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Pancreaticoduodenal artery aneurysms are rare visceral artery aneurysms that may be associated with stenosis of the coeliac trunk. We present a case of a 48-year-old woman with a symptomatic aneurysm of the inferior pancreaticoduodenal artery caused by occlusion of the coeliac trunk due to median arcuate ligament syndrome. The patient was treated with an aorto-hepatic bypass and excision of the aneurysm. We discuss the case and the complexities and controversies in the treatment of this disease.
- MeSH
- aneurysma * diagnostické zobrazování etiologie chirurgie MeSH
- arteria coeliaca diagnostické zobrazování chirurgie MeSH
- arteria mesenterica superior MeSH
- lidé středního věku MeSH
- lidé MeSH
- pankreas * chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION: Classifications are important clinical tools that enable data arrangement, patient categorisation and comparative research. The care of patients with end-stage renal disease who have vascular access requires collaboration of several specialists. In such a field, where several different specialties overlap, strong evidence and well-grounded recommendations for good practice are essential. In this protocol, we aim to search the literature to identify classification systems regarding vascular access for haemodialysis. This protocol serves as a pragmatic tool for setting a systematic approach using scoping review methodology. It also aims to make the study transparent and avoid potential duplication. METHODS AND ANALYSIS: We will follow the Joanna Briggs Institute methodology for the conduct of scoping reviews during the course of the proposed review. Scopus, Web of Science, PubMed, Google Scholar and the ClinicalTrials.gov registry will be searched by two researchers. Titles and abstracts will be screened and articles featuring classifications regarding vascular access for haemodialysis will be eligible for full-text analysis. There will be no age, sex or race limitation for the study populations. The title and abstract (if abstract available) must be in English but there will be no language restrictions for full-text review. Databases will be searched from inception to the date of search. All patients indicated for creation or placement of vascular access will be eligible, as well as patients with already existing vascular access. Classifications regarding preprocedural assessment, vascular access insertion or creation, complications and their management will be included in the study. Classifications regarding peritoneal dialysis will not be eligible. A comprehensive summary of the available evidence will be presented. ETHICS AND DISSEMINATION: The protocol and the review are exempt from ethical approval as there is no direct patient involvement and the review will summarise data from already published literature. The final article will be submitted to a peer-reviewed scientific journal.
A large tumorous mass completely surrounding and compressing the coeliac trunk was identified on computed tomography in a young woman with a six-month history of progressive abdominal pain. The tumor was excised along with the coeliac trunk and the proximal parts of its branches. The hepatic artery was reconstructed with an aorto-hepatic autogenous bypass. Postoperatively the patient had neurogenic diarrhea, which subsided on medical treatment. Seven months after surgery the patient is in a good state of health and living a normal life.
- MeSH
- arteria coeliaca diagnostické zobrazování patologie chirurgie MeSH
- arteria hepatica diagnostické zobrazování patologie chirurgie MeSH
- disekce MeSH
- dospělí MeSH
- ganglioneurom diagnostické zobrazování patologie chirurgie MeSH
- lidé MeSH
- ligace MeSH
- vena saphena transplantace MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVE: Aneurysms arising from arteriovenous fistulae are a common finding among dialysed patients and pose a risk of acute bleeding. The aim of this study was to perform a systematic review and meta-analysis evaluating the surgical options for the treatment of aneurysmal arteriovenous fistulae. METHODS: A systematic review and meta-analysis of articles published between January 1973 and March 2019 describing the surgical treatment of arteriovenous fistulae aneurysms. RESULTS: A total of 794 records were identified. After duplicate and low quality studies were removed, 72 full text articles were reviewed and from these 13 were included in the meta-analysis. The total number of patients was 597. Aneurysms were located in the upper arm in 289 (59%) cases and the smallest diameter of a treated aneurysm was 15 mm. The most frequent indication for treatment was bleeding prevention in 513 (86%) cases. Aneurysmorrhaphy was the surgical method of choice in all 13 studies. The pooled primary patency at 12 months was 82% (95% CI 69%-90%, 12 studies, I2 = 84%, p < .01). The 12 month primary patency rates were similar for aneurysmorrhaphy with external prosthetic reinforcement (85%, 95% CI 71%-93%, two studies, I2 = 0%, p = .33) and aneurysmorrhaphy performed using a stapler (74%, 95% CI 61%-83%, four studies, I2 = 0%, p = .48) and without a stapler (82%, 95% CI 60%-94%, six studies, I2 = 92%, p < .01). CONCLUSION: Aneurysmorraphy of arteriovenous fistulae is a procedure with acceptable short and long term results, with a low complication and aneurysm recurrence rate.
