular , Células Cultivadas , Ratones Transgénicos , Músculo Liso Vascular/patología , Miocitos del Músculo Liso/metabolismo , Neointima/patología , Monoéster Fosfórico Hidrolasas/metabolismo , Lesiones del Sistema Vascular/genética , Lesiones del Sistema Vascular/prevención & control , Lesiones del Sistema Vascular/metabolismo , Proteínas Serina-Treonina Quinasas/metabolismo , Quinasa Tipo Polo 1RESUMEN
BACKGROUND: Displaced pediatric tibial tubercle fractures are commonly stabilized with screws directed posteriorly toward neurovascular structures. Here, we (1) characterize the variation of the popliteal artery among pediatric patients; and (2) recommend a safe screw trajectory for fixation of tibial tubercle fractures. METHODS: We retrospectively identified 42 patients (42 knees; 29 female) aged 12-17 years with lower-extremity magnetic resonance imaging (MRI) at a tertiary academic center. The mean patient age was 14.5 (range: 12-17) years, and the mean body mass index value was 19.1 (range: 14.9-25.1). We included patients with open physes or visible physeal scars and excluded those with prior instrumentation or lower-extremity injury. Using sagittal MRI, we measured the distances from 5 levels each on the anterior and posterior tibial cortex to the popliteal artery (level 1, midpoint of proximal tibial epiphysis; level 2, the proximal extent of the tubercle; level 3, tubercle prominence; level 4, 2 cm distal to the proximal extent of the tubercle; level 5, 4 cm distal to the proximal extent of the tubercle). Using coronal MRI, we measured the width of the tibia at each level and the distance from the lateral-most and medial-most cortex to the artery. RESULTS: The popliteal artery was laterally positioned in all knees. The mean distance between the artery and lateral-most aspect of the tibia at each level ranged from 1.9 to 2.4 cm, and from 2.3 to 3.9 cm from the medial-most aspect of the tibia. The mean distance that a screw can advance before vascular injury was 5.1 cm at level 1. The shortest mean distance to the popliteal artery was 1.7 cm, at level 5. There is minimal distance between the posterior tibial cortex and the artery at all levels. CONCLUSIONS: Understanding the position of the popliteal artery in pediatric patients can help when stabilizing tibial tubercle fractures. Because the artery is close to the posterior cortex, a drill exiting in line with the popliteal artery risks vascular injury. Therefore, we recommend that screws exit within the medial 60% of the tibia. LEVEL OF EVIDENCE: IV.
Asunto(s)
Fracturas de la Tibia , Lesiones del Sistema Vascular , Niño , Femenino , Humanos , Articulación de la Rodilla/cirugía , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/lesiones , Estudios Retrospectivos , Tibia/diagnóstico por imagen , Tibia/cirugía , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/prevención & controlRESUMEN
OBJECTIVES: To correlate computed tomography findings and endoscopic localisation of the anterior ethmoidal artery during surgery, and to analyse the intranasal landmarks and abnormalities of the artery. METHOD: The anterior ethmoidal artery was studied with high-resolution computed tomography and endoscopic surgery in 30 patients undergoing functional endoscopic sinus surgery (group A), and with endoscopic dissection on 30 human cadavers (group B). RESULTS: The anterior ethmoidal artery was demonstrated on computed tomography in 25 patients and intra-operatively in 12 (group A). It was identified in 26 cadavers (group B). Dehiscence of bony canal and branching was noted in 10.53 per cent of cases. The mean (± standard deviation) intranasal length of the anterior ethmoidal artery was 7.29 (± 1.21) mm, the distance of the artery from the axilla of the middle turbinate was 16.24 (± 2.75) mm, and the mean distance from the ground lamella was 8.97 (± 1.46) mm. CONCLUSION: High-resolution computed tomography scanning prior to functional endoscopic sinus surgery is mandatory to identify the anterior ethmoidal artery. Endoscopically, the axilla of the middle turbinate and the ground lamella can serve as dependable reference points to identify the artery. Cadaver dissection improves understanding of anatomy.
