Preservation Of Vessels Research Articles

Spleen-preserving pancreatectomy with removal of splenic vessels: impact on splenic parenchyma ?

BackgroundWhile outcomes after spleen-preserving distal pancreatectomy (SP-DP) have been widely reported, impacts on splenic parenchyma have not been well studied. This study aimed to compare postoperative outcomes, particularly spleen-related outcomes, by assessing splenic imaging after SP-DP with or without splenic vessels removal.MethodsData for all patients who underwent SP-DP with splenic vessels removal (Warshaw technique, WDP) or preservation (Kimura technique, KDP) between 2010 and 2022 in two tertiary centres were retrospectively analysed. Splenic ischemia and volume at early/late imaging and postoperative outcomes were reviewed.ResultsEighty-seven patients were included, 51 in the WDP and 36 in the KDP groups. Median Charlson’s Comorbidity Index was significantly higher in the WDP group compared with the KDP group. Postoperative morbidity was similar between groups. There was more splenic ischemia at early imaging in the WDP group compared to the KDP group (55% vs. 14%, p = 0.018), especially severe ischemia (23% vs. 0%). Partial splenic atrophy was observed in 29% and 0% in the WDP and KDP groups, respectively (p = 0.002); no complete splenic atrophy was observed. Platelet levels at POD 1, 2 and 6 were significantly higher in the WDP group compared to KDP group. At univariate analysis, age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction were prognostic factors for development of splenic atrophy. No episodes of overwhelming post-splenectomy infection or secondary splenectomy were recorded after a median follow-up of 9 and 11 months in the WDP and KDP groups, respectively.ConclusionsSplenic ischemia appeared in one-half of patients undergoing SP-DP with splenic vessels removal at early imaging, and partial splenic atrophy in almost 30% at late imaging, without clinical impact or complete splenic atrophy. Age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction could help to predict the occurrence of splenic atrophy.

Is Dissection and Preservation of Adherent Popliteal Vessels From a Posterior Soft Tissue Mass Associated With a Higher Proportion of Local Recurrence in Patients With a Distal Femoral Osteosarcoma?

Is Dissection and Preservation of Adherent Popliteal Vessels From a Posterior Soft Tissue Mass Associated With a Higher Proportion of Local Recurrence in Patients With a Distal Femoral Osteosarcoma?

Protective Effects of Different Hypothermal Preservation Solutions on Structure and Function of Isolated Rat Arteries.

With the increasing application of vascular reconstruction in surgical procedures, allogeneic vessels are becoming more popular in clinical practice due to their abundant sources, precise diameter matching, improved histocompatibility, and higher long-term patency rate. This study aimed to investigate the protective effect of various preservation solutions on the function and structure of the isolated rat abdominal aorta preserved under hypothermal conditions. The study utilized a total of 150 Sprague-Dawley (SD) rats, with 144 rats allocated to the experimental groups and 6 rats allocated to the control groups. The abdominal aorta of the rats was chosen as the subject of our research. The aorta in the experimental groups were randomly assigned to 4 groups: University of Wisconsin (UW) solution group, histidine-tryptophan-ketoglutarate (HTK) solution group, normal saline (NS) group, and sodium lactate Ringer's solution (RS) group. Samples were subjected to examination after preservation periods of 1 day, 3 days, 5 days, 7 days, 14 days, 30 days, and 90 days. Evaluation of vascular physiological function involved detecting and assessing vasoconstriction ability and measuring cell viability through the MTT test. Evaluation of the vascular wall structure involved tension tolerance tests and pathological staining. The pathogen-positive rate in the HTK group and NS group at 1 month was 16.7%. Regarding the vascular skeleton structure, both the UW group and HTK group exhibited intact structures after 2 weeks of preservation, with slightly edematous collagen and elastic fibers, which was significantly better than that of the NS group and RS group. In terms of cell activity and contractile function, all preservation groups showed similar effects within 2 weeks. However, after 2 weeks, the UW group showed the most favorable preservation effect (P<0.05). In terms of vascular tension, different groups exhibited similar effects within 1 week. However, after 2 weeks, the UW group showed the best preservation effect (P<0.05). All 4 types of preservation solution had a preservation effect on the structure and function of isolated blood vessels during short-term hypothermal preservation. However, after 2-week preservation, the UW solution was found to be the most suitable solution for the preservation of blood vessels.

