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Objective To compare the re-intervention rates of myomectomy, uterine artery embolization (UAE) and magnetic resonance-guided focused ultrasound surgery (MRgFUS) for uterine fibroids (UFs) in different follow-up time. Methods Two investigators searched PubMed for clinical studies published in English from 1 Jan 2000 to 31 Dec 2020, and independently examined the paper to select qualified studies, extracted relevant information and assessed the risk of bias. Meanwhile, a meta-analysis of 31 studies containing totally 42103 patients was conducted to compare the re-intervention rate of myomectomy, UAE and MRgFUS. Results In the meta-analysis of 42103 patients, the 12-month re-intervention rates of myomectomy, UAE and MRgFUS for UFs were 0.06 (95%CI, 0.01-0.11), 0.07 (95%CI, 0.06-0.09), and 0.12 (95%CI, 0.04-0.20) respectively. The 24-month re-intervention rates were 0.10 (95%CI, 0.04-0.16), 0.08 (95%CI, 0.01-0.17), and 0.14 (95%CI, 0.07-0.21) respectively. The 36-month re-intervention rates were 0.09 (95%CI, 0.05-0.13), 0.14 (95%CI, 0.05-0.23), and 0.22 (95%CI, 0.11-0.32) respectively. Additionally, the 60-month re-intervention rates were 0.19 (95%CI, 0.15-0.24), 0.21 (95%CI, 0.17-0.25), and 0.49 (95%CI, 0.21-0.77) respectively. Conclusions The myomectomy has the lowest re-intervention rate of the three regimens in short time and long time while the MRgFUS has the highest. The rate of MRgFUS increased rapidly in the 60th month after the treatment.

Objective To assess the long-term outcomes and the factors affecting local recurrence of uterine fibroids after ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation. Materials and methods 629 patients with a solitary uterine fibroid smaller than 10 cm in diameter treated with USgHIFU at our institutes between January 2011 and December 2016 were retrospectively analyzed. The patients were requested to take pre-HIFU and one day post-HIFU MRI. The patients were asked to return to the hospital every 3 months until January 2020, for imaging evaluation and to check on improvement in symptoms. Results Five hundred and thirty-six patients completed follow-up according to our protocol. The median follow-up time was 69 (interquartile range: 48 to 89) months. Among them, local recurrence was detected in 110 patients. 18 (16.4%) patients required additional treatment between 12 and 24 months after USgHIFU treatment, 59 (53.6%) patients required additional treatment 24 months after USgHIFU. Therefore, in total, 77 patients required additional treatment, of which 32 received USgHIFU and 45 underwent myomectomy. The median non-perfused volume (NPV) ratio in patients with recurrence was 73%, compared to 89% among patients without recurrence. Multivariate analysis showed that NPV ratio, maximum fibroid diameter and fibroid enhancement type were the independent factors affecting the recurrence of fibroids after USgHIFU treatment. Conclusions Achievement of NPV ratio higher than 70% has led to acceptable re-intervention rate during the follow-up period after USgHIFU. NPV ratio, maximum fibroid diameter, and fibroid enhancement type were the independent factors affecting the recurrence of fibroids after USgHIFU treatment.

Background Our purpose is to compare the stent patency and clinical outcome of trans-jugular intra-hepatic porto-systemic shunt (TIPS) through the left branch portal vein (TIPS-LPV) to the standard TIPS through the right branch (TIPS-RPV). We retrospectively reviewed all patients (n = 54) with refractory portal hypertension who were subjected to TIPS-LPV at our institute (TIPS-LPV) between 2016 and 2018. These patients were matched with 56 control patients treated with the standard TIPS-RPV (TIPS-RPV). The 2 groups were compared regarding the stent patency rate, encephalopathy, and re-interventions for 1 year after the procedure. Results TIPS-LPV group showed 12 months higher patency rate (90.7% compared to 73.2%) (P < 0.005). The number of the encephalopathy attacks in the TIPS-LPV group was significantly lower than that of the TIPS-RPV group at 6 and 12 months of follow-up [P = 0.012 and 0.036, respectively]. Re-bleeding and improvement of ascites were the same in the two groups [P > 0.05]. Patients underwent TIPS-LPV needed less re-interventions and required less hospitalizations than those with TIPS-RPV [P = 0.039 and P = 0.03, respectively]. Conclusion The new TIPS approach is to extend the stent to LPV. This new TIPS-LPV approach showed the same clinical efficiency as the standard TIPS-RPV in treating variceal bleeding and ascites. However, it proved a better stent patency with lower rates of re-interventions, encephalopathy, and hospital admissions than TIPS through the right branch.

Objectives: We investigated the first re-interventions of two- and three-surface direct restorations on posterior teeth, specifically noting the type and time of the first re-intervention. Materials and methods: In 2002, altogether 5542 posterior two- and three-surface composite and amalgam restorations were done for 3051 patients aged 25-30 years at Helsinki City Public Dental Service (PDS). Based on electronic patient records, we analysed all restorations (n = 2445) having re-intervention during a 13-year follow-up. We recorded the type of tooth, restoration size, and type of first re-intervention. The time to re-intervention was the interval between the date of the placement of restoration at the year 2002 and its first re-intervention. Results: Restorative treatment was the most common (77.9%) first re-intervention, followed by endodontics (11.5%), extractions (5.2%), and other (5.4%). Males, more frequently than females, had extraction or endodontics as first re-intervention. The average time to re-intervention was 5.7 years (SD 3.8; median 5.2). Both median and mean times were shortest for cases involving endodontics or extractions. Conclusions: For the majority of two- and three-surface posterior restorations, the first re-intervention is restorative (replacement or repair of restoration). The shortest time to re-intervention is for restorations that have endodontics or extraction as the first re-intervention.