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Puntos Anatómicos de Referencia , Endoscopía/métodos , Complicaciones Intraoperatorias/prevención & control , Arteria Oftálmica/diagnóstico por imagen , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Senos Paranasales/cirugía , Lesiones del Sistema Vascular/prevención & control , Adolescente , Adulto , Anciano , Cadáver , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Oftálmica/anatomía & histología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
BACKGROUND: Chemokine (C- Cmotif) ligand 5 (CCL5) and its receptor C-C motif chemokine receptor 5 (CCR5), have been broadly studied in conjunction with infectious pathogens, however, their involvement in cardiovascular disease is not completely understood. NADPH oxidases (Noxs) are the major source of reactive oxygen species (ROS) in the vasculature. Whether the activation of Noxs is CCL5/CCR5 sensitive and whether such interaction initiates vascular injury is unknown. We investigated whether CCL5/CCR5 leads to vascular damage by activating Noxs. MATERIAL AND METHODS: We used rat aortic smooth muscle cells (RASMC) to investigate the molecular mechanisms by which CCL5 leads to vascular damage and carotid ligation (CL) to analyze the effects of blocking CCR5 on vascular injury. RESULTS: CCL5 induced Nox1 expression in concentration and time-dependent manners, with no changes in Nox2 or Nox4. Maraviroc pre-treatment (CCR5 antagonist, 40uM) blunted CCL5-induced Nox1 expression. Furthermore, CCL5 incubation led to ROS production and activation of Erk1/2 and NFkB, followed by increased vascular cell migration, proliferation, and inflammatory markers. Notably, Nox1 inhibition (GKT771, 10uM) blocked CCL5-dependent effects. In vivo, CL induced pathological vascular remodeling and inflammatory genes and increased Nox1 and CCR5 expression. Maraviroc treatment (25 mg/Kg/day) reduced pathological vascular growth and Nox1 expression. CONCLUSIONS: Our findings suggest that CCL5 activates Nox1 in the vasculature, leading to vascular injury likely via NFkB and Erk1/2. Herein, we place CCR5 antagonists and/or Nox1 inhibitors might be preeminent antiproliferative compounds to reduce the cardiovascular risk associated with medical procedures (e.g. angioplasty) and vascular diseases associated with vascular hyperproliferation.
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Músculo Liso Vascular/citología , Miocitos del Músculo Liso/metabolismo , NADPH Oxidasa 1/metabolismo , Receptores CCR5/metabolismo , Lesiones del Sistema Vascular/metabolismo , Animales , Antagonistas de los Receptores CCR5/farmacología , Movimiento Celular/efectos de los fármacos , Células Cultivadas , Quimiocina CCL5/genética , Quimiocina CCL5/farmacología , Regulación de la Expresión Génica/efectos de los fármacos , Masculino , Maraviroc/farmacología , Ratones Endogámicos C57BL , Miocitos del Músculo Liso/efectos de los fármacos , NADPH Oxidasa 1/genética , Ratas , Receptores CCR5/agonistas , Receptores CCR5/genética , Proteínas Recombinantes/farmacología , Lesiones del Sistema Vascular/prevención & controlRESUMEN
Pulmonary arterial hypertension (PAH) is a chronic, incurable condition characterized by pulmonary vascular remodeling, perivascular inflammation, and right heart failure. Regulatory T cells (Tregs) stave off autoimmunity, and there is increasing evidence for their compromised activity in the inflammatory milieu of PAH. Abnormal Treg function is strongly correlated with a predisposition to PAH in animals and patients. Athymic Treg-depleted rats treated with SU5416, an agent causing pulmonary vascular injury, develop PAH, which is prevented by infusing missing CD4+CD25highFOXP3+ Tregs. Abnormal Treg activity may also explain why PAH disproportionately affects women more than men. This mini review focuses on the role of Tregs in PAH with a special view to sexual dimorphism and the future promise of Treg therapy.
