Intermediate-term Follow-up Results Research Articles

Adjustable Male Sling for The Treatment of Postprostatectomy Stress Urinary Incontinence: Intermediate-Term Follow-Up Results.

Objective To evaluate the outcomes of adjustable male sling (Argus®) implantation in the management of post-prostatectomy incontinence (PPI) with intermediate-term follow-up results. Materials and methods The data on adjustable male sling surgery between September 2015 and September 2020 were retrospectively analyzed. Patients were preoperatively evaluated with a voiding diary, 24-hour pad test, and validated questionnaire. Functional outcomes were also evaluated using 24-hour pad requirement and pad weight, and the International Consultation on Incontinence (ICIQ-SF) score. Results A total of 16 patients (eight having undergone the transurethral resection of the prostate [TUR-P] and eight radical prostatectomy [RP]) were enrolled in the study. Thirteen patients had moderate (81.25%) PPI, and three patients (18.75%) had severe PPI. With the mean follow-up of 36.9±14.3 months, nine patients (56.2%) were noted as cured and four (25%) as improved, with an overall success rate of 81.2%. At the last follow-up visit, the median number of pads used per day decreased from 3.5 to 1, and the 24-hour pad test result decreased from 300 to 50 gr (p < 0.001 and p < 0.001, respectively). The ICIQ-SF score decreased from the initial mean of 15.8 ± 2.3 to 7.1 ± 6.6 (p < 0.001). When the outcomes were compared according to the etiology, there was no statistically significant difference (p = 0.522). Conclusions Male sling surgery can be performed safely in patients with moderate and severe stress urinary incontinence with low complication and high success rates. The results of TUR-P-related PPI are similar to those of surgery performed due to the etiology of RP.

A Novel Fenestrating Device: Quick Fenestrater for Reconstructing Supra-aortic Arteries In Situ During Thoracic Endovascular Aortic Repair

BackgroundIn situ fenestration (ISF) is an effective approach for reconstructing supra-aortic branches during thoracic endovascular aortic repair (TEVAR). A dedicated device is needed for ISF. MethodsThe Quick Fenestrater (QF) underwent in vitro, animal-based, and initial clinical testing. In vitro, the polytetrafluoroethylene and Dacron aortic endografts were fenestrated using the QF, and the structure of the graft, fenestration hole, and shed particulate material were evaluated. Eight white swine had QF-aided ISF combined with TEVAR and bridge-stent implantation. The outcomes were assessed using intraoperative angiography and biopsy. Finally, 13 patients were treated with QF-assisted ISF combined with TEVAR, and the success rate, technical details, and intra- and postoperative complications were recorded. ResultsThe endograft structure was not damaged during in vitro testing. The fenestration hole was clean, and no particulate material was detected. In animal studies, all animals survived, the supra-aortic arteries were patent, and the endografts and bridge stents had normal morphology. In clinical studies, the technical success rate was 100%, and no fenestration-related neurologic complications or death occurred. One patient had a local access-related hematoma perioperatively and recovered after conservative treatment. Three patients had type III endoleaks, which resolved with no additional treatment. During a mean follow-up of 22.1 ± 6 months, no thoracic complications were identified, and the bridge stents were patent with no endoleaks. No adverse cerebrovascular events, cardiovascular events, or death occurred. ConclusionsQF-assisted ISF is a safe and effective method for the reconstruction of supra-aortic branches during TEVAR. Intermediate-term follow-up results validate the application of the novel fenestration device.

Transcatheter closure of the patent foramen ovale in children: intermediate-term follow-up results.

The patent foramen ovale is almost a normal anatomical hole between the atria with ~30% incidence in the general population. It has been suggested that the patent foramen ovale is the cause of some neurological events, which is explained by paradoxical embolism. Transcatheter closure of the patent foramen ovale is a common procedure in adult patients with cerebral ischaemic events, but there are limited data investigating the results in children. Between January, 2005 and February, 2014, 17 patients' patent foramen ovales were closed by the transcatheter approach in our department. The indications for closure were transient ischaemic attack in 10 patients, stroke in four patients, and migraine in three patients. The mean age and mean weight at the time of the procedure were 11.1±3.7 years and 42.1±15.4 kg, respectively. We asked our patients whether their previous ailments continued. All patients responded to the study survey. In 15 patients, ailments did not continue after patent foramen ovale closure and they significantly decreased in two of them. We suggest that under the right conditions device closure of the patent foramen ovale is a safe solution for these cryptogenic ischaemic events and migraine.