Surgical Equipment for Neuroendoscopic Surgery

The development of endonasal endoscopic surgery has been advanced one step further by the image quality and expressiveness of endoscopes. The widespread use of HD endoscopic cameras has enabled tumor dissection, preservation of vital vessels, and delicate dissection of nerves during endonasal surgery through the close and detailed observation of intracranial structures. The observation of high image quality is essential. In addition, instruments that can be carefully manipulated are essential for achieving this image quality. Traditionally, endoscopic surgery has relied on axial back-and-forth movement in many situations due to the inability of the instruments to move sufficiently laterally, and it has been said that precise and effective instrument movement cannot be achieved. However, the ingenuity of surgical techniques to create an adequate operative field, movements specific to endoscopic surgery, and the emergence of specialized instruments have made delicate manipulation possible. Exoscopes, which appear as adjuncts to endoscopic surgery or alternatives to microscopic surgery, have also influenced the form of endoscopic surgery because, like endoscopes, they are heads-up surgeries. Recent developments in the peripheral equipment related to neuroendoscopic surgery have been described.

Minimally invasive vessel-preservation spleen preserving distal pancreatectomy-how I do it, tips and tricks and clinical results

BackgroundMinimally invasive spleen-preserving distal pancreatectomy (SPDP) has emerged as a parenchyma-preserving approach and has become the standard treatment for pancreatic benign and low-grade malignant lesions. Nevertheless, minimally invasive SPDP is still technically challenging, especially when vessel preservation is intended. This study aims to describe the technique and outcomes of laparoscopic (LSPDP) and robot-assisted spleen-preserving distal pancreatectomy (RSPDP) with intended vessel preservation, highlighting the important tips and tricks to overcome technical obstacles and optimize surgical outcomes.MethodsA retrospective observational study of consecutive patients undergoing LSPDP and RSPDP with intended vessel preservation by a single surgeon in two different centers. A video demonstrating both surgical techniques is attached.ResultsA total of 50 patients who underwent minimally invasive SPDP were included of which 88% underwent LSPDP and 12% RSPDP. Splenic vessels were preserved in 37 patients (74%) while a salvage vessel-resecting technique was performed in 13 patients (26%). The average surgery time was 178 ± 74 min for the vessel-preserving and 188 ± 57 for the vessel-resecting technique (p = 0.706) with an estimated blood loss of 100 mL in both groups (p = 0.663). The overall complication rate was 46% (n = 23) with major complications (Clavien Dindo ≥ III) observed in 14% (n = 7) of the patients. No conversions occurred. The median length of hospital stay was 4 days.ConclusionThis study presented the results after minimally invasive SPDP with intended vessel preservation by a highly experienced pancreatic surgeon. It provided tips and tricks to successfully accomplish a minimally invasive SPDP, which can contribute to quick patient rehabilitation and optimal postoperative results.Graphical

Preserving Sunken Military Vessels as Underwater Cultural Heritage in Colombia: Legal Challenges and Prospects for the USS Kearsarge Wreck Site

This study examines the legal challenges related to preserving sunken military vessels as Underwater Cultural Heritage (UCH) in Colombia. These challenges include Spanish galleon shipwrecks, limited international cooperation, and the lack of legal recognition for sunken military vessels under domestic law (Law 1675 of 2013). To address these issues, this article reviews the concepts of warship and sovereign immunity as they relate to the status of sunken military vessels. The study places a particular focus on the USS Kearsarge, a military shipwreck in Colombian territorial waters protected by the Sunken Military Craft Act of 2004 (SMCA) of the United States. Additionally, it analyzes the legal frameworks and management of UCH in both Colombia and the United States, as well as providing two lists of Colombia’s sunken military vessels and foreign sunken military vessels in its waters. The research concludes by highlighting the complexities of managing UCH in Colombia and offering a prospectus on the future of the USS Kearsarge wreck site as shared heritage. Ultimately, this study underscores the need for a more comprehensive legal framework and greater international cooperation to ensure the preservation and protection of sunken military vessels in Colombia.