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Hipertensión Arterial Pulmonar/inmunología , Hipertensión Arterial Pulmonar/prevención & control , Linfocitos T Reguladores/inmunología , Lesiones del Sistema Vascular/inmunología , Lesiones del Sistema Vascular/prevención & control , Animales , Autoinmunidad , Endotelio Vascular/inmunología , Endotelio Vascular/patología , Humanos , Indoles/efectos adversos , Hipertensión Arterial Pulmonar/patología , Pirroles/efectos adversos , Ratas , Caracteres Sexuales , Lesiones del Sistema Vascular/patologíaRESUMEN
C-type natriuretic peptide (CNP) is an important vascular regulator that is present in the brain. Our previous study demonstrated the innate neuroprotectant role of CNP in the neonatal brain after hypoxic-ischemic (HI) insults. In this study, we further explored the role of CNP in cerebrovascular pathology using both in vivo and in vitro models. In a neonatal mouse HI brain injury model, we found that intracerebroventricular administration of recombinant CNP dose-dependently reduces brain infarct size. CNP significantly decreases brain edema and immunoglobulin G (IgG) extravasation into the brain tissue, suggesting a vasculoprotective effect of CNP. Moreover, in primary brain microvascular endothelial cells (BMECs), CNP dose-dependently protects BMEC survival and monolayer integrity against oxygen-glucose deprivation (OGD). The vasculoprotective effect of CNP is mediated by its innate receptors NPR2 and NPR3, in that inhibition of either NPR2 or NPR3 counteracts the protective effect of CNP on IgG leakage after HI insult and BMEC survival under OGD. Of importance, CNP significantly ameliorates brain atrophy and improves neurological deficits after HI insults. Altogether, the present study indicates that recombinant CNP exerts vascular protection in neonatal HI brain injury via its innate receptors, suggesting a potential therapeutic target for the treatment of neonatal HI brain injury.
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Hipoxia-Isquemia Encefálica/patología , Péptido Natriurético Tipo-C/farmacología , Lesiones del Sistema Vascular/prevención & control , Animales , Animales Recién Nacidos , Encéfalo/metabolismo , Edema Encefálico/patología , Infarto Encefálico/metabolismo , Lesiones Encefálicas/patología , Células Cultivadas , Células Endoteliales/metabolismo , Femenino , Hipoxia-Isquemia Encefálica/metabolismo , Infusiones Intraventriculares , Masculino , Ratones , Péptido Natriurético Tipo-C/metabolismo , Péptido Natriurético Tipo-C/fisiología , Fármacos Neuroprotectores , Lesiones del Sistema Vascular/metabolismoRESUMEN
BACKGROUND: When performing filler injection procedures to the nasojugal groove, there is the risk of iatrogenic damage to the detoured facial artery. OBJECTIVE: To determine the 3-dimensional location of the detoured facial artery. MATERIALS AND METHODS: The branches of the facial arteries from 118 cadaveric hemifaces were scanned using computed tomography and reconstructed using the Mimics software program. RESULTS: Detoured facial arteries were found in 47 of the 118 hemifaces (39.8%). Two main arterial patterns were identified: in Type I (29 of 47 cases), there were both detoured and nasolabial trunks where the facial artery originated, whereas in Type II (18 of 47 cases), there was only a detoured trunk. The detoured trunk originated 32.0 ± 5.3 mm from the midsagittal line, 5.0 ± 2.8 mm from the occlusion plane, and 5.9 ± 3.5 mm below the skin layer; the inflection of the detoured trunk was located 30.0 ± 5.6 mm laterally, 26.2 ± 4.4 mm superiorly, and 5.7 ± 2.6 mm deep. The meeting point with the inferior orbital rim plane was located 17.1 ± 3.4 mm laterally, 43.4 ± 3.1 mm superiorly, and 2.8 ± 1.7 mm deep. CONCLUSION: The 3-dimensional location of the detoured facial artery as reported here will help clinicians to avoid iatrogenic damage when they are performing filler injection procedures.