- MeSH
- aneurysma chirurgie MeSH
- arteriovenózní zkrat * škodlivé účinky MeSH
- čas MeSH
- dialýza ledvin * škodlivé účinky MeSH
- horní končetina krevní zásobení chirurgie MeSH
- lidé MeSH
- průchodnost cév fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
Vzhledem k demografickému vývoji společnosti je nutné již dnes připravit funkční plán zdravotní péče pro seniory. Jednou z možností je provést operační výkon u nekomplikovaných a běžných diagnóz v režimu jednodenní chirurgie. V rámci retrospektivní analýzy souboru seniorů operovaných ve standardním režimu provozu velké nemocnice univerzitního typu a seniorů operovaných v režimu jednodenní chirurgie byla porovnána homogennost obou skupin a bylo provedeno statistické zhodnocení výsledků. Komplikace byly uvedeny podle Clavienovy-Dindovy klasifikace. Při srovnání obou skupin nebyly statisticky významné rozdíly v demografických údajích a klasifikaci předoperačního rizika (ASA). Skupina operovaných v jednodenní chirurgii měla méně komplikací a kratší průměrnou dobu hospitalizace. Vysoký věk pacienta není jediným kritériem pro posouzení biologického stavu organismu, a tudíž neznamená vždy nutnost operování ve velké nemocnici s velkým akutním a turbulentním provozem. Řada seniorů ocení spíše individuální přístup a dostatek informací, které je možné nabídnout ve zdravotních zařízeních pouze s elektivním programem. Skutečným limitem není kalendářní věk pacienta, ale zdravotní stav.
Due to population aging in developed countries, it has become necessary to prepare a functional health care plan for the elderly. One of the possibilities to improve postoperative outcomes and recovery in elderly patients is to perform common surgical procedures in the regime of one-day surgery. We compared elderly patients who underwent surgery in a large university hospital with elderly patients who underwent surgery in a facility dedicated to one-day surgery. The homogeneity and clinical outcomes of the two groups were statistically analyzed. Complications were assessed according to the Clavien-Dindo classification. There were no statistically significant differences in demographic data and pre-operative risk assessment (ASA). The one-day surgery group had fewer complications and a shorter average hospital stay. Advanced age is not the only criterion for assessing the biological state of the patient and therefore does not always necessitate surgical care in a university hospital setting with a high volume of acute and complicated cases. Many elderly patients will benefit from a more individualized approach and healthcare facilities that specialize solely in elective procedures. When indicating elderly patients for one-day surgery, their health status is more important than their calendar age.
- MeSH
- ambulantní chirurgické výkony MeSH
- hospitalizace MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony * MeSH
- pooperační komplikace MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
This review article summarizes the most recently available data covering the modern trends and methods in the diagnosis and treatment of mesenteric artery disease. Its aim is to point out the critical moments in the whole spectrum of matters such as early diagnosis and treatment of the chronic form of bowel ischemia, role of MDCT in prompt diagnosis, and urgent therapeutic modalities of treating its acute forms. To achieve the best possible results, we must minimize the time of diagnosis while the treatment has to be tailored individually to each patient according to occlusion type, age and co-morbidities (Fig. 2, Ref. 66).
This paper provides a summary of up-to-date information and experience with the combined treatment of patients suffering from peripheral arterial disease (PAD) with endovascular and open surgery, performed simultaneously and in a single operating room. Hybrid intervention is reported to have good results in well-indicated groups of patients with acute and chronic limb ischemia, even with older, high-risk patients. The indications for the use of this technique remain unclear with inconsistent opinions among vascular surgeons. The indications for treatment were divided into three main groups: 1) Patients with chronic limb ischemia, 2) acute limb ischemia, and 3) occlusion of a previous vascular reconstruction. The operating techniques for the most commonly used combinations are described. In conclusion, hybrid operating techniques are often useful when treating complex problems and multilevel disease in patients with chronic or acute lower limb ischemia. Modern vascular surgeons need to master both open and endovascular techniques, and to combine them in a creative fashion to the benefit of our patients.
- MeSH
- akutní nemoc MeSH
- chronická nemoc MeSH
- endovaskulární výkony metody MeSH
- lidé MeSH
- onemocnění periferních arterií chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