“Parenchyma transection-first” strategy is superior to “tunnel-first” strategy in robotic spleen-preserving distal pancreatectomy with conservation of splenic vessels

BackgroundCreating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection (“tunnel-first” strategy) has long been used in spleen-preserving distal pancreatectomy (SPDP) with splenic vessel preservation (Kimura's procedure). However, the operation space is limited in the tunnel, leading to the risks of bleeding and difficulties in suturing. We adopted the pancreatic “parenchyma transection-first” strategy to optimize Kimura's procedure. MethodsThe clinical data of consecutive patients who underwent robotic SPDP with Kimura's procedure between January 2017 and September 2022 at our center were retrieved. The cohort was classified into a “parenchyma transection-first” strategy (P-F) group and a “tunnel-first” strategy (T-F) group and analyzed. ResultsA total of 91 patients were enrolled in this cohort, with 49 in the T-F group and 42 in the P-F group. Compared with the T-F group, the P-F group had significantly shorter operative time (146.1 ± 39.2 min vs. 174.9 ± 46.6 min, P < 0.01) and lower estimated blood loss [40.0 (20.0–55.0) mL vs. 50.0 (20.0–100.0) mL, P = 0.03]. Failure of splenic vessel preservation occurred in 10.2% patients in the T-F group and 2.4% in the P-F group (P = 0.14). The grade 3/4 complications were similar between the two groups (P = 0.57). No differences in postoperative pancreatic fistula, abdominal infection or hemorrhage were observed between the two groups. ConclusionsThe pancreatic “parenchyma transection-first” strategy is safe and feasible compared with traditional “tunnel-first strategy” in SPDP with Kimura's procedure.

The clinical difference and CT finding of fluid collection after laparoscopic distal pancreatectomy according to spleen and splenic vessel preservation

The clinical difference and CT finding of fluid collection after laparoscopic distal pancreatectomy according to spleen and splenic vessel preservation

Intraoral anastomosis for primary microsurgical reconstruction in patients of oral cavity malignancies: Retrospective analysis of 30 cases from a tertiary care center in India

In patients undergoing either robotic neck dissection or no neck dissection, the neck recipient vessels for the free flaps remain unexposed. Intraoral vessels have been successfully used as microvascular recipients but their use in intraoral malignancies is uncommon. We describe our initial experience of using intraoral recipients in 30 patients with oral cavity malignancies. For this retrospective observational study, the hospital records of all patients who underwent microvascular reconstruction using intraoral recipient vessels over a 14-month period at a tertiary care hospital in India were studied. Patient demographics, disease profile, details of oncosurgical resection, reconstructive procedure details, and postoperative recovery data were analyzed. Intraoral anastomosis was successfully performed in 30 patients. The average patient was middle-aged (mean age 54 years) and male (26/30). Location of the postexcision defect was the buccal mucosa in 16/30 and the tongue in 12/30 patients. Anterolateral thigh flap (ALT) was used in 28/30 patients. Recipient vessels were facial vessels in 24/30 patients and lingual vessels in 6/30 patients. Venous anastomotic coupler was used in 27/30 patients. Three patients underwent re-exploration for flap congestion with loss of flap in 2/30 patients. The intraoral approach offers consistent vascular anatomy and can be performed without any external incision and oro-cervical tunneling. Being technically challenging, it has an initial learning phase. Adequate mouth opening and preservation of recipient vessels during excision and neck dissection are important prerequisites. This approach can offer a scarless reconstruction, which can improve the psycho-social rehabilitation of the patients.

Handling Severe Intraoperative Hemorrhage and Avoiding Iatrogenic Stroke During Brain Tumor Surgery: Techniques for Prevention of Hemorrhagic and Ischemic Complications

Nationwide databases show that iatrogenic stroke and postoperative hematoma are among the commonest complications in brain tumor surgery, with a 10-year incidence of 16.3/1000 and 10.3/1000, respectively. However, techniques for handling severe intraoperative hemorrhage and dissecting, preserving, or selectively obliterating vessels traversing the tumor are sparse in the literature. Records of the senior author's intraoperative techniques during severe haemorrhage and vessel preservation were reviewed and analyzed. Intraoperative media demonstrations of key techniques were collected and edited.In parallel,aliterature search investigating technique description in handling severe intraoperative hemorrhage and vessel preservation in tumor surgery was undertaken. Histologic, anesthetic, and pharmacologic prerequisites of significant hemorrhagic complications and hemostasis were analyzed. The senior author's techniques for arterial and venous skeletonization, temporary clipping with cognitive or motor mapping, and ION monitoring were categorized. Vessels interfacing with tumor are labeled intraoperatively as supplying/draining the tumor, or traversing en passant, while supplying/draining functional neural tissue. Intraoperative techniques of differentiation were analyzed and illustrated. Literature search found 2 vascular-related complication domains in tumor surgery: perioperative management of excessively vascular intraparenchymal tumors and lack of intraoperative techniques and decision processes for dissecting and preserving vessels interfacing or traversing tumors. Literature searches showed a dearth of complication-avoidance techniques in tumor-related iatrogenic stroke, despite its high prevalence. A detailed preoperative and intraoperative decision process was provided along with a series of case illustrations and intraoperative videos showing the techniques required to reduce intraoperative stroke and associated morbidity addressing a void in complication avoidance of tumor surgery.

