Postoperative Vascular Complications Research Articles

The prevalence of vascular injury utilising the lateral parapatellar approach for malignant distal femoral tumour resections: a case series

ABSTRACT BACKGROUND: Distal femoral tumour resections are mostly performed through a medial or anteromedial approach. The lateral parapatellar approach is an alternative method. This case series assessed vascular complications during the resection of malignant distal femoral tumours via the lateral parapatellar approach METHODS: A retrospective case series at a private practice in Pretoria was performed. All patients who underwent malignant distal femoral tumour resections through a lateral parapatellar approach between 2001 and 2019 were included in the study. All cases were performed by a single surgeon. An analysis of the patients' files was performed, to determine if there were any intraoperative or immediately postoperative vascular complications RESULTS: Thirty-six patients were identified who underwent resection of their malignant distal femoral tumours via the lateral parapatellar approach. Osteosarcoma was the most prevalent bone tumour (81%). All resection margins were clear on histology reports. The vascular complication rate was 3% (95% CI 0-8%). Twelve patients demised over the 18-year period (33% CONCLUSION: The findings suggest that a low risk of vascular complications can be expected when resecting malignant distal femoral tumours through a lateral parapatellar approach. This rate of vascular injury is comparable to other studies that also performed distal femoral tumour resections through other approaches Level of evidence: Level 4 Keywords: malignant distal femoral tumours, lateral parapatellar approach, vascular complications, tumour resection, endoprosthesis

Crucial Roles of Vascular Surgeons in Oncovascular and Non-Vascular Surgery

Vascular surgeons can be useful in non-vascular surgery cases, especially in oncology where complete resection is important. Such activity has been quantified at least locally, but maybe not adequately reported in a systematic manner, or studied prospectively. This study aimed to describe the roles of vascular surgeons in oncovascular surgery (OVS) and non-vascular surgery (NVS), and to analyse the yearly trends of consult surgery, early mortality and morbidity and risk factors for poor outcomes. This study was a five year retrospective review of the role of vascular surgeons in various settings at a tertiary hospital. Electronic medical records and images were reviewed retrospectively. Between January 2014 and December 2018, the vascular surgery registry data of Seoul National University Hospital were reviewed for OVS or NVS assisted by vascular surgeons and operations primarily done by vascular surgeons. Demographic data, clinical characteristics, operative data, vascular related data and operative outcomes were collected. The operations were classified into primary surgery or consult surgery. Consult procedures were divided into planned or unplanned surgery. Of 564 cases, vascular surgeons performed 74 OVS as primary surgery, and retroperitoneal tumour was the most frequent diagnosis (n=34). There were 490 intra-operative requests for a vascular surgeon's assistance, of which 109 were emergency calls. Total intra-operative consultations increased by 115.9% over five years, and the proportion of unplanned operations also increased. Unplanned assistance was most commonly requested for bleeding, whereas node dissection was the most common reason for planned surgery. The mortality rate was not different between the planned and unplanned surgery groups, but the latter showed worse outcomes in total operating time, length of hospital stay, post-operative consultations, and post-operative vascular related complications. Vascular surgeons have an essential role to play in the modern practice of cancer surgery. Oncovascular surgery enables gross resection of a tumour even in the presence of major vessel invasion. Emergency unplanned surgery had worse outcomes; therefore, pre-operative vascular consultation and multidisciplinary management are highly recommended for better patient outcomes.

