The increasing acceptance of custom-made devices for elective thoracoabdominal aortic aneurysms does not translate to suitability in emergency settings, where the endograft's production timeframe of up to four months is prohibitive. Multibranched, off-the-shelf devices with standardized configurations have made possible the emergent endovascular treatment of ruptured thoracoabdominal aortic aneurysms. In 2012, the Zenith t-Branch device (Cook Medical), the first readily available graft outside the US to secure CE marking, now stands as the most extensively studied device for its respective medical applications. The E-nside thoracoabdominal branch endoprosthesis OTS multibranched endograft (Artivion) and the GORE EXCLUDER thoracoabdominal branch endoprosthesis OTS multibranched endograft (W. are now both available for purchase. According to projections, the L. Gore and Associates report is scheduled for release in 2023. Due to the lack of definitive guidelines for ruptured thoracoabdominal aortic aneurysms, this review summarizes existing treatment options (like parallel grafts, physician-modified endografts, in situ fenestrations, and OTS multibranched devices), contrasts their indications and limitations, and identifies the research gaps that demand attention within the next ten years.
Abdominal aortic aneurysms, ruptured and encompassing the iliac arteries, present a life-threatening crisis, often resulting in high mortality even following surgical intervention. Recent advancements in perioperative care have led to improved outcomes, facilitated by the increasing application of endovascular aortic repair (EVAR), intraoperative aortic balloon occlusion, a centralized treatment protocol in high-volume centers, and optimized perioperative management. EVAR, in the present day, is applicable in nearly every conceivable scenario, even those involving urgent medical needs. In the postoperative trajectory of rAAA patients, abdominal compartment syndrome (ACS) stands as a rare yet potentially lethal complication, influenced by various contributing factors. For the prompt and appropriate management of acute compartment syndrome (ACS), thorough surveillance protocols and accurate transvesical intra-abdominal pressure measurements are essential. Early clinical diagnosis, while often overlooked, is imperative for the initiation of emergency surgical decompression. The future trajectory of rAAA patient outcomes may be significantly improved through the application of simulation-based training, encompassing surgical technical and non-technical skills along with those of all associated healthcare professionals, and simultaneously facilitating the transfer of all such patients to specialized vascular centers with proven expertise and a high case volume.
For a growing number of medical conditions, vascular encroachment is now considered not a counterindication to surgery with curative intent. This has broadened the scope of vascular surgeons' practice, including pathologies they were not previously involved with. Multidisciplinary collaboration is crucial for effectively managing these patients. New kinds of emergencies and complications have come into existence. Thorough planning and seamless collaboration between oncological surgeons and a dedicated vascular surgery team are crucial in preventing emergencies during oncovascular surgery. Difficult vascular dissection, combined with complex reconstructive techniques, is a frequent component of these operations, performed in a setting that could be both contaminated and irradiated, thereby increasing the likelihood of postoperative complications and blow-outs. Even after a challenging surgical procedure, a successful operation and positive immediate postoperative period often contribute to faster recovery in patients, exceeding that of the usual fragile vascular surgical patient. The focus of this narrative review rests on emergencies commonly found in the context of oncovascular procedures. A scientific methodology, underpinned by international collaboration, is paramount for determining the optimal surgical candidates, anticipating and proactively managing potential complications through meticulous planning, and ultimately achieving improved patient outcomes.
The potentially fatal nature of thoracic aortic arch emergencies requires a complete surgical toolbox, encompassing complete aortic arch replacement using the frozen elephant trunk approach, hybrid interventions, and complete endovascular options with standard or individualized stent grafts. Pathologies of the aortic arch demand an optimal treatment strategy selected by a multidisciplinary aortic team. This strategy must consider the aorta's complete morphology, from its root to the point beyond its bifurcation, and the patient's overall clinical picture, including any comorbidities. The intended outcome of the treatment is a complication-free postoperative period and the complete elimination of the need for future aortic reinterventions. Single Cell Analysis In all instances of therapy, patients should be subsequently affiliated with a specialized aortic outpatient clinic. This review sought to present a broad perspective on the pathophysiology and current treatment strategies for thoracic aortic emergencies, specifically including cases involving the aortic arch. find more This report encompassed a summary of preoperative preparations, intraoperative protocols, surgical approaches, and postoperative patient follow-up.
