Loeys-Dietz Syndrome

Velchev JD, Van Laer L, Luyckx I, Dietz H, Loeys B. Loeys-Dietz Syndrome. Adv Exp Med Biol. 2021;1348:251-264. Full-text for Emory users.

From: Table 11.1. Clinical features at initial diagnosis of LDS. (Velchev JD, et al., p. 253.)

  • Vascular findings
    • Arterial tortuosity 92%
      • Most common in head and neck vessels
        • Carotids (55%)
        • Vertebral (56%)
        • Intracranial (37%)
        • Ascending aorta (5%), aortic arch (10%)
        • Descending thoracic (4%) or abdominal
        • (7%) Ao, also other vessels (e.g. iliacs)
  • Aneurysms
    • Aorta
      • Root 87%
      • Ascending 27%
      • Arch 10%
      • Desc thoracic 15%
      • Abdominal 12%
    • Vessel beyond Ao 30%
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Remote endarterectomy

Saaya S, et al. A prospective randomized trial on endovascular recanalization with stenting vs. remote endarterectomy for the superficial femoral artery total occlusive lesions. J Vasc Surg. 2022 Feb 26:S0741-5214(22)00380-9. Full-text for Emory users.

Key Findings: In patients with superficial femoral artery total occlusive lesions of size greater than 250 mm, the 1-year and 4-year cumulative primary patencies of stenting (EI) and remote endarterectomy (RE) were 83% vs 82% and 28% vs 46% (P = .04), respectively. Patencies of endovascular reintervention subgroups (65 patients in the EI subgroup and 32 patients in the RE subgroup) were 37% and 60% (P = .04), respectively.

Take Home Message: RE has a better 4-year primary patency compared with stenting in patients with superficial femoral artery total occlusive lesions of size greater than 250 mm. Endovascular reinterventions after RE showed a higher patency compared with reinterventions after EI.

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Acute limb ischemia and antithrombotic therapy in COVID-19 patients

Galyfos G, et al. Acute limb ischemia among patients with COVID-19 infection. J Vasc Surg. 2022 Jan;75(1):326-342. doi: 10.1016/j.jvs.2021.07.222. Epub 2021 Aug 12.

Results: In total, 34 studies (19 case reports and 15 case series/cohort studies) including a total of 540 patients (199 patients were eligible for analysis) were evaluated. All studies were published in 2020. Mean age of patients was 61.6 years (range, 39-84 years; data from 32 studies) and 78.4% of patients were of male gender (data from 32 studies). There was a low incidence of comorbidities: arterial hypertension, 49% (29 studies); diabetes mellitus, 29.6% (29 studies); dyslipidemia, 20.5% (27 studies); chronic obstructive pulmonary disease, 8.5% (26 studies); coronary disease, 8.3% (26 studies); and chronic renal disease, 7.6% (28 studies). Medical treatment was selected as first-line treatment for 41.8% of cases. Pooled mortality rate among 34 studies reached 31.4% (95% confidence interval [CI], 25.4%%-37.7%). Pooled amputation rate among 34 studies reached 23.2% (95% CI, 17.3%-29.7%). Pooled clinical improvement rate among 28 studies reached 66.6% (95% CI, 55.4%%-76.9%). Pooled reoperation rate among 29 studies reached 10.5% (95% CI, 5.7%%-16.7%). Medical treatment was associated with a higher death risk compared with any intervention (odds ratio, 4.04; 95% CI, 1.075-15.197; P = .045) although amputation risk was not different between the two strategies (odds ratio, 0.977; 95% CI, 0.070-13.600; P = .986) (data from 31 studies).

Conclusions: SARS-CoV-2 infection is associated with a high risk for thrombotic complications, including ALI. COVID-associated ALI presents in patients with a low incidence of comorbidities, and it is associated with a high mortality and amputation risk. Conservative treatment seems to have a higher mortality risk compared with any intervention, although amputation risk is similar.

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Lithotomy-related complications in the lower limbs after colorectal surgery

Sajid MS, Shakir AJ, Khatri K, Baig MK. Lithotomy-related neurovascular complications in the lower limbs after colorectal surgery. Colorectal Dis. 2011 Nov;13(11):1203-13. Full-text for Emory users.

Results: LRNVC after prolonged lithotomy position during colorectal surgery can be classified into vascular, neurological and neurovascular combined. Compartment syndrome (CS) is the most common clinical presentation. Seven case reports and 10 case series on 34 patients (27 men, 6 women) with CS have been reported. Risk factors included the lithotomy position and duration of surgery of more than 4 h.

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Caprini Risk Assessment Model for DVTs

Cronin M, Dengler N, Krauss ES, et al. Completion of the Updated Caprini Risk Assessment Model (2013 Version). Clin Appl Thromb Hemost. 2019 Jan-Dec;25:1076029619838052.

Abstract: The Caprini risk assessment model (RAM) has been validated in over 250,000 patients in more than 100 clinical trials worldwide. Ultimately, appropriate treatment options are dependent on precise completion of the Caprini RAM. As the numerical score increases, the clinical venous thromboembolism rate rises exponentially in every patient group where it has been properly tested. The 2013 Caprini RAM was completed by specially trained medical students via review of the presurgical assessment history, medical clearances, and medical consults. The Caprini RAM was completed for every participant both preoperatively and predischarge to ensure that any changes in the patient’s postoperative course were captured by the tool. This process led to the development of completion guidelines to ensure consistency and accuracy of scoring. The 2013 Caprini scoring system provides a consistent, thorough, and efficacious method for risk stratification and selection of prophylaxis for the prevention of venous thrombosis.

Internal jugular vein versus subclavian vein as the percutaneous insertion site for totally implantable venous access devices

Wu S, Huang J, Jiang Z, et al. Internal jugular vein versus subclavian vein as the percutaneous insertion site for totally implantable venous access devices: a meta-analysis of comparative studies. BMC Cancer. 2016 Sep 22;16(1):747. Free full-text.

Results: Twelve studies including 3905 patients published between 2008 and 2015, were included. Our meta-analysis showed that incidences of TIVAD-related infections (odds ratio [OR] 0.71, 95 % confidence interval [CI] 0.48-1.04, P = 0.081) and catheter-related thrombotic complications (OR 0.76, 95 % CI 0.38-1.51, P = 0.433) were not significantly different between the two groups. However, compared with SCV, IJV was associated with reduced risks of total major mechanical complications (OR 0.38, 95 % CI 0.24-0.61, P < 0.001). More specifically, catheter dislocation (OR 0.43, 95 % CI 0.22-0.84, P = 0.013) and malfunction (OR 0.42, 95 % CI 0.28-0.62, P < 0.001) were more prevalent in the SCV than in the IJV group; however, the risk of catheter fracture (OR 0.47, 95 % CI 0.21-1.05, P = 0.065) were not significantly different between the two groups. Sensitivity analyses using fixed-effects models showed a decreased risk of catheter fracture in the IJV group.

Conclusion: The IJV seems to be a safer alternative to the SCV with lower risks of total major mechanical complications, catheter dislocation, and malfunction. However, a large-scale and well-designed RCT comparing the complications of each access site is warranted before the IJV site can be unequivocally recommended as a first choice for percutaneous implantation of a TIVAD.

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Portal hypertensive bleeding: The place of portosystemic shunting

Knechtle SJ, Galloway JR. (2017) Chapter 85. Portal hypertensive bleeding: The place of portosystemic shunting. Ed.: Jarnagin WR, In Blumgart’s Surgery of the Liver, Biliary Tract and Pancreas, 2-Volume Set (6th ed.), Elsevier, pgs. 1218-1230.e3.

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