Success Rate of Grafts With Multiple Renal Vessels in 3136 Kidney Transplants

Multiple renal vessels are often detected in living and deceased organ donors. In the past, transplant with multiple renal vessel grafts has been a contraindication because of high vascular and urological complication rates. However, improvements in vascular reconstruction and anastomosis techniques have allowed graft function to be maintained for many years. Here, we retrospectively evaluated transplant of multiple renal vessel grafts and graft survival and postoperative vascular and urological complications. From November 1975 to July 2020, there were 3136 renal transplants (716 deceased donors, 2420 living donors) performed in our center. There were 2167 living donors and 643 deceased donors with single renal vessel grafts and 253 living donors and 73 deceased donors with multiple renal vessel grafts. For anastomoses, external iliac, internal iliac, common iliac, and inferior epigastric arteries and external iliac veins were used. Cold ischemia time, anastomosis time, postoperative vascular and urological complications, acute tubular necrosis, creatinine clearance, serum creatinine levels, graft rejection episodes, and graft and patient survival rates were evaluated. With regard to creatinine clearance, cold ischemia and anastomosis time, acute tubular necrosis, rejection episodes, and 1-, 2-, and 5-year posttransplant serum creatinine levels, there were no significant differences between the groups. Graft survival rates in the single renal vessel group were 92.9% at 1 year posttransplant and 78.3% at 5 years posttransplant; rates in the multiple renal vessel group were 93.1% at 1 year and 79.7% at 5 years. The corresponding patient survival rates were 95.5% (1 year) and 92.9% (5 years) for the single renal vessel group and 96.9% (1 year) and 87.2% (5 years) for the multiple renal vessel group. Improved anastomosis and recon struction techniques have allowed the safe transplant of multiple renal vessel grafts that may remain functional for many years.

Hospital Based Study of Traumatic Neck Injuries: A Decision Making Approach

Introduction
 Traumatic neck injuries can cause serious morbidity and mortality. They have very serious outcomes and require emergent surgical interventions. This study illustrated 31 traumatic neck injury cases and their management over a period of 3 years.
 
 Materials and Methods
 Thirty nine (39) patients were studied retrospectively and analyzed. Patients admitted through emergency room with a history suggestive of vascular trauma in the neck, between February 2014 and March 2017 were included. Thirty one (31) patients which were treated surgically were selected for analysis. All the patients were taken to the operating room immediately and made hemodynamically stable, other parameters were quickly corrected and urgent measurements were undertaken to maintain vascular integrity.
 Results
 Out of 31 patients suspected to have vascular neck injuries, only 29 (74%) were established to have vascular neck injuries. Forty seven percent 47% were stabilized hemodynamically and underwent operations under elective conditions. 16 (55%) patients were found to be hemodynamically unstable with fair signs of vascular injuries and were taken to the operating room immediately. 41% had arterial injuries and 59 % had venous injury. No patients had any post-operative vascular complication. One patient expired on the 11th postoperative day as a result of multiple organ injury and brain injuries.
 Conclusion 
 Patients with severe neck injuries leading to acute bleeding and hematoma must be taken to the surgery for best outcome. Prompt decision making plays very important role to minimize disastrous consequences leading to further vascular and neurological derangements.

Role of ultrasonography in assessment of postoperative vascular complications in recipients of living donor liver transplantation

Objective The aim was to evaluate the role of color Doppler ultrasonography (CDUS) in the evaluation of vascular complications detected in recipients of living donor liver transplantation (LDLT). Background Post-transplant-related vascular complications remain threat to the recipients' survival. A higher risk for vascular complications was found in LDLT recipients because of complex vascular reconstruction and slender vessels. CDUS acted as a first-modality imaging technique to detect vascular complications in the early and late follow-up period. Patients and methods A total of 60 liver transplant recipients who underwent LDLT in National Liver Institute Menoufia University were included. The study was done over a period of 25 months from January 2016 to January 2018. These recipients underwent serial color Doppler sonographic evaluation of hepatic arteries, portal vein, and hepatic veins after surgery. Patients with abnormal sonographic finding underwent subsequent angiography. Results The study was done by gray-scale, CDUS and included 47 patients of 60 recipients who showed suspicious vascular complications as follows: 26, 13, and eight patients had suspected arterial, portal, and hepatic venous complications, respectively. All these patients underwent conventional angiography. The sensitivity and specificity of CDUS in the evaluation of arterial, portal, and hepatic venous complications were 95, 87.5, and 87%, respectively, and 86, 91, and 96%, respectively, and for the latest complications was 87 and 96%, respectively. Conclusion CDUS was the preferred postoperative screening method; it was an initial recipient workup for post-LDLT. Providing a perfect evaluation of hepatic vasculature and assessment of early and lately presented vascular complications.

