Postoperative Occlusion Research Articles

A Comparison of Post-Operative Occlusion with 3-D vs. 2-D Miniplate Fixation in the Management of Isolated Mandibular Angle Fractures

Mandibular angle fractures (MAFs) are treated in a variety of ways; however, the standard therapy is still up for debate. Despite the fact that many studies have generated evidence for the appropriate biomechanical stability of 3-D miniplates, there is an insufficient amount of data on the treatment of mandibular angle fractures with these plates. A comparative study was conducted at The Department of Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Patients were randomly divided into two groups of 52 patients each. Patients in group A were treated with 3-D miniplate placement on the lateral cortex following the principle of 3-D fixation proposed by Farmand and Dupoirieux, whereas patients included in group B were treated using 2-D conventional miniplate, placed according to Champy’s line of ideal osteosynthesis. A single surgical team performed the procedure. On the first and seventh post-operative days, the first month, and then the third month after surgery, regular evaluations were conducted. Assessment regarding Post Open Reduction and Internal Fixation (ORIF) occlusion was performed with the help of measuring tools. On the first day post-operative follow-up, 41 (78.8%) patients in group A and 31 (59.6%) patients in group B had satisfactory occlusion. The seventh day post-operative follow-up showed that 43 (82.7%) patients in group A and 41 (78.8%) patients in group B had satisfactory occlusion (p > 0.05). In both treatment groups, the first and third month follow-up evaluations revealed optimal occlusion. In comparison to conventional 2-D miniplate, the 3-D miniplate system produced better results and can be recommended as a better option for the management of mandibular angle fractures.

Focus on the use of maxillomandibular fixation in mandibular fracture oseosynthesis

ObjectivesThe objective of this study was to evaluate the efficiency of three methods of isolated mandibular fracture intraoperative reduction. Materials and methodsThis 6-year retrospective study included patients with isolated extra-articular mandibular fractures who would benefit from osteosynthesis. The endpoint was postoperative occlusion according to the type of intraoperative immobilization: screws, arch, or manual reduction. ResultsA total of 145 patients were included, with 233 fractures. Forty-five patients underwent manual reduction without maxillo-mandibular fixation (MMF), 51 MMF with screws, and 49 MMF with arch, with 11.1%, 5.9% and 4.1% of patients in these groups experiencing postoperative malocclusion, respectively. The overall malocclusion rate was 6.9%. There was no significant difference among the 3 methods according to univariate statistical analysis (p = 0.42) or after comparing MMF (grouping screws and arches) to manual reduction without MMF (p = 0.29). ConclusionThis study did not show a significant difference between the different methods of intraoperative reduction of isolated extra-articular mandibular fractures, even though intraoperative MMF was much more commonly used for complex fractures. However, there is a non-significant tendency to get a better post-operative occlusal result with MMF, which remains the reference traitement. Intraoperative manual reduction without MMF may be used within trained teams in some instances.

Comparative Efficacy of Lag Screw and 3D Plate in Fixation of Symphysis and Parasymphysis Fractures of MandibleA Prospective Interventional Study