Background and aim Endovascular aneurysm repair (EVAR) has revolutionized the management of abdominal aortic aneurysm (AAA). The re-intervention rate following EVAR has been a subject of debate in many studies. The study aims to evaluate the short-term outcomes in terms of the early (four-year) re-intervention rate following EVAR at our centre and compare it to the average re-intervention rate of the main studies assessed by the National Institute of Health and Care Excellence (NICE). Methods The EVAR procedures performed over two years (2015 and 2016) were retrieved using the operation codes. The clinical portal and PACS systems were used to review the discharge summaries, clinic and multidisciplinary team (MDT) letters, as well as the scans and interventional radiology procedures to assess the patients' adherence to follow-up and identify any re-intervention procedure done to correct underlying problems related to the EVAR performed. Patients who switched their follow-up to another hospital were contacted and interviewed about any re-intervention undergone. Results A total of 108 patients underwent EVAR during the two-year study period. Twenty EVAR-related re-interventions (18.5%) were recorded, irrespective of the cause or the type of intervention. This is slightly higher than the average rate by NICE (16.89%). Type 1 endoleak represented the leading cause for re-intervention (30%). Most of the cases of re-intervention were done endovascularly (60%). Forty-five percent of the patients had a re-intervention during the first year and 35% in the third year. Conclusion This study shows that although our re-intervention rate following EVAR was slightly higher than the international average, EVAR is still a safe method for the repair of AAA with relatively low peri-operative morbidity and mortality. However, long-term follow-up of these patients is mandatory as re-interventions are frequently required. Nonetheless, the majority of re-interventions can be done with minimal morbidity to the patient.

Unsuccessful stent replacement in transpapillary biliary drainage with plastic stents (PSs) has a significant impact on patient prognosis, thus, a safe and reliable replacement method is required. We aimed to compare the snare-over-the-guidewire (SOG) method, wherein the PS lumen is used as an access route to the biliary tract and the PS is removed with a snare inserted via the inserted guidewire, with the conventional side-of-stent (SOS) method, wherein the biliary approach is performed from the side of the PS. This retrospective single-center study included 244 consecutive patients who underwent biliary PS replacement between January 2018 and July 2020. The procedural success rates were compared between the two methods. A predictive analysis of unsuccessful PS replacement was also performed. The procedural success rate in the SOG group was significantly higher than that in the SOS group (p = 0.026). In the proximal biliary stenosis lesion, the same trend was observed (p = 0.025). Multivariate analysis also showed that the SOS method (p = 0.0038), the presence of proximal biliary stenosis (p &lt, 0.0001), and parapapillary diverticulum (p = 0.0007) were predictors of unsuccessful PS replacement. The SOG method may be useful for biliary PS replacement, especially in cases of proximal hilar bile duct stenosis.

Background Operative mortality after endovascular aneurysm repair (EVAR) has been reported as lower than open surgical repair (OSR) for abdominal aortic aneurysm (AAA) in randomized controlled trials. However, many cohort studies have demonstrated similar mortality rates for both procedures. We compared operative mortality between EVAR and OSR, at our institution. Methods All AAA operations from 2012 to 2017 were reviewed, and baseline characteristics were collected. Outcomes included 30-day mortality, operative data, complications, length of hospital stay (LOS), costs, re-intervention, and survival rates were compared. A multivariable analysis with unbalanced characteristics was performed. Results We had a total of 162 patients, 100 having OSR and 62 for EVAR. The EVAR group was older, with higher ASA classification. Thirty-day mortality rate did not significantly differ (0/100 for OSR and 2/62 (3%) for EVAR; p = 0.145), while the EVAR group had less blood loss, shorter operative times, and LOS, but higher re-intervention rates (adjusted hazard ratio 6.4 (95%CI: 1.4, 26.8)). Survival rates did not significantly differ between the groups. EVAR cost approximately 1-million yen more. Conclusions OSR had low 30-day mortality rate in selected low-risk patients whereas EVAR had less blood loss, shorter operative times, LOS and could be done in high-risk patients with low 30-day mortality but with higher re-intervention rate.

Introduction Percutaneous transhepatic biliary drainage (PTBD) is a useful alternative treatment for malignant biliary obstruction (MBO) when patients have difficulty with endoscopic transpapillary drainage. We examined the feasibility of conversion of PTBD to endoscopic ultrasound‐guided biliary drainage (EUS‐BD) in patients with MBO unsuited for endoscopic transpapillary biliary drainage. Methods This retrospective study included patients who underwent conversion of PTBD to EUS‐BD between March 2017 and December 2019. Eligible patients had unresectable MBO, required palliative biliary drainage, and were not suited for endoscopic transpapillary drainage. Initial PTBD had been performed for acute cholangitis or obstructive jaundice in all patients. EUS‐BD was performed following improvements in cholangitis. Sixteen patients underwent conversion of PTBD to EUS‐BD. We evaluated technical success, procedure time, clinical success (defined as subsequent external catheter removal), adverse events (AEs), time to recurrent biliary obstruction (TRBO), and re‐intervention rates. Results Technical success was achieved in all patients (100%). The median procedure time was 45.0 minutes (interquartile range [IQR] 30.0–50.0 minutes). Clinical success was achieved in all patients (100%). There were mild early AEs in two patients (12.5%) (acute cholangitis: 1, bile peritonitis: 1), which improved with antibiotic administration alone. Recurrent biliary obstruction (RBO) occurred in six patients (37.5%). Kaplan‐Meier analysis revealed a 50% TRBO of 95 days (IQR 41–246 days). Endoscopic treatment was possible in all RBO cases, and repeat PTBD was not required. Conclusions Conversion of PTBD to EUS‐BD for the management of MBO is both feasible and safe. This approach is expected to be widely practiced at centers with little experience in EUS‐BD.

