| 1. |
- Bilos, Linda, et al.
(författare)
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EndoVascular and Hybrid Trauma Management (EVTM) for Blunt Innominate Artery Injury with Ongoing Extravasation
- 2017
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Ingår i: Cardiovascular and Interventional Radiology. - New York, USA : Springer. - 0174-1551 .- 1432-086X. ; 40:1, s. 130-134
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Tidskriftsartikel (refereegranskat)abstract
- Innominate artery (IA) traumatic injuries are rare but life-threatening, with high mortality and morbidity. Open surgical repair is the treatment of choice but is technically demanding. We describe a case of blunt trauma to the IA with ongoing bleeding, treated successfully by combined (hybrid) endovascular and open surgery. The case demonstrates the immediate usage of modern endovascular and surgical tools as part of endovascular and hybrid trauma management.
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| 2. |
- Ersryd, Samuel, et al.
(författare)
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Risk Factors for Abdominal Compartment Syndrome After Endovascular Repair for Ruptured Abdominal Aortic Aneurysm : A Case Control Study
- 2021
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 62:3, s. 400-407
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Ruptured abdominal aortic aneurysms (rAAA) are treated by endovascular aneurysm repair (rEVAR) increasingly often. Despite rEVAR being a minimally invasive method, abdominal compartment syndrome (ACS) remains a significant post-operative threat. The aim of this study was to investigate risk factors for ACS after rEVAR, including aortic morphological features. Methods: The Swedish vascular registry (Swedvasc) was assessed for ACS after rEVAR in the period 2008 - 2015. All patients identified were compared with controls (i.e., patients who did not develop ACS after rEVAR), matched by centre and repair date. Case records were reviewed, and radiology images analysed in a core laboratory. Comparisons were performed with respect to physiological and radiological risk factors. Results: The study population consisted of 40 patients with ACS and 68 controls. Pre-operatively, patients with ACS had a lower blood pressure (BP) than controls (median 70 mmHg vs. 97 mmHg; p <.001). Intra-operatively, they had aortic balloon occlusion more often (55.0% vs. 10.3%; p <.001) and received more transfusions than controls (median nine units of packed red blood cells [pRBC] vs. two units; p <.001). Ninety-seven per cent of those who developed ACS had a pre-operative BP < 70 mmHg, aortic balloon occlusion, or received more than five pRBC unit transfusions. Treatment outside the instructions for use did not differ between patients and controls (57.5% vs. 54.4%; p=.84), and neither did the pre-operative patency of the inferior mesenteric artery (57.1% vs. 63.9%; p=.52) nor the number of visible lumbar arteries on pre-operative imaging (2 vs. 4; p=.014). In multivariable logistic regression, the number of intra-operative transfusions were predictive of ACS (p <.001), while pre-operative hypotension (p=.32) and aortic balloon occlusion (p=.018) were not. Conclusion: ACS after rEVAR is mainly associated with physiological factors and is unlikely to develop without the presence of a pre-operative BP < 70 mmHg, the need for an aortic occlusion balloon, or more than five intraoperative pRBC unit transfusions. Treatment outside the IFU or any other morphological factor were not associated with a risk of ACS.
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| 3. |
- Ersryd, Samuel, 1978-, et al.
(författare)
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Risk factors for abdominal compartment syndrome after endovascular repair for ruptured abdominal aortic aneurysm: A case-control study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Ruptured abdominal aortic aneurysms (rAAA) are increasingly often treated by endovascular aneurysm repair (rEVAR). Despite rEVAR being a minimal invasive method, abdominal compartment syndrome (ACS) remains a significant postoperative threat. The aim was to investigate risk factors for ACS after rEVAR, including aortic morphological features.Methods: The Swedish vascular registry (Swedvasc) was assessed for ACS after rEVAR during 2008-2015. All patients identified were compared with controls, i.e. patients who did not develop ACS after rEVAR, matched by centre and repair date. Case records were reviewed, and radiologic images were analysed in a core-lab. Comparisons were performed with respect to physiological and radiological risk factors.Results: After data validation the final study population consisted of 40 patients with ACS after rEVAR and 68 controls. Preoperatively, ACS patients had lower blood pressure (BP) than controls (median 70mmHg vs 97mmHg, p<.001). Intraoperatively, they had aortic balloon occlusion more often (55.0% vs 10.3%, p<.001) and received more transfusions than controls (median 9 packed red blood cells (pRBC) vs 2 pRBC, p<.001). Postoperatively, they received more transfusions than controls (5 pRBC vs 0 pRBC, p<.001). Ninety-seven percent of those who developed ACS had either preoperative BP <70mmHg, aortic balloon occlusion or received >5 intraoperative pRBC transfusions. Neither treatment outside instructions for use (IFU) nor preoperative patency of the inferior mesenteric artery differed between cases and controls (57.5% vs 54.4%, p=.842 and 57.1% vs 63.9%, p=.522 respectively), while the number of visible lumbar arteries on preoperative imaging were fewer among ACS patients (2 vs 4, p=.014).Conclusions: ACS after rEVAR is mainly associated with physiologic factors and is unlikely to develop without the presence of either preoperative BP <70mmHg, need for aortic occlusion balloon, or >5 intraoperative pRBC transfusions. Neither treatment outside IFU nor any other morphological factor could be associated with risk for ACS.
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| 4. |
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| 5. |
- McGreevy, David, 1988-, et al.