Introduction: Mandible is well known for its unique anatomy and is the second most prevalent facial bone to fracture followed by fracture of nasal bone. Fracture of the mandible causes deranged occlusion, trismus, mobility of fractured fragments, pain, oedema and results in functional as well as aesthetic deformity. Therefore, the fixation of mandibular fracture plays a major role in rehabilitation of the jaw. The goal of management is to restore the premorbid occlusion and function. Aim: To compare the efficacy of osteosynthesis of mandibular anterior fracture by two different methods of open reduction, i.e, titanium lag screw and titanium 3 Dimensional miniplate. Materials and Methods: This prospective interventional study was conducted in the Department of Oral and Maxillofacial Surgery of Navodaya Dental College and Hospital, Raichur, Karanataka, India from January 2019 to February 2021. A total of 10 patients with symphysis and parasymphysis fracture were included in this study and were divided into two groups, five patients for Group A (osteosynthesis by titanium lag screw fixation) and five patients for Group B (osteosynthesis by titanium 3D plate fixation) and were treated accordingly. Parameters such as occlusion, mobility of fracture segments, interincisal mouth opening, facial oedema, pain, approximation of the lower border and lingual cortex and hardware failure were assessed clinically and radiographically, and the patients were followed up for three months. Recorded data was compared and was analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Independent sample t-test was used for comparison between the groups. Chi-square test and Fisher exact test were used for qualitative data and p-value was set at 0.05. Results: There was no significant difference noted between two groups when assessed radiographically on 1st day, one and a half month later and after three months. There was no significant difference noted in occlusion as well as in pain when measured postoperatively between the groups, but lag screw fixation provided normal immediate postoperative occlusion in all the cases. A significant improvement in the postoperative mouth opening was noted with lag screw group when compared to 3 Dplates with a p-value of 0.015 when measured after a week postoperatively. When oedema was measured in transverse direction, it was statistically significantly less in 3D plates group postoperatively first day with a p-value of 0.028 and after a week with a p-value of 0.044. Oedema when measured in vertical direction revealed no statistically significant difference between two groups. Conclusion: In the present study a significant improvement in the mouth opening as well as in terms of reduction in pain and oedema was noted with lag screw osteosynthesis group. Immediate postoperative occlusion was better with titanium lag screw osteosynthesis when compared to titanium 3D plates. Based on our study we conclude that both the osteosynthesis materials provide good interfragmentary stability in the management of anterior mandibular fractures and can be used satisfactorily for the fixation of mandibular fractures.

Brachial artery injuries - the impact of the anatomical site of injury on postoperative outcomes

The start of the armed conflicts in Libyan society in 2011 led to a dramatic increase in the incidences of unusual types of brachial artery injuries, which were previously uncommon. In this study, the postoperative outcomes have been compared prospectively between patients who have had injuries at the proximal anatomical half of the brachial artery with those who suffered injuries at the distal anatomical half.A cohort study was undertaken to compare patients who had an injury at the proximal anatomical half of the brachial artery (considered as the first group) and patients who had an injury at the distal anatomical half of the brachial artery (considered as the second group). This was undertaken to analyse the influence of the anatomical site of injury on the postoperative outcomes in patients who underwent urgent surgical repair procedures at the hospital from February 2011 to December 2016.Out of fifty-one patients, 31 (60.8%) patients had gunshot injuries, 12 (23.5%) had explosive injuries, four (7.8%) had stab wounds and four (7.8%) were victims of road traffic accidents. There were 13 (25.5%) patients in the first group and 38 (74.5%) patients in the second group. Three patients (5.9%) had postoperative arterial occlusion due to thrombosis, while two (3.9%) had postoperative graft occlusion due to thrombosis; the other two (3.9%) had compartment syndrome.Based on the anatomical background, critical limb ischaemia and postoperative ischaemic complications, as well as delayed limb amputation, are more associated with the injuries to the proximal anatomical half of the brachial artery due to poor collateral circulation at this level.

Portal Vein Reconstruction Using Cryopreserved Veins in Pancreatoduodenectomy for Advanced Pancreatic Head Carcinoma

Introduction: For advanced pancreatic head carcinoma, removal and reconstruction of the portal vein and/or the superior mesenteric vein are sometimes necessary to achieve R0 resection. Our institute has Tissue-Bank stocking the cryopreserved venous allografts donated based on the voluntary wish after the cardiac death. We have utilized these grafts to various surgeries with combined vascular resection. Methods: We retrospectively reviewed medical records of the 23 cases undergoing pancreatoduodenectomy with the combined resection of the portal venous systems and reconstructed it using the venous grafts for advanced pancreatic carcinoma between January 2002 and December 2019. Results: There were 12 male and 11 female, aged 73 (31-81), (median and range, same applies hereafter). Operative time was 749 (610-1148) min, estimated blood loss was 1305 (690-4350) gram. The type of portal vein resection consisted of 13 cases of circumferential segmental resection, 10 cases of wedged resection. Median postoperative hospital stay was 30 (18-105) days. There was no surgical complication greater than Clavien-Dindo IIIb. Five cases of postoperative occlusion of the allografts were observed. Graft patency rate in six months after the surgery was 75.0% and no occlusion later than 6 months were detected. Overall survival rate in one, three, and five years were 71.9%, 36.0%, 30.0% respectively. Conclusions: Reconstruction of portal vein using cryopreserved venous allografts is safe and its therapeutic effects is feasible for the pancreatoduodenectomy for advanced pancreatic carcinoma. Our techniques will be shown with a short videoclip.