Background and aims Drug‐eluting devices (DEDs) are usually used as a standard therapy for revascularization in femoropopliteal artery disease. Randomized controlled trails have found that DEDs with paclitaxel result in superior patency rates and decreased target lesion revascularization. A meta‐analysis by Katsanos et al indicated an increased long‐term mortality in patients treated with paclitaxel‐coated devices. The aim of this observational clinical study was to assess the long‐term clinical outcomes and mortality risk after paclitaxel‐coated balloon angioplasty in patients with symptomatic peripheral artery disease. Methods We retrospectively evaluated 287 patients with peripheral interventions, including 173 drug‐coated balloon (DCB) angioplasties and 114 plain old balloon angioplasties (POBA), performed at our center between 2015 and 2018. Results There were no significant differences in mortality rates between patients who received DCB angioplasty and those who received POBA. In the first year, the hazard ratio (HR) for DCB angioplasty was 0.59 (95% confidence interval [CI] 0.31 to 1.12, P = .104). After 2 years, this HR was 0.64 (95% CI 0.36‐1.17, P = .145), while the 3‐year and 4‐year HR increased to 0.71 and 1.30 (3‐year: 95% CI 0.37‐1.33, P = ,283; 4‐year: 95% CI 0.55‐3.08, P = .546). No paclitaxel dose‐response relationship with mortality rate was identified when adjusted for key predictors of mortality. Conclusions Analyses of patient level data identified no significant mortality differences between DCB angioplasty and POBA after 4 years of follow‐up. Furthermore, there was no dose‐response relationship between paclitaxel and mortality. These findings demonstrate that paclitaxel DCB is safe. Further long‐term multicenter studies are needed to determine the risk of late mortality.

International audience; Purpose: Complete surgical excision is the main factor for successful breast-conserving surgery in patients with ductal carcinoma in situ (DCIS) of the breast. Preoperative magnetic resonance imaging (MRI) may allow surgery optimization in this indication. From an economic standpoint, systematic preoperative MRI is associated with an extra cost, which may be offset by a decrease in the number of re-interventions. We performed an economic evaluation alongside IRCIS randomised controlled trial (NCT01112254) to determine whether systematic preoperative MRI in DCIS is a cost-effective strategy. Methods: 360 patients were included in IRCIS trial. Costs were assessed from the French national health insurance perspective. Resource use was prospectively collected during a 6-month period after randomisation. We estimated the mean cost per averted re-intervention. Results: Despite extra costs due to MRI and additional biopsies, difference in total costs between arms was not statistically significant (mean cost of €9980 in MRI arm and €9682 in no MRI arm, cost difference: €298 [CI95% : −470; 1063]). There was a non-significant decrease in the rate of re-hospitalisations for positive or close margins (20% in MRI arm versus 27% in No MRI arm, difference −7% [CI95% : −17; 3]). At a willingness to pay of €500 to avert a re-intervention, the probability that MRI strategy is cost-effective was 93%. Conclusion: Systematic preoperative MRI in patients with DCIS of the breast may be a cost-effective strategy. However, the modest clinical benefit associated with such a strategy limits the interest for this procedure in routine practice given the current MRI techniques.

Background and aims Drug‐eluting devices (DEDs) are usually used as a standard therapy for revascularization in femoropopliteal artery disease. Randomized controlled trails have found that DEDs with paclitaxel result in superior patency rates and decreased target lesion revascularization. A meta‐analysis by Katsanos et al indicated an increased long‐term mortality in patients treated with paclitaxel‐coated devices. The aim of this observational clinical study was to assess the long‐term clinical outcomes and mortality risk after paclitaxel‐coated balloon angioplasty in patients with symptomatic peripheral artery disease. Methods We retrospectively evaluated 287 patients with peripheral interventions, including 173 drug‐coated balloon (DCB) angioplasties and 114 plain old balloon angioplasties (POBA), performed at our center between 2015 and 2018. Results There were no significant differences in mortality rates between patients who received DCB angioplasty and those who received POBA. In the first year, the hazard ratio (HR) for DCB angioplasty was 0.59 (95% confidence interval [CI] 0.31 to 1.12, P = .104). After 2 years, this HR was 0.64 (95% CI 0.36‐1.17, P = .145), while the 3‐year and 4‐year HR increased to 0.71 and 1.30 (3‐year: 95% CI 0.37‐1.33, P = ,283; 4‐year: 95% CI 0.55‐3.08, P = .546). No paclitaxel dose‐response relationship with mortality rate was identified when adjusted for key predictors of mortality. Conclusions Analyses of patient level data identified no significant mortality differences between DCB angioplasty and POBA after 4 years of follow‐up. Furthermore, there was no dose‐response relationship between paclitaxel and mortality. These findings demonstrate that paclitaxel DCB is safe. Further long‐term multicenter studies are needed to determine the risk of late mortality., This study aimed to assess the long‐term clinical outcomes and mortality risk after paclitaxel‐coated balloon angioplasty in patients with symptomatic peripheral artery disease.Analyses of patient level data identified no significant mortality differences between DCB angioplasty and POBA after four years of follow up. Furthermore, there was no dose‐response relationship between paclitaxel and mortality. These findings demonstrate that paclitaxel DCB is safe. Further long‐term multicenter studies are needed to determine the risk of late mortality.