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Arterias/anatomía & histología , Técnicas Cosméticas/efectos adversos , Rellenos Dérmicos/efectos adversos , Cara/irrigación sanguínea , Lesiones del Sistema Vascular/prevención & control , Adolescente , Adulto , Anciano , Variación Anatómica , Arterias/diagnóstico por imagen , Arterias/lesiones , Cadáver , Rellenos Dérmicos/administración & dosificación , Femenino , Humanos , Imagenología Tridimensional , Inyecciones Subcutáneas/efectos adversos , Inyecciones Subcutáneas/métodos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Lesiones del Sistema Vascular/etiología , Adulto JovenRESUMEN
Peripheral vascular access and closure are fundamental skills in cardiovascular surgery, especially in the era of transcatheter and minimally invasive surgical techniques. Conventional arterial access via surgical cutdown typically requires vascular clamps for surgical control and primary closure. We have been utilizing a surgical preclosure technique that does not require vascular clamping. The technique utilizes 4 to 5 full-thickness Prolene sutures placed in an interrupted fashion at the site of access instead of traditional purse-string sutures. These sutures are placed prior to vascular access. The sutures are not tied down until the procedure is complete and the vascular sheath is removed. This technique allows for adequate control and closure of the peripheral access artery without the use of vascular clamps and avoids traumatic manipulation of the artery.
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Estenosis de la Válvula Aórtica/cirugía , Arteria Axilar/cirugía , Cateterismo Periférico , Complicaciones Intraoperatorias/prevención & control , Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/métodos , Humanos , Masculino , Técnicas de Sutura , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Resultado del Tratamiento , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/prevención & controlRESUMEN
BACKGROUND: Anatomical knowledge of the zygomatico-orbital artery and its most relevant clinical applications is essential for ensuring the safety of filler injection into the temporal region. The purpose of this study was to provide the precise position, detailed course, and relationship with surrounding structures of the zygomatico-orbital artery. METHODS: Fifty-eight patients who underwent head contrast-enhanced three-dimensional computed tomography and 10 fresh frozen cadavers were investigated. RESULTS: The zygomatico-orbital artery was identified in 93 percent of the samples in this work. Ninety-four percent of the zygomatico-orbital arteries derived directly from the superficial temporal artery, and the remaining arteries started from the frontal branch of the superficial temporal artery. According to the origin of the zygomatico-orbital artery, it was classified into type I and type II. Type I arteries were then classified into three subtypes. The trunk of the zygomatico-orbital artery was located between the deep temporal fascia and the superficial temporal fascia. Deep branches of the zygomatico-orbital artery pierced the superficial layer of the deep temporal fascia. The zygomatico-orbital artery originated from 11.3 mm in front of the midpoint of the apex of the tragus, and most of its trunks were located less than 20.0 mm above the zygomatic arch. The mean diameter of the zygomatico-orbital artery was 1.2 ± 0.2 mm. There were extensive anastomoses between the zygomatico-orbital artery and various periorbital arteries at the lateral orbital rim. CONCLUSION: The precise anatomical knowledge of the zygomatico-orbital artery described in this study could be helpful for cosmetic physicians for improving the safety of temporal augmentation.
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Variación Anatómica , Técnicas Cosméticas/efectos adversos , Frente/irrigación sanguínea , Arterias Temporales/anomalías , Lesiones del Sistema Vascular/prevención & control , Adulto , Anciano , Cadáver , Medios de Contraste/administración & dosificación , Rellenos Dérmicos/administración & dosificación , Femenino , Humanos , Imagenología Tridimensional , Inyecciones Subcutáneas/efectos adversos , Masculino , Persona de Mediana Edad , Órbita/irrigación sanguínea , Arterias Temporales/diagnóstico por imagen , Arterias Temporales/lesiones , Tomografía Computarizada por Rayos X , Lesiones del Sistema Vascular/etiología , Cigoma/irrigación sanguíneaRESUMEN
Pillar pain represents one of the most common complications of classic open carpal tunnel release (CTR). This complication causes a sense of discomfort worse than the compression syndrome itself. We, herein, introduce a new treatment method for CTR through a mini-incision, which allows subcutaneously cutting the transverse carpal ligament (TCL) and releasing the median nerve without neurovascular complications. This mini-incision approach can allow the direct visualization and preservation of the thenar motor branch in those rare cases where it has an aberrant origin. For the past 10 years, we have consecutively performed this technique in the surgical treatment of 318 patients with the diagnosis of primary CTS, without developing any neurovascular and tendon injuries as well as pillar pain.