Surgical Technique of Glans Wings Creation with Preservation of Glanular Vascular Arcade and Creating Flaps for Tension-Free Glansplasty in Hypospadias Repair.

The objective of this study is to report the technical nuances of glans wings creation in anatomical plane facilitating liberal glans wings mobilization with preservation of glanular vessels for tension-free glansplasty in surgery of hypospadias in primary and redo cases. Eighty-six primary hyposapdias and 7 cases of distal hypospadias, operated elsewhere and presented with glans and urethroplasty dehiscence, undergoing tubularized-incised-plate (TIP) repair were included after ethical approval. Technical points of glans wings creation in the subfascial plane included (i) creation of Buck's fascia window, just proximal and lateral to the point of bifurcation of corpus spongiosum, (ii) creation of subfascial-pret unical plane on the tunica albuginea of corpora cavernosa up to ventral limit of laid open glanular meatus, (iii) release of pillars of corpus spongiosum off the glans base keeping the basal lamina propria covering the vascular arcade intact, (iv) release of glans base off the tip of corpora cavernosa and composite flap of corpus spongiosum pillars with Buck's fascia off the corpora cavernosa, (v) approximation of glans wings over the tubularized-incised-plate covered with dartos, and (vi) approximation of fasciospongioplasty flaps at hypospadiac meatus. Outcome measurement included (i) intra and postoperative problems and (ii) elimination of glans dehiscence. There occurred 1 injury to the tunica albuginea of ventral corpora cavernosa and 1 button-hole injury to subcoronal mucosal collars. Flaps for fasciospongioplasty were short in 11. One glans dehiscence occurred in flat glans. This technique is effective in creating glans wings in the anatomical plane with the preservation of glanular vessels and flaps for fasciospongioplasty eliminating the possibility of glans dehiscence in both fresh and redo cases.

UK Vessel Health and Preservation Framework 2020: a users’ survey

The review and update of the UK Vessel Health and Preservation Framework 2020 (VHP2020) was undertaken by a working group that included members of the Infection Prevention Society, the Royal College of Nursing, the National Infusion and Vascular Access Society and the Medusa Advisory Board and was launched in 2020. The VHP working group developed a survey to understand whether the VHP2020 had reached its intended audience, and what respondents thought were the benefits and drawbacks of its use in practice. Although the survey response was lower than expected, the responses received were largely positive and have provided feedback on how the VHP2020 is being used and some of the benefits. Most importantly, the survey has highlighted the need to communicate the benefits of the framework more effectively to reach a wider audience.

Preliminary experience with a new robotic technique to facilitate distal pancreatectomy with spleen preservation: left lateral approach in right lateral decubitus position.

Spleen-preserving distal pancreatectomy (SP-DP), for patients with benign or small low-grade malignant tumors of the body or tail of the pancreas, is the ideal procedure although it is technically demanding. The robotic da Vinci system has been introduced to overcome these technical challenges and reduce operative risks. We report our experience of a new variation in surgical technique: the left lateral approach robotic spleen-preserving distal pancreatectomy (RSP-DP) in right lateral decubitus position. We performed this new variant of SP-DP, in five patients, using the da Vinci Xi system. Technical and clinical feasibility are described. The mean age and body mass index were 53.4years and 31.4kg/m2, respectively. The mean total operative time was 323min. The estimated mean blood loss was 240ml. In all patients, the spleen could be preserved. In four patients, the splenic vessels were also preserved. One patient required a Warshaw technique due to significant fibrosis attached to the splenic vein. The postoperative period of all patients was uneventful except the presence of biochemical leak (BL) in two patients that only required maintenance of the drainage at home. The mean length of hospital stay was 6days after surgery. The left lateral approach robotic SP-DP in right lateral decubitus position is a feasible and safe procedure for distal benign or small low-grade malignant tumors of the left pancreas. The right lateral decubitus position associated to robotic surgery can facilitate this complex procedure, especially when splenic vessels preservation is indicated, with a lower risk of conversion and shortening of the learning curve.