BACKGROUND AND OBJECTIVES We investigated the effectiveness of balloon dilatation of homograft conduits in the pulmonary position in delaying surgical replacement. SUBJECTS AND METHODS We reviewed the medical records of patients who underwent balloon dilatation of their homograft in the pulmonary position from 2001 to 2015. The pressure gradient and ratio of right ventricular pressure were measured before and after the procedure. The primary goal of this study was to evaluate the parameters associated with the interval to next surgical or catheter intervention. RESULTS Twenty-eight balloon dilations were performed in 26 patients. The median ages of patients with homograft insertion and balloon dilatation were 20.3 months and 4.5 years, respectively. The origins of the homografts were the aorta (53.6%), pulmonary artery (32.1%), and femoral vein (14.3%). The median interval after conduit implantation was 26.7 months. The mean ratio of balloon to graft size was 0.87. The pressure gradient through the homograft and the ratio of right ventricle to aorta pressure were significantly improved after balloon dilatation (p

The purpose of this study was to evaluate the long term results of endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysm (AAA) and ectatic common iliac arteries (CIAs).In a retrospective analysis of a prospectively collected database in two high volume centres, patients with AAAs undergoing elective standard EVAR were divided into two groups: those with both CIA diameters18 mm, and those with at least one ectatic iliac artery (CIA ≥ 18 mm). Patients with an intentional external iliac artery landing zone were excluded. Primary outcomes were survival and freedom from re-intervention. Secondary end points were EVAR failure and iliac related endoleak and iliac re-intervention.From 2000 to 2015, 648 patients were included in the study, 277 (43%) had at least one CIA ≥ 18 mm. Pre-operative risk factors were similar between the two groups, with the exception of chronic renal insufficiency (p = .010) and cerebrovascular events (p = .040), which were higher in the ectatic CIA group. At 30 days from primary procedure, there was a higher rate of type Ib endoleak in patients with ectatic iliacs (p = .020). A statistically significant increase in the incidence of late type Ib endoleak in patients with ectatic iliac arteries was confirmed at a mean follow up of 74.8 months (p = .01). The need for iliac related re-intervention was higher in patients with CIAs ≥18 mm (odds ratio 1.94; 95% confidence interval 1.1-3.2).Ectatic iliac arteries are considered suitable landing zones for EVAR, although there is an increased risk of secondary interventions in time mainly due to late CIA dilation and secondary type Ib endoleak. Patients receiving EVAR with flared iliac limbs may benefit a more intensive surveillance to avoid late failures.

Introduction: Re-operative laparoscopic colorectal surgery is becoming increasingly common. It can be a challenging procedure, but its benefits can outweigh the associated risks. Methods: A systematic review of the literature reporting re-operative laparoscopic surgery was carried out. Retrospective and prospective cohort studies and case series were included, with case reports being excluded. Results: Seventeen articles dated from 2007 to 2020 were included in the systematic review. In total, 1555 patients were identified. Five hundred and seventy-four of them had a laparoscopic procedure and 981 an open re-operation. One hundred and eighty-three women had a laparoscopic operation. The median age ranged from to 44.9 years to 68.7 years. In seven studies, the indication of the index operation was malignancy, one study regarded re-laparoscopy for excision of lateral pelvic lymph nodes, and one study looked at redo surgery of ileal J pouch anal anastomosis. There were 16 mortalities in the laparoscopic arm (2.78%) and 93 (9.4%) in the open surgery arm. One hundred and thirty-seven morbidities were recorded in the open arm and 102 in the laparoscopic arm. Thirty-nine conversions to open occurred. The median length of stay ranged from 5.8 days to 19 days in laparoscopy and 9.7 to 34 days in the open surgery arm. Conclusions: Re-operative laparoscopic colorectal surgery is safe when performed by experienced hands. The management of complications, recurrence of malignancy, and lateral pelvic floor dissection can be safely performed. The complication rate is low, with conversion to open procedures being relatively uncommon.

Objective/Background The aim was to describe the re-interventions after endovascular and open repair of rupture, and investigate whether these were associated with aortic morphology. Methods In total, 502 patients from the IMPROVE randomised trial (ISRCTN48334791) with repair of rupture were followed-up for re-interventions for at least 3 years. Pre-operative aortic morphology was assessed in a core laboratory. Re-interventions were described by time (0–90 days, 3 months–3 years) as arterial or laparotomy related, respectively, and ranked for severity by surgeons and patients separately. Rare re-interventions to 1 year, were summarised across three ruptured abdominal aortic aneurysm trials (IMPROVE, AJAX, and ECAR) and odds ratios (OR) describing differences were pooled via meta-analysis. Results Re-interventions were most common in the first 90 days. Overall rates were 186 and 226 per 100 person years for the endovascular strategy and open repair groups, respectively (p = .20) but between 3 months and 3 years (mid-term) the rates had slowed to 9.5 and 6.0 re-interventions per 100 person years, respectively (p = .090) and about one third of these were for a life threatening condition. In this latter, mid-term period, 42 of 313 remaining patients (13%) required at least one re-intervention, most commonly for endoleak or other endograft complication after treatment by endovascular aneurysm repair (EVAR) (21 of 38 re-interventions), whereas distal aneurysms were the commonest reason (four of 23) for re-interventions after treatment by open repair. Arterial re-interventions within 3 years were associated with increasing common iliac artery diameter (OR 1.48, 95% confidence interval [CI] 0.13–0.93; p = .004). Amputation, rare but ranked as the worst re-intervention by patients, was less common in the first year after treatment with EVAR (OR 0.2, 95% CI 0.05–0.88) from meta-analysis of three trials. Conclusion The rate of mid-term re-interventions after rupture is high, more than double that after elective EVAR and open repair, suggesting the need for bespoke surveillance protocols. Amputations are much less common in patients treated by EVAR than in those treated by open repair.