Risk Factors of Early Kidney Graft Transplantectomy

BackgroundKidney allograft explant in the first month after transplant is a major concern for medicosurgical teams specialized in kidney transplantation and unacceptable graft loss in the current shortage. The aim of our study was to evaluate the risk factors of early kidney graft explant. MethodsWe retrospectively analyzed all adult kidney transplantations performed at our center from January 2006 to December 2011. Recipient, donor, and transplant characteristics were collected, as well as operating data and early postoperative complications. Univariate and multivariate logistic regression models were used to determine risk factors of early renal allograft explant. ResultsFrom a total of 707 kidney transplantations, 28 transplantectomies were performed in the first month following transplantation (3.96%). The average delay in days ± SD was 7.6 ± 10. Eighty-six percent of transplantectomies were due to vascular complications. In multivariate analysis, obesity (odds ratio [OR] = 9.6; 95% confidence interval [CI], 1.63-56.5; P = .0007), range of transplantation (OR = 36.89; 95%CI, 5.5-245; P = .0006), intraoperative complications (OR = 3.99; 95%CI, 1.22-13; P = .026), and early postoperative vascular complications (OR = 85.15; 95%CI, 23.6-306; P < .0001) were independent risk factors. Neither donors nor graft characteristics were significant. ConclusionsEarly renal graft transplantectomies are rare but account for 50% of renal graft loss in the first year. Because obesity, perioperative complications, and early vascular complications are independent factors associated with early transplantectomies, their prevention should be based on meticulous surgery during organ procurement, implantation of the kidney, and on the rehabilitation of future recipients.

The role of multislice computerized tomography angiography in assessing postoperative vascular complications in liver transplant patients

Background/aim Vascular complications can be detected in liver transplant patients. Digital subtraction angiography has served as the gold standard to make this diagnosis; however, due to its invasive nature, ultrasonography is used for the preliminary evaluation. The purpose of this study was to evaluate the role of multislice computerized tomography angiography (MSCTA) in the detection of vascular complications of symptomatic and asymptomatic liver transplant patients and to compare the results with Doppler ultrasound (Doppler US) findings. Materials and methods Fifty-three liver transplant patients (6 symptomatic, 47 asymptomatic) underwent Doppler US examination followed by an MSCTA. The findings in each modality were interpreted in a blinded fashion and then compared. Results MSCTA detected 15 abnormalities, none of which were detected by Doppler US. There were hepatic and splenic artery aneurysms (n = 4) and various stenoses (n = 4), infrarenal aortic anastomosis (n = 4), vena cava inferior thrombosis (n = 1), arteriovenous malformation (n = 1), and esophageal varices (n = 1). Conclusion MSCTA detected more lesions and we believe that it should be considered as a road map for Doppler US follow-ups as well as a routine screening modality for early detection of vascular complications in symptomatic and asymptomatic liver transplantation patients that may be missed by Doppler US.

Vascular Complications and Procedures Following Transcatheter Aortic Valve Implantation