Comparison Between Covered and Bare Cheatham-Platinum Stents for Endovascular Treatment of Patients With Native Post-Ductal Aortic Coarctation: Immediate and Intermediate-Term Results

This study sought to evaluate the outcomes of endovascular treatment with covered versus bare Cheatham-platinum stents (NuMed, Hopkinton, New York) in coarctation of aorta (CoA) patients. Covered stenting has been newly recognized as a useful therapeutic method for patients with native CoA, but there has been no study comparing the use of covered stents with bare stents for treating CoA. In this randomized clinical trial, 120 patients with a mean age of 23.60 ± 10.99 years (range 12 to 58 years, 79 men), with post-ductal, short-segment, severe native CoA underwent implantation of bare Cheatham-Platinum (bCP) (n = 60) or covered Cheatham-Platinum (cCP) (n = 60) stents. Patients were followed clinically at 1, 3, 6, and 12 months after the stenting and yearly thereafter. During follow-up, multislice computed tomography (64 slices) was scheduled to assess any complications. The procedural success rate was 100% in both groups. Patients were followed for 31.1 ± 19.2months. Although recoarctation was seen only in the bCP group during follow-up, the difference betweengroups did not reach statistical significance (6.7% vs. 0%; p= NS). Two cases of pseudoaneurysm (3.3%) occurred in the cCP group, but none was observed in the bCP group (p= NS). Normotensive statussignificantly increased during follow-up in both groups (from 15% to 73.3% in the bCP group and16.7%to78.3% in the cCP group, p < 0.001 for each group and not significant between groups). Implanting bCP and cCP stents have very high success rates with remarkable hemodynamic effects in severe native CoA patients. Patients undergoing cCP stent implantation experienced a nonsignificantly lower recoarctation rate and a higher occurrence of pseudoaneurysm formation with respect to bCP stenting during follow-up. These findings indicate that CoA stenting isasafe procedure. (Endovascular Stenting With Covered CP Stent Compared With Bare CP Stent forAdultPatients With Coarctation: The Initial and Intermediate-Term Follow-Up Results; IRCT201012045311N1).

Review of outcome of radiofrequency cardiac catheter ablations carried out at Madras Medical Mission, India

Context: Radiofrequency ablation (RFA) is a recognised mode of therapy for cardiac arrhythmias. The procedure is carried our regularly at the Cardiac Catheterization Laboratory of Madras Medical Mission, India. Aim: To evaluate the intermediate term follow-up results of radiofrequency catheter ablations. Subjects and Methods: This was a retrospective study carried out in the Cardiac Electrophysiology Department of the Institute of Cardiovascular Diseases, Madras Medical Mission (MMM), India. Records of consecutive cardiac electrophysiologic studies carried out between January and October 2009, together with records of follow-up to March 2014 for those that underwent RFAs were reviewed. In total, the records of 139 cases that had RFAs were analysed. Results: The 139 patients comprised of 65 males and 74 females. The indication for RFA was drug refractory arrhythmias in the vast majority (137 patients). There was a very high success rate (97.1%), following cardiac ablations. Early complications were observed in only 3 (2.2%) patients. Recurrence rate of the indication for RFA was very low (1.43%), and there was no mortality associated with the procedure. Conclusions: The treatment of patients with cardiac arrhythmias using RFA, was associated with a high rate of success, and low rate of complications.

Subjective Results after Surgical Treatment for Displaced Intra-articular Calcaneal Fractures

We present a retrospective study investigating the results of the subjective assessment of displaced intra-articular calcaneal fractures in a selected cohort of 42 patients treated operatively, with a follow-up duration of at least 3 years. The adjusted American Orthopaedic Foot and Ankle Society questionnaire, Foot Function Index, and visual analog scale were used to quantify the subjective evaluations. Our hypothesis was that good subjective results could be predicted and obtained in patients with specific characteristics if anatomic reduction of the fracture was achieved. The results of the study confirmed our hypothesis. A number of specific subgroup analyses were undertaken. The study confirmed that Böhler angle restoration and the quality of reduction of the subtalar joint facet are important prognostic factors related to the outcome. In contrast, gender and Sanders type had less influence at the intermediate-term follow-up results. The main weaknesses of the present study included its retrospective nature, the lack of a control group managed nonoperatively for comparison, and the small sample size. Moreover, the operating surgeon performed the radiographic measurement and categorized the quality of the surgical reconstruction.