The most significant pathologies affecting the descending thoracic aorta (DTA) are aneurysms, dissections, and traumatic injuries, respectively. In acute scenarios, these conditions can cause significant risk of bleeding or organ ischemia in essential organs, which can ultimately prove fatal. Endovascular techniques and medical therapy improvements have not eliminated the considerable morbidity and mortality associated with aortic conditions. Through a narrative review, we present a summary of the changing approaches to managing these pathologies, analyzing the current problems and potential future solutions. Thoracic aortic pathologies and cardiac diseases present a diagnostic challenge in that they must be differentiated. A blood test capable of swiftly distinguishing these pathologies has been the subject of considerable research efforts. The cornerstone of diagnosing thoracic aortic emergencies is the computed tomography scan. Our understanding of DTA pathologies has been substantially improved by the significant advances in imaging techniques during the past two decades. This comprehension has led to a revolutionary change in the treatment strategies for these disorders. Prospective and randomized studies, unfortunately, have yet to provide compelling evidence for the management of the majority of DTA diseases. For early stability during these life-threatening emergencies, medical management plays a pivotal part. For patients who have suffered a ruptured aneurysm, intensive care monitoring, meticulous heart rate and blood pressure control, and the possible acceptance of permissive hypotension are integral elements of care. Over the course of several years, the surgical management of DTA pathologies evolved from traditional open repair techniques to the more modern endovascular approach utilizing dedicated stent-grafts. There has been a marked increase in the effectiveness of techniques across both spectrums.
The acute conditions of symptomatic carotid stenosis and carotid dissection within the extracranial cerebrovascular system can cause transient ischemic attacks or strokes. These pathologies can be addressed through various treatment modalities: medical, surgical, or endovascular procedures. A review of acute extracranial cerebrovascular vessel conditions focuses on their management strategies, spanning from the initial symptoms to definitive treatment, including instances of post-carotid revascularization stroke. Carotid endarterectomy, a primary component of carotid revascularization, combined with appropriate medical therapy, is beneficial for patients with symptomatic carotid stenosis (over 50%, as defined by the North American Symptomatic Carotid Endarterectomy Trial criteria) who have experienced transient ischemic attacks or strokes within two weeks of symptom onset, helping to decrease the probability of recurrent strokes. Exit-site infection While acute extracranial carotid dissection often necessitates a different approach, medical management, including antiplatelet or anticoagulant therapy, can effectively prevent the occurrence of new neurological ischemic events, reserving stenting for symptom recurrence. A stroke following carotid revascularization can result from carotid manipulation, the release of detached plaque fragments, or ischemia from the clamping procedure. Carotid revascularization is followed by neurological events, and the cause and timing of these events then dictate the appropriate medical or surgical interventions. The acute pathologies of extracranial cerebrovascular vessels are diverse and varied, and optimal management substantially diminishes the frequency of symptom recurrence.
To assess post-operative complications, retrospectively, in dogs and cats fitted with closed suction subcutaneous drains, categorized into in-hospital management (Group ND) and home discharge for continued outpatient care (Group D).
During a surgical procedure, 101 client-owned animals, comprising 94 dogs and 7 cats, received a subcutaneous closed suction drain.
A retrospective review was carried out on electronic medical records, ranging from January 2014 up to and including December 2022. Patient characteristics, the reason for the drain's insertion, the surgical technique employed, the placement details (location and duration), the drain's output, antibiotic use, culture and sensitivity data, and any intraoperative or postoperative issues were all recorded. Investigations into the connections between variables were carried out.
Group D included 77 animals, significantly more than the 24 animals recorded for Group ND. Of the complications observed (n=26), a majority (21) were classified as minor and derived from Group D patients. The time required for drain removal was substantially greater in Group D (56 days) compared to the 31 days in Group ND. Complications were not linked to the position of the drain, the period it was left in place, or the presence of surgical site contamination.