Vascular complications (VCs) remain a significant cause of morbidity in transcatheter aortic valve implantation (TAVI) patients and are associated with worse outcomes. This research analysed the incidence, impact, and predictors of VCs in transfemoral cases. A retrospective chart review was performed of 388 consecutive TAVI patients between January 2007 and April 2015, which included 237 transfemoral cases. Major and minor VCs were characterised according to the Valve Academic Research Consortium (VARC) guidelines. Logistic regression was completed to identify predictors of VCs. While VCs occurred in 68 (28.7%) cases, only seven (3.38%) were classified as major complications. Twenty-six (10.9%) of these complications occurred intra-operatively, with four being major (1.6%) and 22 minor (9.3%). Post-operative VCs occurred in 42 cases (17.2%), with three (1.3%) being major. Procedures to correct VCs occurred in 10 (4.2%) cases, with the majority (90%) being surgical and the remainder being treated by endovascular techniques. Nine surgical procedures, predominantly embolectomy, were performed to correct post-operative complications. Female gender was a predictor of all major VCs (B=-2.1, p<.006). Further, a logistic regression analysis found that when the largest sheath was located on the left side, there were increased minor post-operative complications (B=-0.99, p=.007). Dissections and haematomas made up the majority of VCs. Thirty day mortality was six patients (n=2.5%), and peri-operative VCs were significantly correlated with 30 day mortality (p=.001, R=0.21). The 30 day readmission rate comprised nine patients (3.8%), with three (1.3%) due to VCs, including haematomas and groin infections. VCs contribute to operative morbidity in TAVI patients. This study demonstrated low major VC rates over an eight year period. Left sided location of largest sheath size and female gender were predictors of VC.

Pervasive wearable device for free tissue transfer monitoring based on advanced data analysis: clinical study report

.Free tissue transfer (FTT) surgery for breast reconstruction following mastectomy has become a routine operation with high success rates. Although failure is low, it can have a devastating impact on patient recovery, prognosis, and psychological well-being. Continuous and objective monitoring of tissue oxygen saturation () has been shown to reduce failure rates through rapid detection time of postoperative vascular complications. We have developed a pervasive wearable wireless device that employs near-infrared spectroscopy (NIRS) to continuously monitor FTT via measurement. Previously tested on different models, the results of a clinical study are introduced. Our goal for the study is to demonstrate that the developed device can reliably detect variations in a clinical setting: 14 patients were recruited. Advanced data analysis was performed on the variations, the relative gradient change, and the classification of the within different clusters of blood occlusion level (from 0% to 100% at 25% step) based on previous studies made on a vascular phantom and animals. The outcomes of the clinical study concur with previous experimental results and the expected biological responses. This suggests that the device is able to correctly detect perfusion changes and provide real-time assessment on the viability of the FTT in a clinical setting.

Vascular Anomalies of the Extrahepatic Artery as a Predictable Risk Factor for Complications After Liver Transplant.

Vascular variations of the extrahepatic artery occur in up to 50% of the population. Exact knowledge of any anomalies is of great significance in hepatobiliary surgery to avoid perioperative complications. In fact, in liver transplant, vascular complications are rare but have a major impact on graft function and survival. This study evaluated variations of the extrahepatic artery in donors and recipients as risk factors for vascular complications after liver transplant. From January 2010 until June 2015, 469 liver transplant procedures were performed at our institution. We included 323 patients in our retrospective analysis after exclusion of retransplants, split-livertransplants, and pediatric patients. We analyzed the impact of anatomic variations of recipients and donors on postoperative vascular complications and organ and patient survival. Of total study recipients, 71.2% had a normal vascular supply according to Michel classification I. However, these patients developed significantly more vascular complications (25.65%) than those with vascular anomalies (15.05%), especially showing higher incidence of arterial stenosis (8.26% vs 2.15%). In contrast, vascular variations in donors and the need for a vascular reconstruction of the graft led to significantly higher mortality (26.76% vs 15.48%). An abnormality of the graft did not influence incidence of postoperative complications or graft survival. Unexpectedly, recipients with variations of the hepatic artery and grafts with an abnormal arterial supply did not show higher rates of com-plications or mortality. Only vascular reconstruction of the graft before transplant raised the mortality of recipients.