Objetivo: Determinar a influência da anatomia do aneurisma da aorta abdominal (AAA) nos resultados a curto e médio prazo após Endovascular Aneurysm Repair (EVAR). Métodos: Estudo retrospetivo de todos os doentes com AAA infrarrenal sem menção de rotura resultados a curto e médio prazo após Endovascular Aneurysm Repair (EVAR). Métodos: Estudo retrospetivo de todos os doentes com AAA infrarrenal sem menção de rotura submetidos a EVAR aorto-biilíaco programado na nossa instituição entre 2011-2013 (n = 112). Todos os exames de follow-up imagiológico foram analisados numa plataforma com Osirix® e foram realizadas medições anatómicas com center lumen line. Apenas foram incluídos os doentes com um follow-up imagiológico superior a 12 meses, o que resultou na exclusão de 33 (29%) casos. Os doentes foram divididos em 2 grupos: grupo com «anatomia favorável para EVAR» (f-IFU); grupo com «anatomia desfavorável para EVAR» (df-IFU). Resultados: Dos 79 doentes elegíveis para o estudo, 35,5% (n = 28) foram realizados em doentes do grupo df-IFU. Estes doentes apresentaram AAA com maiores dimensões (64,4 ± 10,1 mm vs. 60,6 ± 10,8 mm, p = 0,046) e colos mais curtos (19,8 ± 11,8 mm vs. 30,4 ± 14,4 mm, p = 0,001). A endoprótese mais utilizada foi a Endurant® (54,5%). Constatou-se que o grupo df-IFU é tratado mais frequentemente com endopróteses com sistema de fixação suprarrenal (85,7% df-IFU vs. 69% f-IFU, p = 0,048). O tempo médio de follow-up foi de 21,9 ± 9,8 meses (12-46 meses). A taxa de mortalidade perioperatória (0% df-IFU vs. 2% f-IFU) e a taxa de mortalidade global por todas as causas (12% df-IFU vs. 11,9% f-IFU) foi semelhante nos 2 grupos (p > 0,05). Não por todas as causas (12% df-IFU vs. 11,9% f-IFU) foi semelhante nos 2 grupos (p > 0,05). Não se verificaram diferenças significativas nas taxas de endoleak (curto prazo 25% df-IFU vs. 22% f-IFU; médio prazo 12% df-IFU vs. 23,8% f-IFU) nem nas taxas de reintervenção (curto prazo7,2% df-IFU vs. 8% f-IFU; médio prazo 4% df-IFU vs. 4,8% f-IFU) (p > 0,05). Conclusão: A realização de EVAR em doentes com anatomia desfavorável produziu resultados que são comparáveis aos dos doentes com anatomia favorável, quer a curto quer a médio prazo. São necessários estudos a longo prazo para confirmar estes achados. Background: The goal of this study is to determine the influence of abdominal aortic aneurysm (AAA) anatomy in endovascular aneurysm repair (EVAR) short and mid-term outcomes. Methods: A total of 112 patients underwent programed aorto-biiliac EVAR at a single center between January 2011 and December 2013. Pre and postoperative imaging follow-up were retrospectively reviewed and anatomical measures were calculated on Osirix® with center lumen line. Only patients with a postoperative imaging follow-up of more than 12 months were included, resulting in the exclusion of thirty three (29%) cases. Patients were divided into 2 groups: the ‘‘EVAR suitable anatomy'' group (f-IFU) and the ‘‘EVAR challenging anatomy'' group (df-IFU). Results: A total of 35.5% (n = 28) patients were in the df-IFU group. These patients had larger AAA diameter (64.4 ± 10.1 mm vs 60.6 ± 10.8 mm) and shorter proximal neck (19.8 ± 11.8 mm vs 30.4 ± 14.4 mm) (p < 0.05). The device preferentially used was Endurant® (54,5%). The df-IFU group was more likely to be treated with suprarenal fixation devices (85.7% df-IFU vs 69% f-IFU, p = .048). Mean follow-up was 21,9 ± 9,8 months (12-46). Perioperative mortality (0% df-IFU vs 2% f-IFU) and all-cause mortality rates (12% df-IFU vs 11,9% f-IFU) were similar between the two groups (p > 0.05). There was no significant difference in endoleak rate (short-term 25% df-IFU vs 22% f-IFU; mid-term 12% df-IFU vs 23.8% f-IFU) and in re-intervention rates (short-term 7.2% df-IFU vs 8% f-IFU; mid-term 4% df-IFU vs 4.8% f-IFU)(p > 0.05). Conclusion: Endovascular treatment of AAA patients with challenging anatomy for EVAR provided acceptable short and mid-term results that are comparable to those in patients with suitable anatomy. Long-term follow-up is unreliable necessary to confirm these results.

OBJECTIVE/BACKGROUND: The aim was to describe the re-interventions after endovascular and open repair of rupture, and investigate whether these were associated with aortic morphology. METHODS: In total, 502 patients from the IMPROVE randomised trial (ISRCTN48334791) with repair of rupture were followed-up for re-interventions for at least 3 years. Pre-operative aortic morphology was assessed in a core laboratory. Re-interventions were described by time (0-90 days, 3 months-3 years) as arterial or laparotomy related, respectively, and ranked for severity by surgeons and patients separately. Rare re-interventions to 1 year, were summarised across three ruptured abdominal aortic aneurysm trials (IMPROVE, AJAX, and ECAR) and odds ratios (OR) describing differences were pooled via meta-analysis. RESULTS: Re-interventions were most common in the first 90 days. Overall rates were 186 and 226 per 100 person years for the endovascular strategy and open repair groups, respectively (p = .20) but between 3 months and 3 years (mid-term) the rates had slowed to 9.5 and 6.0 re-interventions per 100 person years, respectively (p = .090) and about one third of these were for a life threatening condition. In this latter, mid-term period, 42 of 313 remaining patients (13%) required at least one re-intervention, most commonly for endoleak or other endograft complication after treatment by endovascular aneurysm repair (EVAR) (21 of 38 re-interventions), whereas distal aneurysms were the commonest reason (four of 23) for re-interventions after treatment by open repair. Arterial re-interventions within 3 years were associated with increasing common iliac artery diameter (OR 1.48, 95% confidence interval [CI] 0.13-0.93; p = .004). Amputation, rare but ranked as the worst re-intervention by patients, was less common in the first year after treatment with EVAR (OR 0.2, 95% CI 0.05-0.88) from meta-analysis of three trials. CONCLUSION: The rate of mid-term re-interventions after rupture is high, more than double that after elective EVAR and open repair, suggesting the need for bespoke surveillance protocols. Amputations are much less common in patients treated by EVAR than in those treated by open repair.

