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Loss of bifurcation patency after cross-over stenting of ostial lesions in superficial femoral artery： possible causes, prevention and reintervention

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Chinese Medical Journal 2014年第18期127卷 3291-3295页

作者： Jiang Junhao Chen Bin Dong Zhihui Shi Yun Li Weimiao Yue Jianing Department of Vascular Surgery Zhongshan Hospital FudanUniversity Shanghai 200032 China

Background Crossover stenting across the origin of the profunda femoral artery （PFA） and occasionally into the common femoral artery （CFA） is commonly used after suboptimal balloon angioplasty of ostial occlusive lesions of the superficial femoral artery （SFA） involving the bifurcation. Late stent occlusion at the bifurcation is not rare and results in severe lower extremity ischemia. Therefore, we tried to assess its possible causes, prevention and reintervention. Methods Using a prospectively maintained single-center database, 12-month femoral bifurcation patency was retrospectively compared and lesion and procedural predictors of stent occlusion were determined among 63 patients （64 lesions） who between July 2011 and February 2013 underwent crossover （36 non-jailed and 15 jailed SFA, and 12 distal and 1 complete CFA） stenting of de novo ostial SFA lesions. Results Twelve-month overall patency rate at the femoral bifurcation was 88%, with no significant difference between jailed-ostial SFA （80%） and distal CFA （67%） stenting （P=0.731）, and significant differences between either and non-jailed ostial stenting （100%,P=0.035 and 0.002）. When PFA ostium was jailed by the stent, patients with preexisting CFA or PFA lesions had a 12-month bifurcation patency rate of 20%, significantly lower than those with simple ostial SFA lesions （83%, P=0.015）. Stent induced intimal hyperplasia caused bifurcation occlusion in 6 surgical reintervention cases. Conclusions In crossover stenting of ostial lesions in SFA, bifurcation patency loss was significantly higher in distal CFA and jailed ostial SFA stenting than non-jailed ostial SFA stenting. Preexisting CFA or PFA lesion is a significant risk factor for bifurcation patency loss when PFA ostium is jailed by crossover stenting.

关键词： peripheral arterial disease endovascular therapy femoral bifurcation perioperative outcomes

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Subsequent total joint arthroplasty: Are we learning from the first stage?

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World Journal of Orthopedics 2024年第3期15卷 230-237页

作者： Christine Jiang Wu Colin Penrose Sean Patrick Ryan Michael Paul Bolognesi Thorsten Markus Seyler Samuel Secord Wellman Department of Orthopaedic Surgery Duke University HospitalDurhamNC 27710United States Department of Orthopaedic Surgery Midwest Center for Joint ReplacementIndianapolisIN 46241United States

BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(Pperioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decrea

关键词： Staged total joint arthroplasty Asynchronous total joint arthroplasty Subsequent total joint arthroplasty Contralateral total joint arthroplasty perioperative outcomes

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Is bactibilia a predictor of poor outcome of pancreaticoduodenectomy?

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Hepatobiliary & Pancreatic Diseases International 2010年第1期9卷 65-68页

作者： Sivanpillay Mahadevan Sivaraj Velayutham Vimalraj Palanichamy Saravanaboopathy Shanmugasundaram Rajendran Sathyanesan Jeswanth Palaniappan Ravichandran Rosy Vennilla Rajagopalan Surendran Institute of Surgical Gastroenterology and Liver Transplantation New Gastroenterology BlockGovernment Stanley Medical College Hospital

BACKGROUND:Although bile infection has been proposed to increase infective complications following pancreaticoduodenectomy,its association with infective complications and non-infective complications like pancreatic fistula is still controversial.METHODS:Seventy-six patients who had undergone pancreaticoduodenectomy between July 2007 and December 2008 were included in a prospective database and their data analyzed.In all patients intraoperative bile from the bile duct was cultured.Preoperative,intra-operative,and post-operative variables were recorded and analyzed.RESULTS:Bile culture showed positive growth in 35 patients and negative growth in 41.Twenty patients in the positive group underwent ERCP and stenting.The patients with a positive bile culture had a higher incidence of infective complications including intra-abdominal abscess (n=8),wound infection (n=27),bacteremia (n=10),and renal insufficiency (n=9).There was no increase in the rate of non-infective complications of pancreaticoduodenectomy including pancreatic fistula (n=7),delayed gastric emptying (n=9),and post-operative hemorrhage (n=3).The hospital stay was significantly prolonged in the patients with a positive bile culture (P=0.0002).CONCLUSIONS:Pre-operative biliary drainage is significantly associated with bile infection,and bile infection increases the overall rates of infective complications and renal insufficiency.Because of the high incidence of complications is associated with infected bile,routine intra-operative bile culture is recommended in patients undergoing pancreaticoduodenectomy.Pre-operative prophylaxis is dependent on sensitivity of cases to perioperative antibiotics and intraoperative bile culture report.Because of its significant association with infected bile,biliary stenting should be used in strictly selected cases.

关键词： bactibilia Whipples pancreaticoduodenectomy perioperative outcomes

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