Surgical outcomes after pediatric kidney transplantation at the University of Heidelberg

Kidney transplantation (KTx) is the treatment of choice for children with end-stage renal disease (ESRD). An update of 48 years of surgical experience with pediatric KTx(PKTx) is presented, and the results between recipients of organs from deceased donors (DDs) and living donors (LDs) are compared. All patients younger than 18 years who underwent KTx between 1967 and 2015 were evaluated. Data from 540 PKTx operations (409 DD and 131 LD) were obtained from the transplant center database. Peri-operative data and graft and patient survival were analyzed in the DD and LD groups. Fewer recipients in the LD group underwent dialysis before PKTx than those in the DD group (50.8% in LD vs. 94.9% in DD, P<0.001). The mean duration of dialysis (DD: 798±525 days vs. LD: 625±650 days, P=0.03), time on the waiting list (DD: 472±435 days vs. LD: 120±243 days, P<0.001), cold ischemia time (CIT) (DD: 1206±368min vs. LD: 140±63min, P<0.001), operation time, and hospital stay were lower in the LD group. Except for arterial stenosis, the rates of postoperative vascular and urological complications were not different between the two groups. The cumulative 25-year graft and patient survival rates were 46.4% and 84.1% in the DD group and 76.5% and 96.1% in the LD group, respectively. PKTx is the treatment of choice for children with ESRD. Graft quality has a direct impact on KTx outcome and rate of graft failure. Better HLA compatibility and shorter CIT reduce the impairment of graft function after LD PKTx. In addition, Establishment of an interdisciplinary approach using an individualized risk assessment and prevention model can improve PKTx outcomes. Compared with DD PKTx, LD PKTx has better graft survival associated with a shorter duration of preceding dialysis, waiting time, and CIT and seems to be more beneficial for children.

Clinical results of transarterial embolization to control postoperative vascular complications after partial nephrectomy

PurposeTo evaluate the safety and clinical efficacy of transarterial embolization for vascular complications after partial nephrectomy. Materials and MethodsThis retrospective study included 1187 patients who underwent partial nephrectomy between January 2006 and December 2017. In total, 36 patients were referred to the interventional radiology department for vascular complications after partial nephrectomy. Data on demographics, clinical manifestations, angiographic findings, embolization procedure, perioperative details, and the technical and clinical success rates were analyzed. Further, renal functions at diagnosis, after embolization, and at the last follow-up were recorded. ResultsA diagnosis of hemorrhage was made at a median of 5 (range, 0–89) days after surgery. The incidence of the requirement of embolization owing to hemorrhage after laparoscopic surgery (5.9%, 17/289) was higher than that after open surgery (1.8%, 8/440; p = 0.003) and robot-assisted surgery (2.4%, 11/458; p = 0.014). The technical and clinical success rates were 100% (36/36) and 94.4% (34/36), with 2 patients requiring additional embolization using n-butyl-2-cyanoacrylate glue. The estimated glomerular filtration rates at diagnosis, post-embolization, and the last follow-up were 81.0 ± 21.6, 83.7 ± 21.0, and 84.9 ± 15.8mL/min/1.73 m2, respectively (p = 0.345). No major complication was observed during follow-up. ConclusionsTransarterial embolization is safe and effective in the management of vascular complications after partial nephrectomy. Moreover, renal functions were well-preserved with superselective TAE.

Impact of Surgeon's Experience on Vascular and Haemorrhagic Complications After Kidney Transplantation