Introduction Severe postoperative pain is an important risk factor for onset of chronic inguinal pain following inguinal hernia repair. All measures must be taken to eliminate postoperative pain. Materials and methods This case report highlights the problems of severe postoperative pain following transabdominal preperitoneal patch plasty (TAPP) inguinal hernia repair and describes a systematic treatment path that may include surgical intervention. Results Following TAPP operation for lateral inguinal hernia, this patient who had been operated on in an external hospital still experienced intense, stabbing inguinal pain on postoperative day 7 during movement, despite optimal pain treatment. Diagnostic examination did not reveal any findings of note. The surgical report documented that the surgeon had used metallic tacks for mesh fixation, i.e., at the pectineal line of the pubic bone, pubic symphysis, upper margin of the mesh, and for closure of the peritoneum. During surgical revision on postoperative day 7, eight tacks and the mesh were removed and, following further dissection, a new mesh was placed and fixed with glue. The patient’s intense stabbing pain resolved immediately after surgery. Conclusion Since the results of late intervention for chronic inguinal pain are anything but satisfactory, early surgical intervention should be considered for patients with severe postoperative pain >3 days of suspected surgical origin.

The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.

Background The number of cardiac rhythm device implantations has been growing fast due to expanding indications and ageing of the population. Complications of implantation were rare in the trials. However, these involved small numbers and selected patients. Prospective real-life data are necessary to assess cardiac device implantation procedure-related risks. Objective To determine the incidence and predictors of lead-related re-intervention in a Dutch high-volume teaching hospital. Methods Data from all patients who underwent cardiac rhythm device implantation between January 2010 and December 2011 were collected in a prospective registry. At least 1 year of follow-up regarding re-intervention was available for all patients. Lead-related reasons for re-intervention were categorised into lead dislodgement, malfunctioning or perforation. Results One thousand nine hundred twenty-nine devices including 3909 leads were implanted. In 595 patients (30.8 %) a CRT-D/P was implanted. Lead-related re-intervention was necessary in 86 (4.4 %) patients; it was more common in younger and male patients, and due to either lead dislodgement (66 %), malfunctioning (20 %) or perforation (18 %). Coronary sinus lead dislodgement or malfunctioning was 1.4 %. Right atrial dislodgement (1.9 %, p

Durante estos años varios centros con experiencia en colecistectomía laparoscópica han publicado sus complicaciones y tratamiento a estas. El objetivo de este estudio es describir la experiencia en 23 pacientes reintervenidos por complicaciones posoperatorias de la colecistectomía laparoscópica realizadas en el Centro Nacional de Cirugía de Mínimo Acceso, según el reporte de los resultados obtenidos. Se realizó un estudio descriptivo, retrospectivo y longitudinal, en el que se revisaron las historias clínicas de los pacientes reintervenidos por sospecha de complicaciones después de la colecistectomía laparoscópica, en el período comprendido de enero de 1998 a junio de 2010. Durante el período de la investigación se realizaron 10 039 colecistectomías laparoscópicas. Fueron reintervenidos 23 pacientes (0,2 %), con una edad media de 49 años (rango 22 a 73 años, DE ± 10). La relaparoscopia fue la vía para la reintervención (70 %) y solo 3 (13 %) requirieron cirugía abierta. Fue la colangiopancreatografía retrógrada endoscópica un procedimiento útil para complementar la solución de algunas de estas complicaciones. El tiempo quirúrgico medio en las reintervenciones fue de 67 min (rango 30-120 min), la estadía hospitalaria tuvo una media de 4 y 5 días respectivamente. Hubo 2 pacientes (9 %) que se reintervinieron tardíamente, a las 72 h de la colecistectomía, que fallecieron con cuadros de shock séptico. La laparoscopia es un procedimiento adecuado para las reintervenciones en pacientes con sospecha de complicaciones después de colecistectomía laparoscópica, con menor morbilidad y mortalidad sobre otros procederes, y su eficacia para el tratamiento de estas complicaciones está demostrada.Over past years some centers with experience in laparoscopic cholecystectomy have published the complications and treatment of this procedure. The aim of present paper is to describe the experience in 23 patients re-operated on due to the postoperative complications of above mentioned procedure carried out in the National Center of Minimal Access Surgery with the report of the results obtained. A longitudinal, retrospective and descriptive study was conducted to review the medical records of the patients re-operated on due suspicion of complications after the laparoscopic cholescystectomy. Twenty three patients were re-operated on (0.2 %) with a man age of 49 years (range 22 to 73 years, SD ± 10). The re-laparoscopy was the route for the re-intervention (70 %) and only 3 (13 %) patients required open surgery and it is the endospic retrograde cholangiopancreatography is a useful procedure to fulfill the solution of some of these complications. The mean surgical time in the re-interventions was of 67 min (range 30-120 min), hospital stay had a mean of 4 and 5 days, respectively. There were 2 patients (9 %) wit a late re-intervention at 72 hours after cholecystectomy and deceased with septic shock pictures. Laparoscopy is an appropriate procedure for the re-interventions in patients with suspicion of complications after laparoscopic cholecystectomy with less morbidity and mortality over other procedures and its effectiveness for treatment of these complications is demonstrated.