Risk of venous occlusion after lead laser extraction preventing future lead implantation

BackgroundLead laser extraction is a well-established method for removing unwanted leads with low morbidity and mortality.ObjectiveIn this observational study, we documented our experience with venous occlusion after lead laser extraction.MethodsRetrospective data of patients who underwent lead laser extraction between May 2010 and August 2018 was analyzed. Two subgroups of patients were identified. First group represented patients after lead laser extraction who suffered postoperative venous occlusion. Second group represents patients after lead laser extraction, who has documented patent venous access after lead laser extraction.Results219 patients underwent percutaneous laser lead extraction. The mean age of patients was 65 ± 14 years. Of these patients, 74% were male. The Most common indication for extraction was Nonfunctional lead (45.2%, n = 99) followed by pocket infection with 33.8% and endocarditis (17.3%). A total number of 447 leads underwent laser extraction. In 7.8% of the patients, lead extraction was partially successful and lead extraction was not successful in only 2.3% of the patients. Only 13 patients developed a documented venous occlusion postoperatively and 26 patients has documented absence of venous occlusion, of whom 17 were under oral anticoagulation.ConclusionLead laser extraction may lead to venous occlusion, which is mostly asymptomatic but it prevents future lead implantation. The use of oral anticoagulant may prevent postoperative venous occlusion.

Long-term outcomes of endovenous laser ablation, n-butyl cyanoacrylate, and radiofrequency ablation for treatment of chronic venous insufficiency

BackgroundIn the present retrospective, single-center study, we evaluated the long-term effectiveness and reliability of endovenous laser ablation (EVLA), endovenous n-butyl cyanoacrylate (NBCA) application, and radiofrequency ablation (RFA) in the management of chronic venous insufficiency (CVI). MethodsThe medical records of patients who had undergone EVLA, NBCA, or RFA for CVI from January 1, 2014 to January 1, 2017 were reviewed. The medical records included data on sex, age, body mass index, American Society of Anesthesiologists score, and symptoms at admission. The great saphenous vein diameter, CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) classification, and venous clinical severity score were also recorded. All the patients were followed up with physical examinations and color Doppler ultrasound scan at the first week and 6 and 12 months after treatment. After 12 months, the follow-up examinations were performed annually. ResultsA total of 232 patients who had undergone lower limb CVI surgical treatment (EVLA, n = 77; NBCA, n = 73; RFA, n = 82). The mean follow-up time was 67.5 ± 4.7 months. The procedure duration was significantly shorter for the NBCA group (13.5 minutes) vs that for the EVLA (31.7 minutes) and RFA (27.9 minutes) groups (P = .001). The pain score was highest in the EVLA group (P = .001). The EVLA group had also experienced a significantly greater incidence of complications and a longer time to return to daily activities (P = .001). The post hoc analysis revealed comparable occlusion success among the three groups on the first postoperative day and at 6, 12, and 24 months postoperatively. However, significantly better occlusion rates were found for RFA vs EVLA at 3 and 5 years of follow-up (P = .024 and P = .011, respectively). The success of NBCA and RFA was similar at 3 and 5 years of follow-up (P = .123 and P = .330, respectively). ConclusionsThe outcomes showed similar early postoperative occlusion success among all three CVI treatment techniques. However, RFA resulted in a significantly higher success rate compared with EVLA at 3 and 5 years of follow-up. Additionally, the NBCA and RFA procedures achieved comparable long-term success. However, EVLA was associated with significantly greater complication rates and pain scores and a longer time to return to daily activities. The NBCA procedure had a significantly shorter operation time compared with the other procedures.

Clinical T4b Squamous Cell Carcinoma Resection With Hemimandibulectomy and Temporomandibular Joint Reconstruction With Bridging Plate and Modified Dautrey Procedure

Clinical T4b oral squamous cell carcinoma is traditionally considered nonoperable. We present a case of right mandibular squamous cell carcinoma (PT4bN0M0, stage IVB). The tumor had extended to the right mandibular condylar head and masticatory space. The patient received right modified radical neck dissection and radical operation with hemimandibulectomy to remove the right mandibular condyle. Then, we reconstructed the resected portion with an anterior lateral thigh free flap and bridging plate, which was bent to form an artificial condyle and fixed using the modified Dautrey procedure. The patient had stable postoperative occlusion and normal hinge movement of the temporomandibular joint. After postoperative concurrent chemotherapy and radiotherapy, the patient is under regular out patient department follow-up with satisfactory jaw function and oral intake.