The aim of this study was to investigate the independent risk factors of vascular and haemorrhagic complications after kidney transplantation (KTx) and to evaluate how the surgeon's experience affects the rate of vascular and haemorrhagic complications. After exclusion of paediatric and multi-organ transplantations, 1462 KTx operations between 2000 and 2016 were analysed. Independent risk factors were evaluated by multivariable logistic regression analysis. The generalised estimating equation logit model was used to display learning curve progression and determine the best cut off number of KTx operations to reduce vascular and haemorrhagic complications. Vascular and haemorrhagic complications occurred in 38 KTx cases (2.6%). Renal vein thrombosis was the most common complication (0.6%). Graft loss occurred in 11 of 38 (28.9%) cases. Donor age of >60 years (OR 3.687, 95% CI 1.663-8.175, p=0.001), recipient cardiovascular disease (CVD) (OR 2.270, 95% CI 1.071-4.810, p=0.032), and surgeon's experience (OR 0.875, 95% CI 0.783-0.977, p=0.018) were independent predictors of vascular and haemorrhagic complications. Twenty-six previous KTx operations are needed to decrease predicted probability of post-KTx vascular and haemorrhagic complications below 2.6%. The surgeon's experience is an independent risk factor for vascular and haemorrhagic complications after KTx. Acceptable post-operative vascular and haemorrhagic complications are achieved after a minimum of 26 KTx. As a donor age of >60 years and recipient CVD are also independent risk factors for vascular and haemorrhagic complications, it is suggested that these patients should preferably be operated on by surgeons who have performed more than 26 KTx operations.

Outcomes of living donor liver transplantation for patients with preoperative portal vein problems

Introduction: Portal vein thrombosis (PVT) is a common complication for patients with end-stage liver disease. The presence of PVT used to be a contraindication to LDLT. This is related to technical difficulties of PV reconstruction, increased blood loss, and the risk for postoperative PV complications. Methods: We reviewed the data of LDLT patients at Liver Transplantation Unit, Mansoura University, Egypt during the period between May 2004 till March 2017. Patients were divided into three groups. Group I: patients without PVT, Group II: attenuated PV patients (PV diameter <8 mm), and Group III PVT patients. Results: During the study period, 500 cases underwent LDLT. Group I included 446 patients (89.2%), Group II included 26 patients (5.2%), and Group III included 28 patients (5.6%). Higher incidence of hematemesis and encephalopathy was detected in Group III. Longer anhepatic phase duration was found in Group III. There were no significant differences regarding operation time, blood loss, and transfusion requirements. Higher incidence of postoperative vascular complications was found in Group III. The median OS was 33 months (4-169). The 1-, 3-, and 5-years OS survival rates of Group I were 80.5%, 77.7%, and 75%, while for Group II were 84.6%, 79.6%, and 73.5%, and for Group III were 88.3%, 64.4%, and 64.4% respectively. There was no significant difference between the groups regarding OS rates (Log-Rank: 0.793). Conclusion: Preoperative PVT increases the complexity of LDLT operation and the operative trauma to the patient, but it does not reduce the OS rates.

Contrast-enhanced ultrasound for the evaluation of hepatic artery occlusion after liver transplantation

Introduction:Vascular complications after liver transplantation remain a major threat to the survival of recipients.HAT is a major cause of graft loss and patient mortality, with an incidence between 3% to 8% in transplant recipients.Early detection of HAT is critical because urgent revascularization is required to avoid severe graft loss. Although ultrasound is the preferred first-line imaging modality in patients with suspected HAT, the accuracy and positive predictive value of HAT on Doppler US are reported to be low. Moreover, Doppler examination of the hepatic vasculature is time consuming and requires a high level of operator skill. Conventional angiography remains the gold standard for diagnosis. Recently, contrast-enhanced ultrasound (CEUS) has begun providing real-time angiographic-like images of vessels at bed side and allowing the accurate diagnosis of arterial diseases such as hepatic artery thrombosis. The purpose of this study was to evaluate the efficacy of CEUS in detecting HAT after liver transplantation: Materials and Methods: This is a retrospective data of the medical records of patients undergoing Liver transplantation in the Osmania General Hospital, Hyderabad between 2016 to 2018. Status of hepatic vascular assessment following liver transplantation done by conventional Doppler Ultra sonography and Contrast Enhanced Ultrasonography tests were obtained from registries of medical records. Results:23 cases of post Liver transplantation aged between 4years and 58 years, with a median age of 30 years were included in the analysis. There were 20 males and 3 females. 14 patients underwent DDLT, 7 patients underwent LDLT, 1underwent split Liver transplantation and another 1 patient underwent Auto liver transplantation. Doppler US was inconclusive regarding patency of the hepatic artery (HA) circulation in 5 (21.7 %) of 23 transplantations. CEUS was performed in these 5 patients and detected HA thrombosis (HAT) in 2 cases and patent HA in 3 transplants. These 5 Transplants were confirmed by CT Angiography /conventional Angiography. In the subset of transplantations examined with CEUS, the sensitivity, specificity and accuracy of CEUS were 100%. CEUS was done at bedside without any Radiation and Nephro toxicity. In approximately 21.7% of cases, conventional Doppler US did not provide sufficient visualization of the HA after liver transplantation. In these cases, correct diagnosis was achieved by supplementary CEUS. Conclusion:CEUS may be a new approach for early diagnosis of postoperative vascular complications after Liver Transplantation, and it can be performed at the bedside. It is safe will not cause any nephron toxicity and Radiation. CEUS is a fast, non-ionizing imaging modality for the initial exclusion of vascular complications after liver transplantation. CEUS shows a high specificity and PPV in the detection of vascular complications. In unclear cases CT still is considered as the gold standard