President’s Message

As I write this message, the AVA Board has just completed its annual retreat. It was good to be together for this planning session. Feeling that we needed to be good examples, all board members did COVID testing before they arrived. Unfortunately, one of our board members could not join us due to a positive test, and one joined virtually due to an injury. It was a packed meeting that I am excited to tell you about in my first message.In the fall of 2022, we sent out a survey to get stakeholder input on our Strategic Plan (SP) review. We received responses from members, non-members, network leaders, network members, and manufacturers. Thank you to everyone who responded. The survey results provided input on Threats, Opportunities, Weaknesses, and Strengths. The findings were organized into affinity groups and reviewed by the board at our retreat. It is incredible how similar the input from disparate groups is. Those areas of alignment of thought provide us with such valuable insight.After reviewing the results, the board identified key themes. Our strategic challenges began with how the profession, association, and membership are undervalued. Communication, marketing/branding, relationships with other organizations, financial support for initiatives, data/research, and network issues were also on the list of challenges.Our strategic opportunities include mentoring, public/patient representation, engaging our student members, making Vascular Access Specialty Day a nationally recognized day, serving students and novice inserters, professional development, research, and identifying social media possibilities. In addition, our strategic advantages include the AVA scientific meeting, passion for vessel preservation, vendor relationships, our distinctive interdisciplinary membership, education, and networking. We want to build on our advantages, take advantage of our opportunities and address our challenges to ensure that AVA continues to be your premier resource and partner as you work to preserve vessel health.We then reviewed our mission statement and determined that it did not adequately reflect the “what, how, and why” of what we do at AVA. So, together we developed and approved a new mission statement that we believe better represents us. However, our vision and tagline will remain unchanged.The board then reviewed our current SP to determine if action items needed modifying to stay on course. We found that our current plan is on target for the most part. We made minor changes to reflect the excellent stakeholder input you gave us. Additional information will be provided in our multiple communication channels throughout the year.As you know, our CEO position has been vacant for a few months. The board has spent considerable time determining our best road forward, as we know that CEO turnover has been a chronic issue. It came up several times in our survey results, which confirmed that it is an issue that also concerns our membership. After research and consideration by a board task force, a recommendation was made to engage an Association Management Company. Request-for-Proposals were sent out, and the responses were analyzed for the best fit for AVA.After carefully considering the proposals and interviews, the board selected Talley Management Group (TMG). They manage 35 associations, primarily in the healthcare space. TMG has over 35 years of association management experience and includes clients who have been with their company from the beginning. In addition, they are an employee-owned company, which we felt was an advantage. Talley also provides us with staff and services that we currently must outsource. We are excited to begin working with them to implement our strategic plan and help us move AVA forward.In our negotiations with TMG, we stipulated that we wanted Tonya Hutchison, Judy Thompson, and Blake Hotchkiss to be retained by Talley and continue to serve AVA as they have in the past. We anticipate that TMG will provide them valuable support in their roles and help AVA become an even stronger organization. We appreciate the work Kayce Maisel and Jennifer Finlayson have done for AVA and wish them well as they move toward their new endeavors.I expect 2023 to be a great year, packed with education, continued work on the Clinical Practice Guidelines, the continual rollout of the Fundamentals of Peripheral IV (PIV) Access curriculum, and another tremendous in-person conference in Portland, Oregon, this October.