Compare the Efficacy of Open Reduction and Internal Fixation of Mandibular Fractures With and Without Use of Intra-Operative Inter-Maxillary Fixation.

Mandible fractures are regularly encountered by maxillofacial surgeons and various treatment protocols are available for the management of these fractures. The aim of study compares the efficacy of open reduction and internal fixation of mandibular fractures with and without use of intra-operative inter-maxillary fixation. Twenty patients between age group ranging l8-65years who reported with single mandibular fracture in Dental college in India, during Oct 2012-March 2015 were the study subjects. These patients were divided into two groups. In one group fracture reduction was done by using inter-maxillary fixation and miniplate fixation was done. In other group fracture reduction was done manually and then fractured fragments were held in position by the assistant and miniplate fixation was done. Post-operatively patients were evaluated for occlusion, bone alignment and soft tissue/hard tissue infection at 1st, 4th, 8th, 12th weeks in both the groups. Statistics done by using Spearman's Rank correlation coefficient and Mann-Whitney U test. It was observed thatthere was no statistically significant difference seen in both the groups in terms of post-operative occlusion, radiological alignment and soft/hard tissue infection. Statistically significant difference was seen when the mean operating time was compared. The Group A showed mean difference of 35.50min more time than Group B. The results of our study suggested that, use of intra-operative IMF does not show any advantages in terms of post-operative occlusion, bone alignment and soft/hard tissue infection. We have concluded from the study that the increased intra-operative time for the placement of IMF increases the cost of the surgery in regard to equipment and theatre time. There is no benefit in terms of radiographic and clinical outcome. Hence use of intra-operative IMF can be avoided for ORIF of single mandibular fracture.

Evaluation of the efficacy, safety, and stability of posterior chamber phakic intraocular lenses for correcting intractable myopic anisometropic amblyopia in a pediatric cohort

BackgroundMyopic anisometropic amblyopia in pediatrics is one of the most challenging clinical situations that can face an ophthalmologist. Conventional correction modalities for myopic anisometropia, using spectacles, contact lenses, and/or occlusion therapy, may not be suitable for some pediatric patients or for some ocular conditions. This may lead to the development of anisometropic amblyopia. The aim of the present study was to evaluate the visual and the refractive efficacy, safety, and stability of Posterior Chamber Phakic Intraocular Lenses (PC-pIOLs) for correcting myopic anisometropic amblyopia in a pediatric cohort.MethodsThis case series, prospective, interventional study was conducted at Watany Eye Hospital, Cairo, Egypt. It comprised children and teenagers with myopic anisometropic amblyopia and unsuccessful conventional therapy. After implantation of Intraocular Collamer Lenses “ICLs” (Visian ICL, Model V4c, STAAR Surgical, Monrovia, California, USA), postoperative follow-up visits were scheduled, with automated refraction and Pentacam imaging performed.ResultsThe study enrolled 42 eyes of 42 patients. The age range was 3 to 18 years (mean ± SD = 10.74 years ±4.16). The mean preoperative spherical equivalent (SE) was − 12.85 D ± 2.74. The results declared a significant improvement in the postoperative Corrected Distance Visual Acuity “CDVA” (P value < 0.01) and SE (P value < 0.01). The efficacy index had a value of 1.18 ± 0.3 and the safety index was 1.09 ± 0.24. The follow-up visits had a mean ± SD of 14.67 months ±16.56 (range of 1 to 54 months). The results showed a refractive stability, with statistically insignificant improvements in the patients’ visual acuity and refractive status on evaluating the enrolled pediatrics during the follow-up visits compared to the first postoperative visits. No postoperative complications were encountered. Worthy of mention is that there was a significant (80%) non-compliance with the prescribed postoperative occlusion therapy.ConclusionsThe present study, with the longest reported follow-up range, declared the long-term efficacy, safety, and stability of Visian ICLs for correcting myopic anisometropic amblyopia in pediatrics. The reported non-compliance with occlusion therapy validates the early implantation of Visian ICLs in cases with failed conventional therapy to guard against anisometropic amblyopia.