Asunto(s)
Síndrome del Túnel Carpiano/cirugía , Descompresión Quirúrgica , Complicaciones Intraoperatorias , Nervio Mediano/lesiones , Dolor , Traumatismos de los Nervios Periféricos , Lesiones del Sistema Vascular , Adulto , Descompresión Quirúrgica/efectos adversos , Descompresión Quirúrgica/métodos , Femenino , Mano/cirugía , Humanos , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/prevención & control , Ligamentos Articulares/cirugía , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Dolor/etiología , Dolor/prevención & control , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/fisiopatología , Traumatismos de los Nervios Periféricos/prevención & control , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/prevención & control , Articulación de la Muñeca/cirugíaRESUMEN
PURPOSE: Among the variations of the right hepatic artery (RHA), the identification of an aberrant RHA arising from the gastroduodenal artery (GDA) is vital for avoiding damage to the RHA during surgery, since ligation of the GDA is necessary during pancreaticoduodenectomy (PD). However, this variation is not frequently reported. The purpose of this study was to focus on an aberrant RHA arising from the GDA, which was not noted in the classifications reported by Michels and Hiatt. METHODS: A total of 574 patients undergoing a PD between Jan 2001 and Dec 2015 at a tertiary care hospital in Switzerland (n = 366) and between Jan 2009 and May 2015 at a hospital in Japan (n = 208) were included in the analysis. Of these, preoperative CT angiography or/and MRI angiography findings were available for 532 patients. We retrospectively analyzed the hepatic artery variations, patient demographics, and surgical outcomes. RESULTS: Among the 532 patients who received a PD, an RHA originating from the GDA was observed in 19 cases (3.5%). Eleven patients (2.1%) had both an aberrant RHA and an aberrant left hepatic artery (LHA) (Hiatt Type 4). Six patients (1.2%) had a replaced CHA arising from the SMA (Hiatt Type 5). We could, therefore, correctly identify the aberration in all cases. CONCLUSIONS: We observed rarely reported but important aberrant RHA variations arising from the GDA. To prevent injury during PD in patients with this type of aberrant RHA, intensive preparations using CT and/or MRI imaging before surgery and intraoperative liver Doppler ultrasonography are considered to be essential.
Asunto(s)
Duodeno/irrigación sanguínea , Arteria Hepática/anomalías , Complicaciones Intraoperatorias/prevención & control , Pancreaticoduodenectomía/métodos , Estómago/irrigación sanguínea , Lesiones del Sistema Vascular/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/lesiones , Humanos , Ligadura , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Periodo Perioperatorio , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler , Adulto JovenRESUMEN
OBJECTIVE: The medium (2-4 cm) convexity located closer to the sinus and parasagittal meningiomas (Sindou type I-â ¢) without obvious invasion of the superior sagittal sinus are considered simple to operate on. However, the tumors are often accompanied by the cortical bridging vein. Because of lack of collateral vein circulation in cortical areas, the damage of peritumoral veins will subsequently lead to venous infarction. To avoid the serious complications caused by intraoperative injury of peritumoral veins, it is necessary to define the classification of the progression of peritumoral veins and tumors to guide surgical safety. METHODS: The clinical information of 57 patients with convexity and parasagittal meningiomas was collected and retrospectively analyzed. All patients underwent preoperative magnetic resonance imaging and magnetic resonance venography scanning to observe the imaging characteristics of peritumoral veins and preoperative evaluation. The actual relationship between the tumor and peritumoral vein was observed intraoperatively. Postoperative computed tomography and magnetic resonance imaging were used to determine tumor resection and the presence of venous infarction. RESULTS: According to preoperative magnetic resonance venography and intraoperative findings, we divided the peritumoral veins into 3 types: type A (n = 33, 57.9%), the vein surrounds the tumor; type B (n = 15, 26.3%), the vein is located on the ventral side of the tumor; and type C (n = 9, 15.8%), the vein is located on the dorsal side of the tumor. Peritumoral vein injury occurred in 6 cases followed by serious complications. Treatments were as follows: 4 cases underwent decompression and 2 cases were treated conservatively. The prognosis Glasgow Outcome Scale (GOS) scores were as follows: 3 cases were score 5 for injury of posterior frontal vein or middle frontal vein, 2 cases were score 3 for injury of the central vein, 1 case was score 1 for death due to injury of the central vein. All cases were followed up for 6 months. CONCLUSIONS: Attention should be paid to the peritumoral vein of special meningiomas. Injured vein in the medial third of superior sagittal sinus carries a high rate of postoperative morbidity. Understanding the type of peritumoral veins preoperatively can be used as a guide in determining the corresponding protective strategy during surgery, which can significantly decrease postoperative disability and improve quality of life.