Corner-Saving Renal Artery Anastomosis for Renal Transplantation

IntroductionRenal transplantation is the preferred treatment for most patients with end-stage renal disease. Postoperative vascular complications that significantly affect graft loss include renal artery stenosis and thrombosis. Many arterial anastomoses have been used at various transplant centers.

Safety and Efficacy of Third Kidney Transplantation in Ipsilateral Iliac Fossa

Kidney retransplantation is an option for patients after graft loss returning to dialysis. However, evidence is lacking whether a third kidney transplant (KTx) in ipsilateral iliac fossa is safe and effective. The aim of this study is to review surgical outcome of third kidney transplantation in ipsilateral iliac fossa in comparison to first and second kidney transplants. Between 2010 and 2016 year, 2074 kidneys were transplanted in the Erasmus Medical Centre, Rotterdam and in University of Medical Centre Groningen. The databases were screened for adult third kidney transplantation in ipsilateral iliac fossa. The donor, recipient and surgical data were collected and analysed. The cohort was divided into three groups: first kidney transplantation (I KTx) (n=1744), second kidney transplantation in ipsilateral iliac fossa (II KTx) (n=44) and third kidney transplantation in the ipsilateral iliac fossa (III KTx) (n=7). We used one-way multivariate analysis of variance (MANOVA) to compare groups. There was significantly higher cold ischemia time in the III KTx group in comparison to I and II KTx group (543 min vs 167 min and 240 min respectively; p<0.001). Median operation time was significantly longer in II and III KTx group in comparison to I KTx group (205 min and 202 min vs 135 min respectively; p<0.001). Postoperative vascular and urological complications did not differ between groups. Median three months glomerular filtration rate was similar between groups. One- and five year graft survival did not differ between groups 96%, 89% (group I) 91%, 82% (group II) and group (III) 85%, 85% (p = 0.214) and (p = 0.116). One- and five year patient survival did not differ between groups 97%, 91% (group I) 100%, 90% (group II) and group (III) 100%, 100% (p = 0.796) and (p = 0.856). Third kidney transplantation in ipsilateral iliac fossa is feasible and viable with similar short and long-term results compared to first or second ipsilateral kidney transplantation.