Abstract Number ‐ 79: Flow Diversion for Traumatic Vertebral Artery Arteriovenous Fistula: A Case Report

Introduction Arterial pseudoaneurysms and arteriovenous fistulas of intracranial and extracranial vessels are an uncommon occurrence following blunt and penetrating trauma and are commonly treated by vessel sacrifice,dependent on collateral flow1‐3. Others have treated these cases with covered stents4 and flow diversion5. Advances in flow diversion technology have led to their use in other pathologies, including carotid cavernous fistulas6 and vertebral artery pseudoaneurysms7. We present a case of a traumatic arteriovenous fistula of the dominant vertebral artery requiring vessel preservation and reconstruction. Methods A 42‐year‐old male presented with a gunshot wound to the face below the right eye. Trauma imaging identified fractures of the right maxillary sinus and orbital floor. CTA of the head/neck showed a dominant right vertebral artery dissection and pseudoaneurysm with a non‐dominant left vertebral artery (VA), effectively ending in PICA. Results Due to the inefficient supply to the posterior circulation via the left VA, the decision was made to preserve and reconstruct the right VA and the patient was brought to the angiography suite. Angiographically, the patient was noted to have retrograde filling of the posterior circulation, basilar and right VA through the anterior circulation in injection of both ICAs, suggesting decreased antegrade flow from the injured right VA. The right VA was catheterized which showed a high‐flow, high‐grade arteriovenous fistula from the V3 segment with venous drainage into multiple extraspinal cervical and epidural cervical veins. This also identified the fistulous point at the location of the pseudoaneurysm on CTA. The diagnostic catheter was exchanged for a guide catheter, and a Phenom 27 microcatheter (Medtronic; Minneapolis, MN) was navigated into the basilar artery. A Duo microcatheter (Microvention; Aliso Viejo, CA)/Synchro 2 (Stryker; Kalamazoo, MI) standard microwire complex was used to identify the fistulous point and positioned for jailing. A Pipeline Flex 4.75×20mm (Medtronic; Minneapolis, MN) was deployed from the proximal V4 segment across the pseudoaneurysm with persistence of the AVF. A second Pipeline Flex 5×20mm was placed in telescoping fashion with persistence of the AVF. A third Pipeline Flex 5×16mm was placed in telescoping fashion and flow diversion was observed. Using the jailed catheter, the pseudoaneurysm and fistulous point were coil embolized using a combination of helical and 3D HydroSoft coils (Microvention; Aliso Viejo, CA) of varying sizes. Final angiogram demonstrated resolution of the high‐flow AVF, improvement of antegrade flow through the right vertebral artery, and a slow‐flow low‐grade fistulous communication with the posterior extraspinal cervical veins. There were no thromboembolic complications and the patient recovered well from the procedure. Follow‐up angiography at 2 months post‐treatment showed obliteration of the AVF with a small remnant pseudoaneurysm of the right V3 segment. Conclusions Flow diversion is viable in the setting of a traumatic arteriovenous fistula requiring reconstruction of the parent vessel.

A Heterotopic Mouse Model for Studying Laryngeal Transplantation

Laryngeal heterotopic transplantation, although a technically challenging procedure, offers more scientific analysis and cost benefits compared to other animal models. Although first described by Shipchandler et al. in 2009, this technique is not widely used, possibly due to the difficulties in learning the microsurgical technique and time required to master it. This paper describes the surgical steps in detail, as well as potential pitfalls to avoid, in order to encourage effective use of this technique. In this model, the bilateral carotid arteries of the donor larynx are anastomosed to the recipient carotid artery and external jugular vein, allowing for blood flow through the graft. Blood flow can be confirmed intraoperatively by the visualization of blood filling in the graft bilateral carotid arteries, reddening of the thyroid glands of the graft, and bleeding from micro vessels in the graft. The crucial elements for success include delicate preservation of the graft vessels, making the correct size arteriotomy and venotomy, and using the appropriate number of sutures on the arterial-arterial and arterial-venous anastomoses to secure vessels without leakage and prevent occlusion. Anyone can become proficient in this model with sufficient training and perform the procedure in approximately 3 h. If performed successfully, this model allows for immunologic studies to be performed with ease and at low cost.

Peripheral vascular catheter use in Latin America (the vascular study): A multinational cross-sectional study.

