Emergency transarterial embolization for mesenteric bleeding – Safety and efficacy

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“Mesenteric bleeding (MB) occurs rarely and its frequency is not well known. It corresponds to bleeding from mesenteric vessels in the abdominal cavity, without intra-luminal digestive bleeding. Although relatively rare, this pathology can be life-threatening if left undiagnosed and untreated. Clinically, MB are characterized by non-systematised abdominal pain and sudden blood loss. MB has many causes such as a post operative complication (especially after pancreaticoduodenectomy), traumatism, tumour, or may be idiopathic with no cause found. CT-scan is the gold standard of diagnostic imaging to identify the cause of MB. While the management of upper and lower gastrointestinal bleeding has been well established, the management of active mesenteric bleeding is less defined in the medical literature.”

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Pancreas-sparing duodenectomy for duodenal polyposis

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“Pancreas-sparing duodenectomy, although technically demanding, eliminates the need for pancreatic resection. Pancreas-sparing duodenectomy is associated with good absorptive capacity, weight gain, and quality of life. Furthermore, it may reduce the risk of subsequent malignancy. Long-term surveillance, however, is still required. Pancreas-sparing duodenectomy is contraindicated in the setting of malignancy.”

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Primary Bile Reflux Gastritis: Which Treatment is Better, Roux-en-Y or Biliary Diversion?

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“Various treatments for [Primary Bile Reflux Gastritis] have been proposed since its recognition. Operations that have been utilized are the Roux-en-Y procedure, the Braun enteroenterostomy, the Henley jejunal interposition, and several modifications of each of these operations. These procedures produce relief from bile reflux, but all have particular side effects of their own. Before the utilization of vagotomy for ulcer disease, stomal ulceration at the gastrojejunal anastomosis was the most frequent postoperative problem. Currently, the most commonly applied operation is the Roux-en-Y gastrojejunostomy, which requires vagotomy and antrectomy and results in the equally disabling Roux stasis syndrome in about one-half of patients.”

“Because of these difficulties, a new procedure is proposed wherein only bile is diverted by means of a Roux-en-Y limb and no gastric procedure is done. This allows minimal disturbance of gastric motility and totally diverts bile away from the gastric lumen.”

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Society for Vascular Surgery (SVS) Clinical Practice Guidelines on Popliteal Artery Aneurysms

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“Popliteal artery aneurysms (PAAs) are the most common peripheral arterial aneurysms, defined as aneurysms outside the aortoiliac system or the brain, accounting for 70% of all peripheral arterial aneurysms. They are more common in men (95%) and tend to occur in the sixth and seventh decades of life. Few modern studies have been performed on the natural history of PAAs, and many of these were retrospective reviews of surgical patients. As such, the timing and details of PAA management remain nuanced.”

“These guidelines focus on PAA screening, indications for intervention, choice of repair strategy, management of asymptomatic and symptomatic PAAs (including those presenting with acute limb ischemia), and follow-up of both untreated and treated PAAs. They offer long-awaited evidence-based recommendations for physicians taking care of these patients.”

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Hepatic Arterial Infusion Pump Chemotherapy for Unresectable Intrahepatic Cholangiocarcinoma

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“Because most patients die from progressive disease in the liver, hepatic arterial infusion pump (HAIP) chemotherapy with floxuridine is an attractive treatment option for unresectable [Intrahepatic cholangiocarcinoma] iCCA. The rationale for HAIP chemotherapy is that iCCA relies mostly on arterial blood supply. Moreover, floxuridine, also known as FUDR, is characterized by its high first-pass effect; approximately 95% is directly metabolized in the liver. Hence, this allows for an up to 400-fold dose increase in subsequent intratumoral exposure compared with systemic treatment, with minimal systemic exposure and side effects”

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Timing of elective surgery and risk assessment after SARS-CoV-2 infection

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“Patients who develop symptoms of SARS-CoV-2 infection within 7 weeks of planned surgery, including on the day of surgery, should be screened for SARS-CoV-2. Elective surgery should not usually be undertaken within 2 weeks of diagnosis of SARS-CoV-2 infection. For patients who have recovered from SARS-CoV-2 infection and who are low risk or having low-risk surgery, most elective surgery can proceed 2 weeks following a SARS-CoV-2 positive test. For patients who are not low risk or having anything other than low-risk surgery between 2 and 7 weeks following infection, an individual risk assessment must be performed. This should consider: patient factors (age; comorbid and functional status); infection factors (severity; ongoing symptoms; vaccination); and surgical factors (clinical priority; risk of disease progression; grade of surgery).”

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