Asunto(s)
Infarto Encefálico/prevención & control , Venas Cerebrales/diagnóstico por imagen , Complicaciones Intraoperatorias/prevención & control , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Lesiones del Sistema Vascular/prevención & control , Adulto , Anciano , Angiografía Cerebral , Venas Cerebrales/lesiones , Femenino , Escala de Consecuencias de Glasgow , Humanos , Angiografía por Resonancia Magnética , Masculino , Neoplasias Meníngeas/irrigación sanguínea , Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/irrigación sanguínea , Meningioma/diagnóstico por imagen , Persona de Mediana Edad , FlebografíaRESUMEN
BACKGROUND: Intraoperative vascular injuries in the cervical spine are rare, but carry significant morbidity and mortality when they do occur. There is a need to better characterize the risk of vertebral artery injury (VAI) after posterior C1-C2 fusion. The aim of this study was to investigate the rate of VAI in patients undergoing posterior C1-C2 cervical fusion. METHODS: An electronic database search was performed to identify studies that reported rates of VAI following posterior cervical fusion at C1-C2 level. Patient-specific risk factors, surgical indication, surgical technique, and other data were collected for each study. Forest plots were created to outline the pooled ratios of VAI in the literature. RESULTS: Eleven studies with 773 patients were identified. Mean age of patients was 48.47 years (range, 6-78 years), and most patients were female (61.7%, n = 399). Trauma was the most frequent indication for surgery (18.8%, n = 146), followed by inflammatory processes affecting the vertebrae (13.2%, n = 102). The rate of VAI per patient was 2% (95% confidence interval = 1%-4%) among 773 patients, while injury rate per screw was 1% (95% confidence interval = 0%-2%) among 2238 screws placed. CONCLUSIONS: The rate of VAI after C1-C2 posterior cervical fusion was found to be 2% for each operated patient and 1% for each screw placed.
Asunto(s)
Vértebra Cervical Axis/cirugía , Atlas Cervical/cirugía , Complicaciones Intraoperatorias/epidemiología , Complicaciones Posoperatorias/epidemiología , Fusión Vertebral/métodos , Lesiones del Sistema Vascular/epidemiología , Arteria Vertebral/lesiones , Articulación Atlantoaxoidea , Angiografía Cerebral , Humanos , Hemorragia Posoperatoria/epidemiología , Lesiones del Sistema Vascular/prevención & controlRESUMEN
Injuries to the pelvic vasculature during total hip arthroplasties are rare but have serious consequence. They demand urgent and early identification so that appropriate treatment can be instituted. If the bleeding is severe, cardiovascular compromise occurs intraoperatively and this will alert the surgeon of this possibility during acetabular screw placement. Alternatively, a delay in diagnosis can occur because the bleeding and the injured vessel are in the pelvic cavity and not visualized during the surgery. In this article, we report two cases from our center occurring within a six-month interval that sustained a vascular injury during acetabular drilling for screw placement for cementless cup fixation. Each case had a different vessel injury and different lessons can be learned from these rare injuries. The first case had an injury of the inferior gluteal artery following a breach of the sciatic notch. The vessel was treated with percutaneous embolization. The second case demonstrated a venous injury, following a medial protrusio technique for congenital hip dysplasia and a short anterosuperior screw, transecting the external iliac vein. This was subsequently repaired using an endovascular technique. We conclude the reasons for these vessel injuries after analyzing advanced imaging, discuss measures to avoid vessel injury and detail the minimally invasive method for their treatment.