(författare)
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Endovascular Resuscitation with Aortic Balloon Occlusion in Non-Trauma Cases : First use of ER-REBOA in Europe
- 2017
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Ingår i: Journal of Endovascular Resuscitation and Trauma Management. - : EVTM Society. - 2002-7567. ; :1, s. 42-49
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Tidskriftsartikel (refereegranskat)abstract
- Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is currently evolving and being used worldwide for trauma management. Smaller sheath devices for REBOA and new advances in endovascular resuscitation methods suggest the potential for the procedure to be utilized in hemodynamically unstable non-trau-matic patients.Methods: We describe five adult patients that underwent hemodynamic control using the 7 Fr sheath ER-REBOA™ catheters for non-traumatic hemorrhagic instability at Örebro University Hospital between February 2017 and June 2017.Results: The ER-REBOA™ catheter was inserted and used successfully for temporary blood pressure stabilization as part of an endovascular resuscitation process.Conclusion: The ER-REBOA™ catheter for endovascular resuscitation may be an additional method for temporary hemodynamic stabilization in the treatment of non-traumatic patients. Furthermore, the ER-REBOA™ catheter may be a potential addition to advanced cardiac life support in the management of non-traumatic cardiac arrest.
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| 6. |
- Nilsson, Carolina, et al.
(författare)
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Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in a Multidisciplinary Approach
- 2017
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Ingår i: Innovations (Philadelphia). - : Lippincott Williams & Wilkins. - 1556-9845 .- 1559-0879. ; 12:4, s. E1-E2
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Tidskriftsartikel (refereegranskat)abstract
- The usage of resuscitative endovascular balloon occlusion of the aorta, also known as aortic balloon occlusion, is an emerging method for bleeding control as a bridge to definitive treatment in trauma management. We describe a trauma case where resuscitative endovascular balloon occlusion of the aorta was used as part of the EndoVascular hybrid Trauma and bleeding Management concept to facilitate transient hemorrhage control and thereby to permit damage control surgery. The case is an illustration of the adoption of a multidisciplinary approach.
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| 7. |
- Rezk, Francis, et al.
(författare)
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Multicenter parallel randomized trial evaluating incisional negative pressure wound therapy for the prevention of surgical site infection after lower extremity bypass
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Ingår i: Journal of Vascular Surgery. - 0741-5214.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Incisional negative pressure wound therapy (iNPWT) applied over all incisions after lower extremity bypass in the prevention of surgical site infections (SSIs) is unclear. The primary and secondary aims of this study were to investigate if prophylactic iNPWT after the elective lower extremity bypass prevents SSI and other surgical wound complications. Methods: This was a multicenter, parallel, randomized controlled trial. Patients undergoing elective lower extremity bypass in 3 hospitals were randomized to either iNPWT or standard dressings. SSIs or other wound complications were assessed within the first 90 days by wound care professionals blinded to the randomized result. The validated Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, and Stay (ASEPSIS) score was used to objectively assess the wounds. ASEPSIS score ≥21 is defined as an SSI. Unilateral and bilateral groups were analyzed with the Fisher exact test and the McNemar test, respectively. Results: In the unilateral group (n = 100), the incidence of SSI in the iNPWT group was 34.9% (15/43), compared with 40.3% (23/57) in the control group, according to the ASEPSIS score (P = .678). In the bilateral group (n = 7), the SSI rate was 14.3% (1/7) in the iNPWT group compared with 14.3% (1/7) in the control group (P = 1.00). In the unilateral group, there was a higher wound dehiscence rate in the control group (43.9%) compared with the iNPWT group (23.3%) (P = .0366). No serious iNPWT-related adverse events were recorded. Conclusions: There was no reduction of SSI rates in leg incisions with iNPWT compared with standard dressings in patients undergoing elective lower extremity bypass, whereas iNPWT reduced the incidence of wound dehiscence.
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| 8. |
- Svensson Björk, Robert, et al.
(författare)
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Negative Pressure Wound Therapy for the Prevention of Surgical Site Infections Using Fascia Closure After EVAR-A Randomized Trial
- 2022
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Ingår i: World Journal of Surgery. - : Springer. - 0364-2313 .- 1432-2323. ; 46:12, s. 3111-3120
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Tidskriftsartikel (refereegranskat)abstract
- Background Surgical site infections (SSI) in the groin after vascular surgery are common. The aim of the study was to evaluate the effect of negative pressure wound therapy (NPWT) on SSI incidence when applied on closed inguinal incisions after endovascular aneurysm repair (EVAR). Methods A multicenter randomized controlled trial (RCT). Between November 2013 and December 2020, 377 incisions (336 bilateral and 41 unilateral) from elective EVAR procedures with the primary intent of fascia closure were randomized and included, receiving either NPWT or a standard dressing. In bilateral incisions, each incision randomly received the opposite dressing of the other side, thereby becoming each others control. The primary endpoint was SSI incidence at 90 days postoperatively, analyzed on an intention-to-treat basis. Uni and bilaterally operated incisions were analyzed separately, and their respective p-values combined using Fishers method for combining P-values. Study protocol (NCT01913132). Results The SSI incidence at 90 days postoperatively in bilateral incisions was 1.8% (n = 3/168) in the NPWT and 4.8% (n = 8/168) in the standard dressing group, and in unilateral incisions 13.3% (n = 2/15) and 11.5% (n = 3/26), respectively (combined p = 0.49). In all SSIs, bacteria were isolated from incisional wound cultures. No additional SSIs were diagnosed between 90 days and 1 year follow-up. Conclusions No evidence of difference in SSI incidence was seen in these low-risk inguinal incisions when comparing NPWT with standard dressings after EVAR with the primary intent of fascia closure.
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