Modified Meso-Rex bypass with umbilical vein recanalization and intra-operative stenting.

The aim of the study was to evaluate the usefulness of a novel modified Meso-Rex bypass surgical technique with umbilical vein recanalization and intra-operative stenting to treat portal vein cavernous transformation. In total, 13 portal vein cavernous transformation patients underwent Meso-Rex bypass surgery, consisting of bypassgrafts between the superior mesenteric vein (SMV) and the recess of Rex as well as through the ligamentum teres hepatis without stent implantation (Group A, n = 9) and umbilical vein recanalization with intra-operative stent implantation (Group B, n = 4). In Group A, the bypass diameter was 0-6mm (median 3mm) and blood flow velocity 25-115cm/s (median 72cm/s) 1month after Meso-Rex bypass surgery, with open bypass times of 0-67months (median 6months); 6 patients in this group developed postoperative Meso-Rex bypass occlusions. A patient in Group A treated with ligamentum teres hepatis recanalization needed a thrombectomy and stent implantation during a second surgery 2days after the Meso-Rex bypass, because of bypass thrombosis and umbilical vein stenosis. In Group B, the average modified Meso-Rex bypass diameter was 5.5-6.5mm (median 6mm), and the bypass vessels remained open in all patients, with blood flow rates of 45-100cm/s (median 76.5cm/s) 1month after the modified Meso-Rex bypass, up to the endpoint (15-33months, median 24months). The rate of bypass occlusions in Group A and Group B were 22.2% and 0%, 30.0% and 0%, and 55.6% and 0% at 1month, 3months, and 1year, respectively, after bypass surgery. Our novel modified Meso-Rex bypass approach for portal vein cavernous transformation treatment was effective with excellent long-term bypass patency.

Evaluation of efficacy of lag screw fixation in the management of mandibular parasymphysis fracture

Objectives: Mandibular fractures are treated surgically by either rigid or semi-rigid fixation. The focus of this study was to determine the efficacy of lag screws in treating mandibular parasymphysis fractures. Materials and Methods: We conducted a quasi-experimental study in which ten patients with mandibular sagittal parasymphysis fractures were enrolled. In these patients, two 2.0 mm stainless steel lag screws were installed for open reduction and internal fixation. Throughout the study, patients were examined for occlusion, fracture stability, screw location in relation to vital anatomical structures, reduction precision, maximum mouth opening (MMO), biting efficiency, and several other complications on the 1st day, 1st, 2nd, and 6th weeks postoperatively. Results: All parasymphysis fractures had a good bony union after surgery. One patient had mild occlusal discrepancies postoperatively, and statistical significance was found between preoperative and postoperative occlusion (P &lt; 0.0004). Only one patient had abnormal mobility between the fracture lines postoperatively, with a highly meaningful statistical observation (P &lt; 0.001). The comparative statistical analysis of MMO at different follow-up periods showed highly significant (P &lt; 0.00001) results. Substantial improvement in biting effectiveness yielded a high statistical significance (P &lt; 0.00001). There was no evidence of postoperative complications such as wound infection, wound dehiscence, intraoral screw exposure, or mental nerve injury in any of these patients. Conclusions: Lag screw fixation is a realistic and reliable method of internally fixing mandibular parasymphysis fractures. This technique allows the skilled surgeon to achieve optimum stability and functional healing by using the least amount of material.

In Vivo Animal Study of a Highly Viscous N-butyl Cyanoacrylate Medical Adhesive for Intravenous Embolization.