AimTo determine whether administrative data can be used to determine metrics to inform the quality agenda. To determine the relationship between these metrics and the method of abdominal aortic aneurysm (AAA) repair undertaken.MethodsThe Hospital Episode Statistics (HES) data were taken for a 5-year period (01.04.2003–31.03.2008). Cases of elective AAA repair were identified. Outcomes were determined in terms of mortality, discharge destination, re-intervention rates and emergency readmission rates. The results were interpreted in light of whether AAA repair was open or endovascular and whether patients were octogenarians or younger patients.ResultsThere were 18,060 elective AAA repairs with a mean in-hospital mortality rate of 5.9%. Of these 14,141 were open repairs with a mean mortality of 6.5% and 3919 EVAR (22%) with a mean mortality of 3.8%. EVAR patients were less likely to be discharged to ongoing care (p

The field of critical care medicine is confronted every day with cases of surgical interventions. When Data Mining is properly applied in this field, it is possible through predictive models to identify if a patient, should or should not have surgery again upon the same problem. The goal of this work is to apply clustering techniques in collected data in order to categorize re-interventions in intensive care. By knowing the common characteristics of the re-intervention patients it will be possible to help the physician to predict a future resurgery. For this study various attributes were used related to the patient's health problems like heart problems or organ failure. For this study it was also considered important aspects such as age and what type of surgery the patient was submitted. Classes were created with the patients' age and the number of days after the first surgery. Another class was created where the type of surgery that the patient was operated upon was identified. This study comprised Davies Bouldin values between -0.977 and -0.416. The used variables, in addition to being provided by Hospital de Santo António in Porto, they are provided from the electronic medical record., info:eu-repo/semantics/publishedVersion

Aortic aneurysm and dissections are potentially life threatening conditions. The advent of endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) has reduced perioperative mortality and morbidity and are now established therapy methods for treatment of aortic disease. Adequate pre- and intraoperative imaging is important for optimal results in endovascular procedures. However, the standard use of CT and angiography may not always be sufficient to provide necessary information required for treatment, and complementary techniques are warranted in selected cases. TEVAR in acute complicated type B aortic dissections is proven effective in several reports, but long-term clinical outcome and aortic remodelling are still not fully evaluated. Intravascular phased array imaging (IPAI) was used in patients undergoing EVAR and TEVAR for aortic aneurysm and dissection. The combined information from IPAI and fluoroscopy allowed exact positioning of the stent graft. The colour Doppler function facilitated detection of blood-flow in relevant arteries during and after the procedures, and it also facilitated control of ceased flow in excluded false lumens or aneurysms. Clinical early and long-term results after TEVAR for acute complicated type B aortic dissection were investigated in all patients treated between 1999 and 2009 at UppsalaUniversityHospital. Results were favourable regarding survival and permanent neurological complications. Long-term follow-up of aortic morphological changes in the same patient group showed overall significant reduction of aortic and false lumen diameters, and an increase of true lumen diameter. Total thrombosis of the false lumen occured more often in patients with DeBakey IIIa aortic dissection, than in IIIb. In conclusion, IPAI may be a complementary tool to traditional imaging modalities in EVAR and TEVAR in selected cases. Long-term clinical outcome is excellent with favourable aortic remodeling after TEVAR in patients with acute complicated type B aortic dissection.

Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations.

Purpose. To describe frequency, type, and outcome of re-intervention after endovascular aortic aneurysm repair (EVAR). Methods. Between September 1996 and December 2003, 308 patients were treated, with data collected prospectively. No patient was lost to follow up, but two were excluded (one primary conversion, and one post-operative death). Vanguard, Talent, Excluder, Zenith, and Quantum devices were used. Follow up required a CT scan before discharge. Initially, a CT scan was done at each follow up. Subsequently, we used duplex ultrasound and abdominal X-ray, with CT scan used selectively. Results. Mean follow-up was 36±22 months. Re-interventions were required in 47 (15%) patients, 31 (66%) elective and 16 (34%) emergency cases. In 32 patients, the primary re-intervention was successful; in 15 patients an additional 13 secondary and four tertiary re-interventions were required. A total of 72 adjunctive manoeuvres were performed: 49 endovascular (68%) and 23 open (32%). The success of endovascular re-interventions was 80%. The success of open re-interventions was 96%. Open conversions were required in nine patients (3%). There was no mortality. Conclusion. EVAR was associated with a low burden of re-interventions, with only 15% patients requiring re-intervention. Our long-term follow up, without regular CT, was simple and effective.

Liver transplantation is the treatment of choice in selected patients with end-stage liver disease. Postoperative complications often require surgical re-intervention. This study is a retrospective single-centre study to assess the incidence and type of surgical re-intervention during the in-hospital period after liver transplantation and to identify predictors of this re-intervention. From 1994 to 2002, 231 consecutive adult liver transplantations were performed. Re-intervention was classified as biliary, vascular, bleeding, septicaemia, re-transplantation or as miscellaneous. One hundred and thirty-nine surgical re-interventions were performed in 79 of 231 patients (34%). Septicaemia (44%) and bleeding (27%) were the most frequent indications for re-intervention, followed by biliary (10%) re-intervention. Vascular re-intervention, re-transplantation, and re-intervention for miscellaneous reasons, were performed in 7% each. Of all analysed variables (gender, age, diagnosis, acute liver failure, Child-Pugh classification, Karnofsky score, previous abdominal surgery, creatinine clearance, prothrombin time, anti-thrombin, platelet count, surgical technique, cold ischaemia time, warm ischaemia time, functional anhepatic time, anatomic anhepatic time, revascularisation time, year of transplantation, aprotinin administration, transfused platelet concentrate, and red blood cell transfusion requirements), only the number of transfused red blood cell concentrates (RBCs) was identified as a predictor of surgical re-intervention. Median RBC transfusion requirement during liver transplantation was 2.9 l (range 0-18.8 l) in the re-intervention group compared with 1.5 l (range 0-13.4 l) in the non-re-intervention group (P