Percutaneous Closure of Coronary Artery Fistulae in Adults with Intermediate Term Follow‐Up Results

Percutaneous closure of coronary artery fistulae (CAF) has become an alternative method to surgery. But there are limited data about intermediate and long-term results. In this manuscript, we aimed to review our experience about the closure of CAF with several percutaneous methods in our center. Seven patients who admitted to our hospital, either symptomatic or having complications attributable to CAF, were analyzed. The immediate closure results and clinical follow-up were reviewed. Five patients were male (71%) and mean age was 58.3 ± 13.3 years. Five of the CAF were draining into pulmonary artery and 2 of them were draining into the right atrium. Closure of CAF was performed with coil embolization in 5 patients, detachable balloon in 1 patient, and a combination of coil embolization and glue in the remaining 1 patient. In the early follow-up, 1 patient had atrial fibrillation and 1 patient had chest pain immediately after the closure procedure; other patients discharged from hospital uneventfully. Intermediate term follow-up results (32-83 months; median, 54 months) revealed that the procedure was clinically successful in all of the patients, despite the complaint of chest pain in 3 patients and minimal flow in 1 of these patients. Percutaneous closure of CAF is feasible and safe in anatomically suitable vessels with good results at intermediate term follow-up.

Laparoscopic versus Open Roux-en-Y hepatojejunostomy for children with choledochal cysts: intermediate-term follow-up results

Laparoscopic hepatojejunostomy (LH) for children with choledochal cysts (CDC) has been gaining popularity recently. However, its safety and efficacy remain unknown. The purpose of this study was to evaluate the intermediate-term results of LH for CDC children. We reviewed 218 patients who underwent LH between October 2001 and October 2009 and 200 patients who underwent open hepatojejunostomy (OH) between September 1993 and September 2001. Ultrasonography, upper gastrointestinal contrast studies, and laboratory tests were performed during the follow-up period. Age, operative blood loss, operative time, postoperative hospital stay, time to full feed, duration of drainage, postoperative complications, and perioperative laboratory tests were evaluated in both groups. The median follow-up periods of the LH and OH groups were 38 and 146 months, respectively. There was no significant difference in age between the two groups. Interestingly, the operative time of the LH group decreased significantly with increasing number of cases (P<0.01). The most recent operative time of the LH group did not differ from that of the OH group (3.04 vs. 2.95 h, P=0.557). The operative blood loss of the LH group was significantly less (P<0.001). The postoperative hospital stay, resumption of alimentation, and duration of drainage in the LH group were significantly shorter (P<0.001, respectively). Two of 218 (0.9%) LH patients developed bile leak. This was significantly less than 11 of 200 (5.5%) in the OH group (P<0.01). The morbidities of LH group were significantly lower than those of the OH group. Postoperative liver function tests and serum amylase levels normalized in both groups (P<0.001). Laparoscopic hepatojejunostomy is safe and effective. Its intermediate-term results are comparable to open surgery.

Percutaneous closure of ruptured sinus of Valsalva aneurysms: intermediate term follow-up results

Surgical repair used to be the conventional treatment of ruptured sinus of Valsalva aneurysms (RSOVA). Recently many articles have described the percutaneous closure of these defects. We report the successful percutaneous closure of seven cases of RSOVA.All the procedures were done under local anaesthesia with fluoroscopic and echocardiographic guidance. The defects were closed with nitinol ductal occluders introduced from the venous side after the establishment of an arteriovenous loop. Of the seven patients (four males, mean age 44.8+/-11 years), six had rupture of the congenital sinus of Valsalva aneurysm, and one had a recurrence following surgical repair. Out of the six patients with aneurysms of the right aortic sinus, four had rupture into the right atrium, one into the right ventricular (RV) inflow and the other into RV outflow. One patient had non-coronary sinus aneurysm rupturing into the right atrium. The size of the distal opening of the aneurysm varied from 2.5 to 12 mm. The left to right shunt flow ratio (Qp/Qs) ranged from 1.5 to 3.6. The size of the nitinol ductal occluders used to close the defects varied from 4 to 16 mm. After a mean follow-up period of 9.3+/-3 months, all patients remained asymptomatic with no residual flow, aortic valvar insufficiency, or evidence of infection.RSOVAs can be safely and effectively closed percutaneously using nitinol ductal occluders.