N-butyl cyanoacrylate (NBCA) is a liquid monomer that undergoes an exothermic polymerization reaction to form a solid upon initiation with hydroxyl anions. Recently, EGpresto, a highly viscous NBCA-based adhesive, has been developed for vascular-occlusion purposes. In this study, we investigated the heat of polymerization of EGpresto and compared the results with those of a low-viscosity NBCA glue. Results show that EGpresto exhibited a lower heat of polymerization (64 ± 7 °C vs. 34 ± 1 °C). This was due to its high viscosity, which resulted in a delayed polymerization time. To investigate the efficacy and safety of EGpresto for intravenous embolization, a 14 d in vivo animal test was conducted using three pigs. Five cc of EGpresto was injected into the epigastric vein of each animal. Complete postoperative vein occlusion was confirmed at 7 and 14 d by ultrasonographic visualization. After the animals were sacrificed, the operated and unoperated veins were exposed, and the injected adhesive was found without migration. During the histology, the injected adhesive was not found in the inner or outer vein walls, and the immune reactions seemed to be the only foreign-body reaction, showing that EGpresto is a non-toxic and safe intravascular embolic agent.

Postoperative occlusion degree after flow-diverter placement with adjunctive coiling: analysis of complications

BackgroundAlthough coiling with a flow diverter may provide immediate dome protection, no studies have evaluated the effect on complications of postoperative occlusion degree immediately postoperatively. The purpose of this study...

Pre-auricular Transparotid Approach for the Management of Mandibular Condylar Fracture: An Experience of 82 Cases.

This paper retrospectively analyses the functional outcomes and complications associated with pre-auricular transparotid approach for the management of mandibular condylar fractures. The retrospective data of 82 condylar fractures were analysing in 73 patients who underwent open reduction and internal fixation with pre-auricular transparotid approach. Evaluation of post-operative complications and the post-operative occlusion status, maximal inter-incise opening, adequacy of reduction and stability of fixation were assessed clinically and radiographically. The exposure of fracture segment was adequate in all the cases, and fixation was easy with 2mm delta miniplate. Transient facial nerve palsy occurred in 2 patients (2.43%). 1 patient developed sialocele which was managed conservatively. There were slight occlusal discrepancies in 10 patients at the end of 1-week follow-up which was corrected with guiding elastics at the end of 1-month follow-up. The reduction was adequate, and fixation was stable. The functional outcomes were satisfactory in term of mouth-opening and range of motion. The pre-auricular transparotid approach provides direct access to the fracture site resulting in less retraction of the tissue containing facial nerve and also less amount of periosteal stripping is required, thus it maintains good vascularity to the fracture segments. It provides direct visualization of the fracture without much retraction of the tissue containing facial nerve branches. It allows better fixation of the fracture with very less complication which results in good functional outcomes.

Clinical assessment of Open Reduction Internal Fixation (ORIF) of Mandibular Body Fractures Using ComputerAssisted Polyetherether Ketone (PEEK) Custom Made Plates Versus Conventional Titanium Plates: A Randomized Clinical Trial

Background and objective: This study aimed at clinical assessment of ORIF of mandibular body fracturesusing computer-assisted PEEK custom made plates versus conventional titanium plates.Materials and Method: Sixteen patients were divided into 2 equal groups. Patients in both groups underwentORIF of mandibular body fractures. In the study group, the fractures were stabilized using computerassisted PEEK custom made plates. In the control group, the mandibular body fractures were stabilizedusing 2.3 &amp; 2.0 titanium plating system. Each patient was assessed in terms of postoperative occlusion,wound dehiscence and mental nerve paresthesia. Moreover, operative time was evaluated in both groups.Results: The postoperative recovery and healing phase were uneventful in all patients. No postoperativecomplications were observed except in one case in the study group (PEEK) where wound dehiscence &amp;mental nerve paresthesia were experienced. Postoperative occlusion was satisfactory in both groups with aninsignificant difference (p&gt;0.05) regarding the assessment criteria. However, the custom made PEEK platesshowed the advantage of decreasing operative time and accuracy of reduction.Conclusion: Patient specific PEEK plate showed satisfactory clinical outcomes in ORIF of mandibularbody fractures. Additional advantages include saving time &amp; effort during the surgery.

Zoopery study on the treatment of intracranial aneurysms with a new blood flow guide device.