Postoperative Doppler Ultrasonography in Liver Transplantation

BackgroundDoppler ultrasonography plays an important role in the postoperative management of liver transplantation. We present our initial experiences evaluating liver transplants with the use of postoperative Doppler sonography. MethodsIn our hospital, we performed 20 liver transplantations from July 2014 to October 2016. Among 20 patients, we performed 15 deceased-donor liver transplantations (DDLTs) and 5 living-donor liver transplantations (LDLTs). For deceased donors, inferior vena cava anastomoses were performed with the use of the piggyback technique, and for living donors, modified right grafts were used with middle hepatic vein reconstruction by Dacron graft. In the intensive care unit, we performed Doppler ultrasound at least once a day and at every clinical need. We checked hepatic blood flow by means of Doppler ultrasound. ResultsEighteen patients underwent Doppler ultrasonography once a day up to postoperative day 6. Of the patients who received LDLT, 2 patients underwent Doppler ultrasonography twice a day because the operator was concerned about the hepatic artery anastomosis. Findings on Doppler ultrasound showed no abnormal wave form in hepatic artery, portal vein and hepatic veins. No patient had abnormal findings on angiographic computerized tomography. There was 1 graft failure in 20 recipients. The graft failure was primary nonfunction, and retransplantation was done. During the hospitalizations, there were no vascular complications. ConclusionsDoppler ultrasonography can be used to evaluate postoperative vascular complications in liver transplant patients. When the operator checks postoperative Doppler ultrasonography, it is possible to differentiate between patients, and it may help to detect the vascular complications earlier.

Microvascular doppler associated with neuronavigation to intraoperative identification and location of internal carotid artery in transsphenoidal endoscopic pituitary macroadenomas surgery

Context: Enhancements in pulsed doppler techniques have made easier to apply those techniques not only to diagnose brain vascular diseases but also in brain surgery, especially to disclose arteries close to tumors and avoid their manipulation. The aim of this paper is to describe the technique of microvascular doppler associated with neuronavigation in transsphenoidal endoscopic surgery to remove pituitary macroadenomas in three patients. Material And Methods: A sterile 2mm 16-MHz probe was used inside a long curved canula of 17 cm length, attached with a neuronavigation reference. The neuronavigation mapping was done with MRI and angiotomography, which took place 24 hours before the procedure. Results: Intraoperatively, the doppler identified arterial flow compatible with the anatomical localization of the cavernous portion of internal carotid artery, as shown by the neuronavigation system, and this place was avoided during surgery, allowing manipulation of the tumor without risk of damage to the internal carotid artery. The results after surgery were total removal of the tumor in all three cases. No postoperative vascular complications were present. Conclusion: The method with microvascular doppler associated with neuronavigation was essential to the intraoperative vascular diagnosis allowing radical tumoral resections while preventing damage to the internal carotid artery.

Simplified Unification Patch Venoplasty for Anomalous Portal Vein Branching in Living Donor Liver Transplantation With Right Lobe Graft

Double portal vein (PV) branches during living donor liver transplantation (LDLT) with right lobe grafts have been considered challenging both in terms of donor safety and the complexity of vascular reconstruction in the recipient. Herein, we describe our experience with 24 adult LDLT recipients during which we employed unification patch venoplasty to reconstruct right lobe grafts with double PV orifices. We retrospectively reviewed the outcomes of 195 adult LDLT recipients receiving right lobe grafts, including 24 cases of adult LDLT recipients in which unification patch venoplasty was used to treat double PVs from January 2010 to June 2015. The anomalous portal vein branches of the donors were of type II in 7 cases (29.2%), type III in 15 cases (62.5%), and type IV in 2 cases (8.3%). We used propensity score matching analysis to compare the clinical outcomes of these recipients with those of 59 recipients who underwent adult LDLT using right lobe grafts with normal PVs in the same period. Intraoperative PV stenting was necessary in 2 (8.3%) of the 24 recipients undergoing unification patch venoplasty. During the follow-up period, all PVs remained patent until death or censoring. No significant difference in terms of postoperative vascular complications was evident between the 2 groups. Moreover, no major complications requiring reoperation or endoscopic and/or radiologic intervention developed in any of the 24 living donors with double PVs. In conclusion, our simplified unification patch venoplasty could be safe and feasible when used to reconstruct double PV orifices in right lobe LDLT from donors with complex PV anomalies.