Comparison of intermediate-term status in Legg-Calve-Perthes Disease patients treated with Varus Derotational Osteotomy with or without subsequent epiphysiodesis of the greater trochanter

Abstract Introduction: The intermediate-term follow-up results of 15 unilateral Legg-Calve-Perthes Disease patients who received Varus Derotational Osteotomy procedures followed by epiphysiodesis of the affected hip were compared with 23 patients who received Varus Derotational Osteotomy without a subsequent epiphysiodesis. Methods: In this case-control study, parameters that were examined clinically were the presence of pain, presence of limp, leg-length discrepancy, and range of motion. Radiographic studies measured Greater Trochanteric height ratio and Mose Index. Seven patients with bilateral L-C-P disease were not included in statistical analysis, but were placed in a subgroup for comparison of clinical outcomes. Patients were classified into three groups: Good/Excellent, Fair, and Poor based on the parameters recorded. Results: Based on clinical data, 35.7% of patients who received an epiphysiodesis were found to have a good/excellent intermediate-term outcome compared to 61.9% of patients who did not receive the same procedure. Radiographic analysis showed 46.7% of patients with an epiphysiodesis to have good/excellent radiographic results compared to 43.8% of those who did not receive the procedure. Conclusions: It was concluded from this study that an epiphysiodesis may be beneficial in decreasing the height of the greater trochanter subsequent to Varus Derotational Osteotomy. Functional benefit for patients, however, was negligible and warrants further investigation.

Need for secondary interventions after endovascular repair of abdominal aortic aneurysms. Intermediate-term follow-up results of a European collaborative registry (EUROSTAR).

The frequency of secondary interventions after endovascular repair of abdominal aortic aneurysms (AAAs) was assessed and correlated with findings at clinical and imaging examination during follow-up. Data were studied from 1023 patients with a follow-up of 12 months or longer, collected by 56 institutions in a multicentre data registry (EUROSTAR). Surveillance data were provided by the centres between September 1996 and November 1999. Overall, 186 patients (18 per cent) had a secondary intervention occurring a mean of 14 months after the initial endograft procedure. Twelve per cent of the interventions were transabdominal, 11 per cent consisted of an extra-anatomic bypass and 76 per cent involved a transfemoral procedure. The rates of freedom from intervention at 1, 3 and 4 years were 89, 67 and 62 per cent respectively. Migration (relative risk (RR) 8.9) and rupture (RR 22.6) were the most frequent causes of secondary transabdominal interventions. Graft limb thrombosis was the principal indication for extra-anatomic bypass (RR 37.5 for clinical evidence of graft limb thrombosis). Endoleak, graft kinking, stenosis or thrombosis and device migration were significant causes for secondary transfemoral interventions (RR 2.5-6.9). The high incidence of late secondary interventions is a cause for concern with regard to broad application of endovascular AAA repair, and emphasizes the need for lifelong surveillance.

Early and intermediate-term complications of self-expanding stents limit its potential application in children with congenital heart disease

OBJECTIVESWe report on the early and intermediate-term follow-up results of self-expanding Wallstent (Schneider, Switzerland) implanted in children with congenital heart disease.BACKGROUNDThe inherent shortcomings of balloon-expandable stents prompted the trial of an alternative stent.METHODSTwenty patients underwent 22 implantations of 25 self-expanding Wallstents between December 1993 and June 1997 in two institutions. The mean age and weight were 10.8 ± 4.5 years and 30.5 ± 14.2 kg, respectively. The patients were divided into two groups: 1) Group I comprised 17 patients with pulmonary arterial stenoses, 2) Group II comprised four patients with venous stenoses (one belonged to both groups). Sixteen patients underwent recatheterization at a median of 5.8 months (range 0.5 to 31, mean 8.1 months) after stenting. Hemodynamic and angiographic changes after the interventional procedures and complications were documented.RESULTSAll the stents were successfully deployed in the intended position. In Group I, the narrowest diameter of the stented vessel increased from 4.1 ± 1.5 to 8 ± 2 mm (95% increase, p < 0.0001) while the systolic pressure gradient across decreased from 24.6 ± 15.8 to 12.1 ± 11.4 mm Hg (51% decrease, p = 0.001). In Group II, the dimensional changes of the narrowest segment increased from 4.3 ± 0.5 to 7.5 ± 0.4 mm (75% increase, p = 0.003), and the pressure gradient reduced from 5.0 ± 2.9 to 0.9 ± 1.0 mm Hg (82% decrease, p = 0.04) across the stented venous channel. Distal migration of two optimally positioned stents occurred within 24 h of implantation. At recatheterization, significant neointimal ingrowth (>30% of the expanded diameter) was noted in 7 (28%) of the 25 implanted stents. This responded poorly to balloon dilation. Predisposing factors for the neointimal ingrowth included stents of smaller diameter (<9 mm) and longer period after implantation.CONCLUSIONSSelf-expanding Wallstent could be deployed easily and safely to relieve vascular stenoses in children. The complications of distal migration, significant neointimal ingrowth and its unyielding design to overdilation limit its application to this patient group.