Peripheral intravenous catheter (PIVC) insertion is one of the most common clinical procedures worldwide, yet little data are available from Latin America. Our aim was to describe processes and practices regarding PIVC use in hospitalized patients related to hospital guidelines, characteristics of PIVC inserters, prevalence of PIVC complications, and idle PIVCs. In 2019 we conducted a multinational, cross-sectional study of adult and pediatric patients with a PIVC in hospitals from five Latin American countries: Argentina, Brazil, Chile, Colombia, and Mexico. We used two data collection tools to collect hospital guidelines and patient-specific data on the day of the study. The vessel health and preservation (VHP) model guided synthesis of the study aims/questions and suggested opportunities for improvement. A total of 9,620 PIVCs in adult (86%) and pediatric inpatients in 132 hospitals were assessed. Routine replacement 8-72 hourly was recommended for adults in 22% of hospitals, rather than evidence-based clinical assessment-based durations, and 69% of hospitals allowed the use of non-sterile tape rather than the international standard of a sterile dressing. The majority (52%) of PIVCs were inserted by registered nurses (RNs), followed by nursing assistants/technicians (41%). Eight percent of PIVCs had pain, hyperemia, or edema, 6% had blood in the extension tubing/connector, and 3% had dried blood around the device. Most PIVCs had been inserted for intravenous medications (81%) or fluids (59%) in the previous 24 h, but 9% were redundant. Given the variation in policies, processes and practices across countries and participating hospitals, clinical guidelines should be available in languages other than English to support clinician skills and knowledge to improve PIVC safety and quality. Existing and successful vascular access societies should be encouraged to expand their reach and encourage other countries to join in multinational communities of practice.

Spleen-preserving total pancreatectomy for low-grade tumors

To justify organ-preserving variants of total pancreatectomy. We retrospectively analyzed the results of classic and modified total pancreatectomy between September 2010 and March 2021. Implementing pylorus-sparing total pancreatectomy with preservation of stomach, spleen, gastric and splenic vessels, we thoroughly analyzed exocrine/endocrine disorders after total pancreatectomy and changes in immune status after splenectomy. Serum C-reactive protein and ferritin were assessed in 1, 3, 5, 7, 14 and 30 days after surgery in both groups. We also estimated daily glycemic profile after total pancreatectomy in classical and organ-preserving modifications. We performed 37 total pancreatectomies including 12 pylorus-preserving total pancreatectomies with preservation of stomach, spleen, gastric and splenic vessels. General and specific postoperative complication rate was significantly lower after modified surgery compared to classic total pancreatectomy with gastric resection and splenectomy. Modified total pancreatectomy is preferable for low-grade pancreatic tumors.

Inkapsulirajuća peritoneumska skleroza - retka i ozbiljna komplikacija peritoneumske dijalize - prikaz slučaja

Introduction: End-stage renal disease is a terminal illness with a glomerular filtration rate of less than 15 mL/min. when must start one of the methods of renal replacement therapy: hemodialysis, peritoneal dialysis or kidney transplantation. Peritoneal dialysis is based on the processes of diffusion and osmosis, while the transport of substances takes place through the peritoneal membrane. The advantages of peritoneal dialysis compared to hemodialysis include longer-term preservation of residual renal function, preservation of blood vessels and a better quality of life for the patient. Complications of peritoneal dialysis can be infectious, metabolic and mechanical. Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of peritoneal dialysis (PD) treatment. The incidence of EPS is variable between 0.7 and 3.7%, while it increases with the length of PD treatment (0.7-6.4% after 5 years to as much as 17.2% after 15 years). The diagnosis of EPS is based on clinical symptoms. and signs as well as specific, but not pathognomonic, radiological and pathohistological findings. Features of IPS on computed tomography (CT) images are thickening and calcification of the peritoneal membrane, thickening of the intestinal wall, narrowing and dilatation of the in-testine, as well as "trapped" fluid collections. Case report: A 60-year-old patient, who has been treated with peritoneal dialysis for 4 years, was hospitalized due to severe gastrointestinal complaints. Due to clinical findings a peritoneal equilibration test was performed, which determined that it was a moderately fast transporter. Based on the findings of the computed tomography, the diagnosis was confirmed. Treatment is started tamoxifen and prednisone was started, the response to therapy was positive. Despite the control of sclerosing peritonitis, death occurred because of cardiac decompensation. Conclusion: Early diagnosis is necessary to start specific treatment in a timely manner and, if possible, preserve peritoneal dialysis as a treatment method and patient survival.

A New Robotic Technique to Facilitate Distal Pancreatectomy with Preservation of Splenic Vessels: Left Lateral Approach in Right Lateral Decubitus Position

A New Robotic Technique to Facilitate Distal Pancreatectomy with Preservation of Splenic Vessels: Left Lateral Approach in Right Lateral Decubitus Position