Category: General

Eur J Vasc Endovasc Surg. 2023 Jan 2:S1078-5884(22)00875-9. doi: 10.1016/j.ejvs.2022.12.033. Online ahead of print.

ABSTRACT

OBJECTIVES: Current European guidelines recommend both eversion CEA and conventional CEA with routine patch closure, rather thar routine primary closure. Polyester and polytetrafluoroethylene (PTFE) have been used as patch material for a long time. More recently, bovine pericardium has been used, however there are few studies comparing long-term results between bovine pericardium and other patch types. The aim of this study was to investigate the short- and long-term results after CEA depending on surgical technique and patch material.

METHODS: Registry-based study on all primary CEAs (n=9205) performed for symptomatic carotid artery stenosis in Sweden from July 2008 to December 2019, cross linked with data from the Swedish stroke registry, Riksstroke, and chart review for evaluation of any events occurring during follow-up. Primary endpoint was ipsilateral stroke <30days. Secondary endpoints were reoperations due to neck haematoma and <30day ipsilateral stroke >30days, all stroke >30days and all-cause mortality.

RESULTS: 2495 patients had undergone eversion CEA and 6710 conventional CEA for symptomatic carotid stenosis. The most commonly used patch-material was Dacron (n=3921), followed by PTFE (n=588) and Bovine pericardium (n=413). 1788 patients underwent conventional CEA with primary closure. 273 patients(3.0%) had a stroke<30days. Primary closure was associated with an increased risk of ipsilateral stroke and stroke or death <30days, OR 1.7(95%CI1.2-2.4), p=0.002; and 1.5(95% CI 1.2-2.0) respectively. During follow up (median 4.2 years), 592 patients had any form of stroke and 1492 died. There was no significant difference in long term risk of ipsilateral stroke, all stroke or death depending on surgical technique or patch material.

CONCLUSIONS: There was an increased risk of ipsilateral stroke <30days in patients operated with primary closure compared to eversion-CEA and patch angioplasty. There was no difference between primary closure, different patch types or eversion after the perioperative phase.

PMID:36603661 | DOI:10.1016/j.ejvs.2022.12.033

Vasc Endovascular Surg. 2023 Jan;57(1):79-82. doi: 10.1177/15385744221124297. Epub 2022 Aug 27.

ABSTRACT

Malignant invasion of the inferior vena cava (IVC) often necessitates complete tumor thrombectomy and IVC reconstruction. Bovine pericardial xenografts and prosthetic grafts are frequently used for partial or entire IVC reconstruction with adequate subsequent patency and freedom from thrombosis. Cryopreserved aortic homografts represent an alternative conduit for vena cava replacement with resistance to infection in contaminated fields or following extensive retroperitoneal dissection. Specific reports of aortic homograft use for IVC reconstruction are scarce. Described are 2 cases of cryopreserved aortoiliac artery allograft use for long segment cava patch repair while avoiding extensive caval reconstruction, mobilization and the need for renal vein and hepatic vein re-implantation.

PMID:36031948 | DOI:10.1177/15385744221124297

Strabismus. 2022 Dec;30(4):171-182. doi: 10.1080/09273972.2022.2123943. Epub 2022 Sep 30.

ABSTRACT

To study the secondary management of strabismus due to third nerve palsy using bovine pericardium (Tutopatch®) when previous conventional surgical therapy had failed. Review of our clinic records of selected patients with third nerve palsy, in whom residual deviation had been managed using Tutopatch® after previous surgical correction. The squint angle was measured preoperatively, and at 1 day, 3 months, and if possible 6 months postoperatively. Nine patients were enrolled in this study. One patient had mainly residual vertical deviation and was corrected with tendon elongation of the contralateral superior rectus. Three patients were operated on with tendon elongation of the lateral rectus muscle with or without medial rectus muscle resection and/or advancement (Group 1). Lateral rectus splitting after tendon elongation in addition to the resection and/or advancement of the medial rectus was performed in five patients with complete third nerve palsy (Group 2). In Group 1, the preoperative median squint angle was -20° (range -17° to -25°), which improved postoperatively to -4.5° (range -12° to +3°). In Group 2, the preoperative horizontal and vertical median squint angles were -27° (range -20° to -40°) and 0.5° (range 0° and 20°), respectively. Postoperatively, they had improved to -12.5° (range-2° to -25°), and 1.5° (range 0° to 7°), respectively. Two patients of Group 2 were re-operated due to residual exotropia. No postoperative complications were observed in any patient. In this small series several complex re-do situations of patients with third nerve palsy were evaluated in which Tutopatch® markedly improved outcomes after an initially ineffective surgical management. For better evaluation of its usefulness a study with more patients is recommended.

PMID:36178167 | DOI:10.1080/09273972.2022.2123943

J Vasc Surg. 2023 Jan;77(1):225-230. doi: 10.1016/j.jvs.2022.08.010. Epub 2022 Aug 18.

ABSTRACT

OBJECTIVE: Bovine pericardial patch (BPP) is currently used in femoral angioplasty as an alternative for autologous vein patch (AVP), but studies comparing the results of the two methods are scarce. In this retrospective study, we aimed to discover the differences between BPP and AVP closure in long-term durability.

METHODS: This study consisted of all femoral endarterectomies with BPP closure performed in Helsinki University Hospital from January 1, 2014, to December 31, 2017. For comparison, the same number of consecutive patients who underwent femoral endarterectomy with AVP closure from January 1, 2014, to October 16, 2016, were reviewed. Follow-up ended December 31, 2020. The mean follow-up was 19 months (range, 0-74 months) in the BPP group and 22 months (range, 0-79 months) in the AVP group. The primary endpoint was primary patency. Secondary endpoints were restenosis at patch site detected by imaging or perioperatively, patch rupture, and deep surgical wound infection. Propensity score analysis was performed for adjustment of differences between the AVP and BPP groups.

RESULTS: Overall primary patency was superior in the AVP group compared with the BPP group: at 1 year, 96.5% vs 85.0% and at 5 years, 83.0% vs 72.3% (P = .04). In propensity score-matched pairs (n = 92), no difference was found between the groups in primary patency: 95.7% and 95.7% at 1 year and 92.5% and 78.6% at 5 years (P = .861) or in freedom from restenosis: 100% and 100% at 1 year and 89.1% and 84.0% at 5 years (P = .057). Deep wound infections occurred slightly more often after BPP closure (8%) than after AVP closure (4%), but the difference was not statistically significant (P = .144). There were no patch ruptures in the BPP group, but in the AVP group, there were five ruptures (3.5%) (P = .024).

CONCLUSIONS: BPP is compatible to AVP in femoral endarterectomy in patency and can be regarded as the safer choice considering the risk of patch rupture.

PMID:35987464 | DOI:10.1016/j.jvs.2022.08.010