The purpose of this study was to evaluate the safety and effectiveness of arterial embolism device system produced by Taijie Weiye Technology Co., Ltd. Twenty healthy adult New Zealand white rabbits weighting from 3 to 4 kg were taken. Ligation and Elastic induction were used to build the aneurysm model of right common carotid artery in rabbits. The angiography and the arterial embolization device were implanted four weeks after the animal models were established. This device has excellent manufacturing, good controllability, and smooth pushing process. Five rabbits were randomly selected for angiography test to observe the healing of aneurysms in the first month, the third month and the sixth month after operation. Three other animal models with successful implantation were examined by arteriography in the first month, the third month and the sixth month, and the effect of implantation device on intercostal artery was recorded and analyzed. In the process of making aneurysm models, sixteen animals were successfully implanted with one device, two animals were given overlapping devices, and only two animals died in the process. The success rate of arterial embolic device system in the treatment of aneurysm was more than 80%. Among them, the two animals with 2 devices also achieved satisfactory therapeutic effect. According to this study, we found that the arterial embolization device system manufactured by Beijing Tajie Weiye Science and Technology Co., Ltd. was excellent in the immediate postoperative aneurysm occlusion rate and the long-term outcomes.

Use of tissue plasminogen activator to alleviate postoperative subcutaneous ureteral bypass obstruction secondary to blood clot in seven cats.

Seven cats were found to have postoperative subcutaneous ureteral bypass (SUB) occlusion secondary to blood clot formation. An increase in serum creatinine led to imaging and clot detection in all but one case. Alteplase, a tissue plasminogen activator, was infused into the SUB via the port in four cats, intravesicularly via a transurethral urinary catheter in one cat, and by both routes in two cats. Patency of the SUB was re-established in all cats within 2 days. No short- or long-term complications directly attributed to alteplase administration were observed. The results of this case series suggest that alteplase infusion via either the SUB port and/or a transurethral catheter should be considered prior to surgical intervention for the treatment of postoperative SUB occlusion secondary to a blood clot.

Surgical Treatment of Asymptomatic Popliteal Artery Aneurysms and Mid-term Outcome

Popliteal artery aneurysm (PAA) is a rare condition with an incidence ranging from 0.8 to 2.8%; however, it constitutes approximately 70–85% of all peripheral artery aneurysms. It is asymptomatic in the majority of cases but can cause pain and edema due to venous and neuronal compression. The most severe complication is limb lost due to thromboembolic event. Although surgical treatment left its place to endovascular treatment in the 1990s, surgical treatment still maintains its importance in preventing complications. Here, we aim to report our experience and results of the surgical management of popliteal aneurysms in this study. In this retrospective study, a total of 21 patients who were operated on due to popliteal artery aneurysm between October 2017 and January 2020 were analyzed. Patients with pseudoaneurysm and those who are infected and complicated were excluded from our study. The mean age was 63.3 ± 9.6; females were 17 (81%). Mean follow-up was 19 ± 8 months. More than two risk factors were found in 14 (66.7%) patients. Aneurysmectomy was performed successfully in all patients. Autologous saphenous vein graft was used in 11 (52.4%), whereas 6-mm polytetrafluoroethylene (PTFE) graft was preferred in 10 (47.6%) patients. During the follow-up period, limb loss rates were 16.7% and 83.3%, respectively. The difference was statistically significant (p < 0.05). No relation was found between the aneurysm diameter and postoperative graft occlusion. Limb loss rate was high in popliteal aneurysm repair using PTFE graft due to graft occlusion; saphenous vein graft is more superior in terms of mid-term graft patency.

Fundamental and essential techniques for supermicrosurgical lymphaticovenular anastomosis: the art of Isao Koshima’s supermicrosurgery

Lymphaticovenular anastomosis (LVA) is a highly effective, minimally invasive surgical treatment for lymphedema. The effect of LVA appears immediately after the creation of lymph-to-venous pathway. However, the long-term outcome of LVA is not always promising when the lymph-to-venous anastomosis has any potential risk of occlusion. The reasons of postoperative LVA occlusions are considered both a technical matter in performing LVA and a strategic matter in preoperative planning. This report focuses on intraoperative techniques of LVA to avoid postoperative occlusions. Depending on the types of undesirable surgical procedures, lymphaticovenular anastomoses are at risk of future occlusions in early, mid-, or late-postoperative course. The authors describe fundamental and essential techniques to perform supermicrosurgical LVA, and the true concept of Isao Koshima’s supermicrosurgery, in which the pith and marrow of the doctrine is not only the way of handling the small vessels or needles, but also the surgeons’ skills to feel intima of the vessels and lymphatic flow itself.