RESUMO Propósito: Avaliar a segurança e eficácia do retratamento da miopia e astigmatismo com excimer laser. Métodos: Foram estudados onze olhos de dez pacientes, com idade variando de 20 a 46 anos. A técnica de reoperação foi a ceratectomia fotorrefrativa (PRK) em seis olhos (54,54%), a ceratectomia foto-terapêutica epitelial (PTK-e) seguida de PRK em dois olhos (18,18%), e a ceratectomia fotoastigmática (PARK) em dois olhos (18,18%). O retratamento foi realizado de 5 a 16 meses após o primeiro tratamento (média de 9,3 ± 3,4 meses). O seguimento pós-operatório variou de 6 a 23 meses (média de 9,2 ± 5,4 meses). Foi utilizado o excimer laser Apex plus Summit, e avaliada a refração, a acuidade visual e a opacidade sub-epitelial, ou "haze". Resultados: O equivalente esférico (EE) médio inicial foi de -8,50 ± 3,66D. Após o primeiro tratamento houve uma diminuição de 55% no EE médio inicial para -4,04 ± 2,42D, que foi estatisticamente significante (p = 0,0004). Após o retratamento houve uma diminuição de 28% no EE médio em relação ao primeiro tratamento, não sendo estatisticamente significante (p=0,09). O astigmatismo médio pre-operatório foi de -2,41 ± -1,84. Após o primeiro tratamento (média de -2,30 ± 1,70) e retratamento (média de -2,10 ± 0,8) não houve mudança estatisticamente significante (p=0,19 e p=0,30 respectivamente). Após o retratamento, 36,36% dos olhos apresentaram AV sc ≥ 20/40 e 63,63% AV sc ≥ 20/60. Trinta e seis por cento dos olhos apresentaram uma refração entre ± 1D da emetropia e 54,54% entre ± 2D da emetropia. Em relação ao pré-operatório, 45,55% perderam entre 1 e 5 linhas da melhor acuidade visual corrigida por óculos após o retratamento. Conclusão: O retratamento com excimer laser é pouco eficaz no caso de altas ametropias residuais, podendo induzir a opacidade sub-epitelial e perda de linhas de visão. SUMMARY Purpose: To evaluate the safety and efficacy of repeated excimer laser for treatment of residual myopia and astigmatism. Methods: Eleven eyes (ten patients) with age ranging from 20 to 46 years underwent reablation with excimer laser. Six eyes (54.54%) were treated using photorefractive keratectomy (PRK), two (18.18%) epithelial phototherapeutic keratectomy (PTK-e) followed by PRK, and two (18.18%) with photoastigmatic keratectomy (PARK). Retreatment was done 5 to 16 month after the first treatment (average 9.3 ± 3.4 months) and follow-up ranged from 6 to 23 months (average 9.2 ± 5.4 months). The laser used was the Apex plus Summit excimer laser. Refractive changes, visual acuity and corneal haze were evaluated. Results: Mean preoperative spherical equivalent was -8.50 ± 3.66D. After the first treatment there was a reduction in the mean spherical equivalent of 55%, -4.04 ± 2.42D, statistically significant (p = 0.0004). After retreatment there was a reduction in the mean spherical equivalent of 28%o compared to the first treatment but this reduction was not statistically significant (p = 0.09). Pre-operative astigmatism was -2.41 ± 1.84. After the first (-2.30 ± 1.70) and second treatment (-2.10 ± 0.80) there was no significant reduction (p = 0.19 e p = 0.30 respectively). After retreatment 36.36% of the eyes presented an uncorrected visual acuity ≥ 20/40 and 63.63% ≥ 20/60. Thirty three percent were within ±1 diopter of emmetropia and 54.54% within 2 diopters. Five eyes (45.54%) lost between one to five lines of the best spectacle-corrected visual acuity after retreatment when compared to preoperative. Conclusion: Excimer laser retreatment lacks efectivity in cases of high refractive residual ametropies. Decrease in the best corrected visual acuity may be expected as a side effect in these cases.

Background This study was performed to evaluate the impact of baseline characteristics and treatment methods on the outcome of sporadic renal angiomyolipoma (AML). Methods This was a pooled analysis of individual data of 441 patients with AML retrieved from 58 studies and 3 institutional series. Results Ninety-three patients underwent nephrectomy, 163 partial nephrectomy/enucleation, 128 embolisation, 19 cryoablation, 6 radiofrequency ablation, and 32 conservative treatment. Their mean follow-up period was 44.5 months. Patients who experienced major bleeding at presentation had significantly larger tumours than did those without bleeding (mean diameter, 10.1 vs. 5.9 cm, respectively; p 6 cm. These results suggest that conservative treatment can be considered in AMLs of

Objectives The study aimed to investigate early and long-term outcome of thoracic endovascular aortic repair (TEVAR) for acute complicated type B dissection. Design This was a retrospective, single-centre, consecutive case series. Materials and Methods During the period 1999–2009, TEVAR was carried out in 50 patients with non-traumatic acute complicated type B dissection, and in another 10 patients with acute complications, including rupture, end-organ ischaemia and acute dilatation during the primary hospitalisation, but >14 days after onset of symptoms. Thus, in total, 60 patients were included; 22 with a DeBakey type IIIa dissection and 38 with a type IIIb; median age was 67 years. Early (30-day) and long-term (5-year) survival, re-intervention rate and complications were recorded until 1 July 2010. Results Within 30 days, two (3%) deaths, one (2%) paraplegia and three (5%) strokes were observed. Five-year survival was 87% and freedom from re-intervention at 5 years was 65%. Conclusions In patients with acute complicated type B aortic dissection, TEVAR can be performed with excellent early and long-term survival, whereas morbidity and long-term durability must be further elucidated.