Intermediate-term follow-up results of balloon aortic valvuloplasty in infants and children with special reference to causes of restenosis

Sixteen infants and children with valvular aortic stenosis underwent percutaneous balloon aortic valvuloplasty over a 36-month period ending August 1988. The mean systolic pressure gradient across the aortic valve decreased from 72 ± 21 (mean ± standard deviation) to 28 ± 13 mm Hg (p < 0.001) immediately after valvuloplasty; the degree of aortic insufficiency did not significantly increase. Follow-up catheterization (in 10 patients) and Doppler data (in all 16 patients) were available 3 to 32 months (mean 12 months) after valvuloplasty and revealed a residual aortic valvular gradient of 37 ± 23 mm Hg, which continues to be significantly lower (p < 0.001) than that before valvuloplasty. There was no increase in aortic insufficiency. On the basis of follow-up data, the 16 children were divided into 2 groups: group I with good results (gradients ≤ 49 mm Hg), 12 patients; and group II with poor results (gradients ≥ 50 mm Hg), 4 patients. All 4 patients in group II required repeat balloon valvuloplasty or surgical vatvotomy; none from group I required these procedures. Seventeen general, anatomic, physiologic and technical variables were examined by a multivariate logistic regression analysis to identify factors associated with restenosis; these,risk factors were: age ≤ 3 years; and immediate aortic valvular gradient after valvuloplasty ≥ 30 mm Hg. The immediate and intermediate-term follow-up results of balloon aortic valvuloplasty are encouraging. Recognition of the risk factors may help identify potential candidates for recurrence. Attempts to reduce the immediate gradients after balloon valvuloplasty to < 30 mm Hg may prevent recurrences at intermediate-term follow-up.

Balloon angioplasty of aortic coarctation: A review

Since the initial report of balloon coarctation angioplasty in 1982, several workers used this technique in native coarctation and postoperative recoarctation. Immediate and intermediate-term follow-up results are generally good with a small chance for recoarctation and aneurysmal formation at the site of coarctation. The causes of recoarctation were identified and include age less than 1 year, isthmus hypoplasia, and a small coarcted aortic segment. Despite good immediate and follow-up results, recommendations for use of balloon angioplasty as a treatment procedure of choice are clouded by the reports of development of aneurysms at the site of coarctation. We feel that balloon coarctation angioplasty is the treatment of choice in neonates and small infants, while general use of this technique in both native and postoperative coarctations in older children should await follow-up results in larger numbers of children at selected centers.

Balloon pulmonary valvuloplasty: a review.

Balloon pulmonary valvuloplasty has been used successfully over the last few years for the relief of moderate to severe valvar pulmonic stenosis in neonates, infants, children, and adults. Both immediate and intermediate term follow-up results have been well documented by cardiac catheterization studies. Electrocardiographic and echo-Doppler evaluation at follow-up is reflective of the results and may avoid the need for recatheterization. The results of balloon valvuloplasty are either comparable to or better than those reported with surgical valvuloplasty. The causes of restenosis have been identified, and appropriate modifications in the technique, particularly the recommended use of a balloon/annulus ratio of 1.2 to 1.5, should give better results than previously documented. Complications of the procedure have been minimal. Further refinement of the catheters and technique may reduce the complication rate even further. The indications for balloon valvuloplasty have not been clearly defined but should probably be similar to those used for surgical valvotomy; only patients with moderate to severe valvar pulmonic stenosis are candidates for balloon valvuloplasty. Previous surgery and pulmonary valve dysplasia are not contraindications for balloon valvuloplasty. The procedure is also applicable to pulmonary stenosis associated with other complex cardiac defects and stenosis of bioprosthetic valves in pulmonary position. Miniaturatization of balloon/catheter systems to further reduce the complication rate and documentation of favorable result at 5- to 10-year follow-up are necessary.